Hospitals’ Adoption of Safety Standards Linked to Nurse Staffing Levels
A new study funded by a grant from the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative (INQRI) concludes that hospitals with larger percentages of registered nurses on staff and more nurse-hours per patient are more likely to have adopted enhanced safety practices.
Published in the September 2011 issue of the Journal of Nursing Administration, the study compared adoption rates for National Quality Forum (NQF) Safe Practices at hospitals designated as “Magnet” hospitals with adoption rates at hospitals not so designated. Magnet status is awarded by the American Nurses Credentialing Center on the strength of hospitals’ work to provide high-quality practice environments for nurses. After concluding that Magnet hospitals did indeed have higher adoption rates, researchers then sought to identify the specific factors that led to those higher rates.
Three factors rose to the surface in that analysis: higher numbers of nurse hours per patient, larger proportions of RNs, and high levels of competition with other hospitals. All three correlated with higher adoption rates. The study also identified other significant differences between Magnet and non-Magnet hospitals, including for-profit or nonprofit status, and the number of patient beds. But researchers concluded those factors did not correlate with higher adoption rates of NQF Safe Practices.
"Our findings suggest that having more nurses than necessary to meet minimum patient needs is key to adopting these practices, which require activities like conducting meetings, collecting and analyzing data, and reviewing the literature on safe practices," study author Jayani Jayawardhana, PhD, of the University of Georgia told Nurse.com. "As hospitals continue to search for ways to cut costs in order to survive in the current economy, we are concerned that some cost-cutting measures may have a negative impact on hospitals' ability to adopt safe practices and provide the highest levels of patient care."
Touch Curtain? Wash Hands!
New research indicates that the hospital privacy curtains commonly used to separate patient care spaces in hospitals and elsewhere are a likely source of dangerous bacteria, and one that nurses and other care providers might not account for with their hand-washing habits.
Michael Ohl, MD, MSPH, of the University of Iowa, and colleagues took multiple swab samples from 43 privacy curtains in Iowa hospitals over a three-week period, testing for the presence of bacteria. The research team also marked curtains to see how often they were changed. The swabs yielded a number of positive results, including for staph bacteria, MRSA, and various species of Enterococci (“gut bacteria”), some of which were resistant to current antibiotics.
In all, researchers found bacteria on 41 of the 43 curtains tested at some point during the study. What’s more, the researchers concluded that replacing the curtains was a short-term solution. Of the 13 curtains replaced during the study, 12 tested positive for bacteria within a week.
"The vast majority of curtains showed contamination with potentially significant bacteria within a week of first being hung, and many were hanging for longer than three or four weeks," Ohl told the Reuters news service. "We need to think about strategies to reduce the potential transfer of bacteria from curtains to patients.... The most intuitive, common sense strategy is [for health care workers] to wash hands after pulling the curtain and before seeing the patient. There are other strategies, such as more frequent disinfecting, but this would involve more use of disinfectant chemicals, and then there is the possibility of using microbial-resistant fabrics. But handwashing is by far the most practical, and the cheapest intervention."