The role of nurse understaffing in nosocomial viral gastrointestinal infections on a general pediatrics ward.

Objective: To examine the relationship between nurse staffing levels and the rate of nosocomial viral gastrointestinal infections (NVGIs) in a general pediatrics population.

Design: Retrospective descriptive study.

Setting: A general pediatrics ward at The Hospital for Sick Children in Toronto, Ontario, Canada, a 320-bed, tertiary-care pediatric institution.

Results: Forty-three NVGIs were detected in 37 patients of 2,929 admissions (1.3%). The monthly NVGI rate correlated significantly with the monthly night patient-to-nurse ratio (r = 0.56) and the monthly day patient-to-nurse ratio (r = 0.50). The nursing hours per patient-day during the preinfection period (PIP) were significantly lower than those during the nonpreinfection period (NPIP; 12.5 vs 13.0). There was no difference between the PIP and the NPIP day patient-to-nurse ratios (3.31 vs 3.32), but there was a significant difference between the PIP and the NPIP night patient-to-nurse ratios (3.26 vs 3.16). The incidence of NVGIs in the 72-hour period after any day when the nursing hours per patient-day were less than 10.5 was 6.39 infections per 1,000 patient-days, compared with 2.17 infections per 1,000 patient-days in periods with more than 10.5 nursing hours per patient-day (rate ratio, 2.94; 95% confidence interval, 2.16 to 4.01).

Conclusion: Nurse understaffing contributed to an increased NVGI rate in our general pediatrics population, and should be assessed as a risk factor in outbreak investigations.