Hospital-Acquired Infection

More patients assigned per nurse and higher nurse burnout rates contribute to higher infection rates.

It’s estimated that each year 7 million patients acquire infections when they’re hospitalized. Nurse researchers at the University of Pennsylvania School of Nursing in Philadelphia used survey data from the Pennsylvania Health Care Cost Containment Council report on hospital infections and the American Hospital Association Annual Survey to explore how staffing and burnout impact urinary tract and surgical site infections.

They found a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04), and found that nurse burnout is significantly associated with urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01) infection.

For each additional patient a nurse is assigned, there was one additional infection per 1,000 patients, and for each 10% increase in a hospital’s number of high-burnout nurses, there was one additional urinary tract infection and two additional surgical site infections. Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of $68 million.

Their data suggest that a root cause of hospital-acquired infection is burnout and inadequate staffing, which foster a climate of short cuts, such as skipping handwashing and poor aseptic technique. It’s not surprising that nursing workload and burnout are associated with increased infection rates and costs. Fortunately, we now have this additional esdata to support a culture of safety and adequate staffing levels in hospitals.


Cimiotti JP, Aiken LH, Sloane DH, et al. Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control 2012; 40(6): 486-490.

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