Nurse Staffing and NICU Infection Rates

Understaffing of nurses in NICUs associated with an increased risk of nosocomial infection among very low-birthweight infants.

Neonatal intensive care unit (NICU) stays are often expensive hospitalizations, requiring high levels of nursing staff. To understand the adequacy of staffing in U.S. NICUs and opportunities to improve quality and reduce costs in health care, this study examines NICU nurse staffing and its impact on rate of infection among very low birth weight (VLBW) infants.

This retrospective cohort study included 67 U.S. NICUs from the Vermont Oxford Network. VLBW infants with a stay of at least three days in the NICU in 2008 (n=5,771) and 2009 (n=5,630) were included in the study, which specifically measured an infection in blood or cerebrospinal fluid culture occurring more than three days after birth among VLBW infants.  Data were collected in 2008 via a web survey of nurses to assess nurse understaffing relative to acuity-based guidelines, while four complete shifts and their data were examined for 2009-2010.

Key Findings:

  • Relative to guidelines, hospitals understaffed 48 percent of NICU infants in 2008 and 32 percent in 2009.
  • Hospitals understaffed 85 percent of high acuity infants in 2008 and 92 percent in 2009.
  • To meet the staffing guidelines overall and among high acuity infants, an additional .11 nurse and .39 nurse is needed, respectively.
  • A 40 percent higher odds of infection was associated with a one standard deviation higher amount of nurse understaffing per infant.

This study’s hospital sample was disproportionately recognized for nursing excellence, and staffing levels across U.S. NICUs may be lower. The authors state that NICU nurse staffing must be assessed to match guidelines, improve care, and contain costs.

Share this


of hospital NICUs were understaffed in 2009, increasing odds of infection in high acuity infants.