Study Suggests Nurse Understaffing Associated With NICU Infection Rates

A study by Jeannette A. Rogowski, Ph.D., of the University of Medicine and Dentistry of New Jersey, Piscataway, and colleagues suggests nurse understaffing in US neonatal intensive care units (NICUs) is associated with higher rates of nosocomial infections among infants with very low birth weights (VLBW). (Online First)

The retrospective study included all inborn VLBW infants, with a NICU stay of at least 3 days, discharged from the NICUs in 2008 (n=5771) and 2009 (n=5630) and all staff registered nurses with infant assignments from sixty-seven U.S. NICUs from the Vermont Oxford Network. Nurse understaffing was measured relative to acuity-based guidelines using 2008 survey data (4,046 nurses and 10,394 infant assignments) and data for four complete shifts (3,645 nurses and 8,804 infant assignments) in 2009-2010.

Hospitals understaffed 32% of their NICU infants and 85% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.39 of a nurse per high acuity infant. Very low birth weight infant infection rates were 16.5% in 2008 and 13.9% in 2009, according to the study results. Higher levels of nurse understaffing was associated with increased odds of infant infection.

“Substantial NICU nurse understaffing relative to national guidelines is wide spread. Understaffing is associated with an increased rise for VLBW nosocomial infection,” the study concludes.

(JAMA Pediatr. Published online March 18, 2013. doi:10.1001/jamapediatrics.2013.18.