NURSE STAFFING, BURNOUT, AND HEALTHCARE-ASSOCIATED

INFECTION

Numbi MediatmapratiaNIM 101414453026

Pendahuluan

• Setiap tahun pasien rawat inap memperoleh infeksi saat dirawat untuk kondisi lain. Perawat telah terlibat dalam penyebaran infeksi nosokomial di rumah sakit, namun sedikit bukti yang tersedia untuk menjelaskan hubungan ini.

• CDC memperkirakan sekitar 1,7 juta pasien rawat inap di RS mendapatkan infeksi nosokomial selama masa perawatan di RS, dan lebih dari 98.000 pasien tersebut meninggal sebagai akibat dari infeksi nosokomial tersebut.

• Bukti terbaru menerangkan bahwa nursing care berhubungan dengan kejadian infeksi nosokomial.

• Nurse staffing, dalam bentuk perbandingan jumlah perawat-pasien dan total waktu nursing care per hari yang berlebihan, terlibat dalam penyebaran infeksi nosokomial.

• Job-related burnout berhubungan dengan pelayanan medis dan kepuasan pasien yang kurang optimal.

• Teori Maslach yang berpendapat bahwa komponen utama dari burnout di tenaga kesehatan adalah kelelahan emosional, yang berhubungan dengan emotional dan cognitive detachment dari pekerjaan sebagai cara untuk mengatasi tuntutan pekerjaan.

• Beberapa bukti menunjukkan bahwa perawat di rumah sakit mengalami job related burnout yang tinggi.

Tujuan penelitian

• Penelitian ini bertujuan untuk melihat pengaruh nurse staffing dan burnout perawat dengan kejadian infeksi nosokomial di rumah sakit di Pennsylvania

Metode Penelitian

1. Penelitian deskriptif, cross sectional2. Jangka waktu penelitian (?) - 20063. Sumber Informasi: (data sekunder)a) Nurse survey datab) The 2006 Pennsylvania Health Care Cost

Containment Council (PHC4) report on hospital infections

c) The American Hospital Association (AHA) Annual Survey on hospital characteristics.

Instrumen Penelitian

• Kuesioner : Maslach Burnout Inventory- Human Services Survey (MBI-HSS) emotional exhaustion subscales

• Used the emotional exhaustion subscale of the MBI-HSS, because emotional exhaustion has been identified as the key component of burnout syndrome (Maslach,1996)

Objek Penelitian

• 7,076 perawat yang bekerja di 161 rumah sakit di Pennsylvania.

• Rumah sakit sampel adalah rumah sakit yang melaporkan data tentang infeksi nosokomial kepada PHC4 di tahun 2006.

• Penelitian pada 2 tipe infeksi nosokomial yaitu, catheter-associated urinary tract infections dan surgical site infections.

• Karakteristik RS (AHA’s Annual Survey) termasuk jumlah tempat tidur, status RS pendidikan, dan teknologi.

• Status RS pendidikan (teaching hospital) ditentukan dari jumlah residen, minor teaching hospitals (dengan rasio residen-bed 1:4) dan major teaching hospitals (dengan rasio residen-bed >1:4).

• Rumah sakit dikatakan berteknologi tinggi bila memiliki fasilitas untuk open-heart surgery, major organ transplants, atau keduanya.

• Data demografi perawat dan burnout diperoleh dari survei perawat. Menggunakan daftar yang disediakan oleh dewan negara keperawatan.

• Survey dikirimkan ke rumah dengan sampel acak dari perawat terdaftar berlisensi dan tinggal di Pennsylvania

• Survei dilakukan dua (untuk mengurangi bias, dan mencapai 92% respon)

Uji Statistik• 3 linear regression models for both types of hospital infections to

assess the individual effect of nurse staffing on infection rate, and the extent to which nurse burnout could explain that effect.

• In first model, we regressed the hospital infection rate on nurse staffing. With nurse burnout excluded, the staffing coefficient in this simple model can be interpreted as the sum of the direct effect of staffing on the infection rate and the indirect effect of staffing on the infection rate as a result of its effect on nurse burnout.

• In second model, we estimated the effect of nurse burnout on the rates of the 2 types of health care-associated infection rates, with staffing excluded.

• In third model included both nurse staffing and burnout as covariates. We used this model to examine whether nurse burnout could account for the effect of staffing on infection rates, that is, whether or not the infection rate differences between hospitals of differing staffing levels could be attributed to nurse burnout, controlling for nurse age and years of experience and hospital teaching status, technology status, bed size, and patient acuity.

Result

• significant staffing coefficient of 0.86 (P = .02); that is, an additional patient assigned to each nurse in a hospital was associated with a 0.86-unit increase (or an increase of nearly 1 per 1,000) in the rate of urinary tract infection.

• Using the same model for surgical site infection, we obtained a significant staffing coefficient of 0.93 (P = .04).

• the association between nurse burnout and infection rate, nurse burnout was highly associated with both urinary tract infections (b = 0.85; P = .02). And surgical site infections (b =1.58; P < .01).

• nurse burnout was highly associated with both urinary tract infections and surgical site infections In other words

• In third model combining burnout and staffing, for both urinary tract and surgical site infections, the staffing effect was no longer significant after adjusting for nurse burnout.

Conclusion & Recommendation• The findings confirm an association between

nurse staffing and health care-associated infection rates

• Based on our finding that the staffing-infection relationship is mediated by job-related burnout,

• Practitioners should work to implement organizational changes known to build job engagement, such as educational interventions, performance feedback, and social support, as strategies to reduce nurse burnout and thereby help control infections in acute care facilities.