Impact of Staffing on Bloodstream Infections in the Neonatal Intensive Care Unit

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Abstract
Objective To examine the association between registered nurse staffing and healthcare-associated bloodstream infections in infants in the neonatal intensive care unit (NICU). Design Prospective cohort study. Setting Two level III-IV NICUs in New York, NY, from March 1, 2001, through January 31, 2003. Participants A total of 2675 infants admitted to the NICUs for more than 48 hours and all registered nurses who worked in the same NICUs during the study period. Intervention Hours of care provided by registered nurses. Main Outcome Measure Time to first episode of healthcare-associated bloodstream infection. Results A total of 224 infants had an infection that met the study definition of healthcare-associated bloodstream infection. In a multivariate analysis, after controlling for infants' intrinsic and extrinsic risk factors, a greater number of hours of care provided by registered nurses in NICU 2 was associated with a decreased risk of bloodstream infection in these infants (hazard ratio, 0.21; 95% confidence interval, 0.06-0.79). Conclusion Our findings suggest that registered nurse staffing is associated with the risk of bloodstream infection in infants in the NICU.