Nurse staffing and healthcare-associated infections in a national healthcare system that implemented a nurse staffing directive: Multi-level interrupted time series analyses.

In 2010, the Veterans Health Administration Office of Nursing Services (VHA ONS) issued a Staffing Methodology (SM) Directive, standardizing the method of determining appropriate nurse staffing for VHA facilities.

To assess associations between the Directive, nurse staffing trends, and healthcare-associated infections.

We conducted multi-level interrupted time series analyses of nurse staffing trends and the rates of two healthcare-associated infections before and after implementation of the Directive, October 1, 2008 - June 30, 2014.

Acute care, critical care, mental health acute care, and longterm care nursing units (called Community Living Centers, CLC in VHA) among 285 VHA facilities were included in nurse staffing trends analyses, while acute and critical care units in 123 facilities were used in the analysis of infection rates.

Monthly rates were calculated at the facility unit level and included nursing hours per patient day (NHPPD) for all nursing personnel and number of catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) per 1000 device days.

Nursing hours per patient day increased in both time periods. However, the differential change in rate of nursing hours per patient day following implementation of the Directive was not statistically significant. On average, we found a statistically significant decrease of 0.05 unit in the post-Directive central line-associated bloodstream infection rates associated with a unit increase in nursing hours per patient day.

System-wide implementation of Staffing Methodology may be one contributing factor impacting patient outcomes.

International journal of nursing studies. 2020 Jan 20 [Epub ahead of print]

Tony Van, Ann M Annis, Matheos Yosef, Claire H Robinson, Sonia A Duffy, Yu-Fang Li, Beth Ann Taylor, Sarah Krein, Sheila Cox Sullivan, Anne Sales

Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, United States. Electronic address: ., Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, United States; College of Nursing, Michigan State University, 1355 Bogue St., East Lansing, MI 48824, United States. Electronic address: ., Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, United States; Department of Psychiatry, University of Michigan, United States. Electronic address: ., Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, United States. Electronic address: ., Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, United States; College of Nursing, Ohio State University, United States. Electronic address: ., Office of Informatics and Analytics, Veterans Health Administration, Department of Veteran Affairs; and Behavioral Nursing and Health Systems, University of Washington, United States. Electronic address: ., VA Clinical Operations, 810 Vermont NW, Washington, DC, United States. Electronic address: ., Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, United States; Department of Internal Medicine, University of Michigan Medical School, United States. Electronic address: ., Office of Nursing Services, Department of Veteran Affairs, Washington, DC, United States. Electronic address: ., Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109, United States; Department of Learning Health Sciences, University of Michigan Medical School, United States. Electronic address: .

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