National Nurses United

12 www.NationalNursesUnited.org tious diseases. Evaluating health care worker disease exposure estimates required combining data from seven separate sources or programs under the Department of Labor, OSHA, and the CDC. The researchers used these estimates in combination with clinical averages regarding specific disease incidence and natural history in order to get a "best guess" annual incidence of health care employee death due to occupational infectious disease exposures. They estimated that 17 to 57 health care work- ers die from occupational infectious diseases per million workers. Understaffing When nurses are understaffed, rates of health care-ac- quired infections for patients and occupational exposures for nurses and other health care workers increase. One review of multiple studies found a significant increase in the risk of bloodstream infections for patients with a higher use of float nurses. In 84.6% of studies reviewed, the results indicated that nurse staffing was significantly associated with the risk of health care-acquired infections. Another review of many studies published a table with detailed results of each study. See Table 2. Increased rates of health care-acquired infections for patients pres- ent more exposure scenarios for nurses and other health care workers. In addition to nurse staffing, understaffing of other health care workers can lead to increased health care-associated infections. For example, studies have examined infection rates before and after outsourcing of housekeeping staff in National Health Service (NHS) hospitals in the U.K. Outsourcing of workers typically means fewer workers on duty at a time and less training for workers. In NHS hos- pitals that outsourced housekeeping staff, the MRSA inci- dence rate was 2.28 in every 100,000 bed days between 2005 and 2009. This is significantly higher than the NHS hospitals that did not outsource their housekeeping staff and saw a MRSA incidence of 1.46 per 100,000 bed days; a difference of almost 50%. Burnout rates for nurses are high and related to under- staffing. One study found that each additional patient per nurse was associated with a 23% increase in the odds of burnout for nurses. Another study found that nurse burnout was associated with a significantly higher risk for health care-acquired urinary tract and surgical site infections among patients. Hospitals that reduced burn- out by 30% had over 6,000 fewer infections. Table 2, from Stone et al. (2004)

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