Does continuity in nursing staff matter? A pilot study on correlation of central line-associated bloodstream infections and employee turnover

Thomas Scheier,Mesida Dunic,Christian Falk,Peter W Schreiber,Stefan P Kuster,Hugo Sax

doi:10.1186/s13756-021-00958-z

Abstract

BackgroundUnderstaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question.MethodsIn January 2016, a semiautomatic surveillance system for CLABSI was implemented at the University Hospital Zurich, a 940 bed tertiary care hospital in Switzerland. Monthly incidence rates (CLABSI/1000 catheter days) were calculated and correlations with human resources management-derived data on employee turnover of HCWs (defined as number of leaving HCWs per month divided by the number of employed HCWs) investigated.ResultsOver a period of 24 months, we detected on the hospital level a positive correlation of CLABSI incidence rates and turnover of nursing personnel (Spearman rank correlation, r = 0.467, P = 0.022). In more detailed analyses on the professional training of nursing personnel, a correlation of CLABSI incidence rates and licensed practical nurses (Spearman rank correlation, r = 0.26, P = 0.038) or registered nurses (r = 0.471, P = 0.021) was found. Physician turnover did not correlate with CLABSI incidence (Spearman rank correlation, r = −0.058, P = 0.787).ConclusionsProspectively determined CLABSI incidence correlated positively with the degree of turnover of nurses overall and nurses with advanced training, but not with the turnover of physicians. Efforts to maintain continuity in nursing staff might be helpful for sustained reduction in CLABSI rates.

Highlights

A recent US point prevalence study found that approximately 3% of all hospitalized patients had a healthcareassociated infection (HAI) [1]
We aimed at this research question using prospectively collected data on central line-associated bloodstream infections (CLABSI) incidence and human resources management derived data on personnel turnover of health care workers
The positive correlation with CLABSI was confirmed for the subgroup of registered nurses (RN) (r = 0.471, P = 0.021) and licensed practical nurses (LPN) (r = 0.426, P = 0.038), but not for assistive nursing personnel (ANP) (r = 0.324, P = 0.122) (Fig. 3b)

Summary

Introduction

A recent US point prevalence study found that approximately 3% of all hospitalized patients had a healthcareassociated infection (HAI) [1]. Fridkin et al identified patient-to-nurse ratio as an independent risk factor for CLABSI [5]. Current guidelines highlight the relevance of staffing [6, 7], e.g. Marschall et al indicate an adequate patient-to-nurse ratio as a component in CLABSI prevention [7]. We aimed at this research question using prospectively collected data on CLABSI incidence and human resources management derived data on personnel turnover of health care workers. Understaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question

Methods

Results

Conclusion