Hospital Staffing and Health Care–Associated Infections: A Systematic Review of the Literature

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This article was originally published as:

Mitchell, B. G., Gardner, A., Stone, P. W., Hall, L., & Pogorzelska-Maziarz, M. (2018). Hospital staffing and health care–associated infections: A systematic review of the literature. The Joint Commission Journal on Quality and Patient Safety, 44(10), 613-622. doi: 10.1016/j.jcjq.2018.02.002

ISSN: 1553-7250


110309 Infectious Diseases| 111003 Clinical Nursing: Secondary (Acute Care)| 111708 Health and Community Services| 111716 Preventive Medicine| 160508 Health Policy

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Previous literature has linked the level and types of staffing of health facilities to the risk of acquiring a health care–associated infection (HAI). Investigating this relationship is challenging because of the lack of rigorous study designs and the use of varying definitions and measures of both staffing and HAIs.


The objective of this study was to understand and synthesize the most recent research on the relationship of hospital staffing and HAI risk. A systematic review was undertaken. Electronic databases MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for studies published between January 1, 2000, and November 30, 2015.


Fifty-four articles were included in the review. The majority of studies examined the relationship between nurse staffing and HAIs (n = 50, 92.6%) and found nurse staffing variables to be associated with an increase in HAI rates (n = 40, 74.1%). Only 5 studies addressed non-nurse staffing, and those had mixed results. Physician staffing was associated with an increased HAI risk in 1 of 3 studies. Studies varied in design and methodology, as well as in their use of operational definitions and measures of staffing and HAIs.


Despite the lack of consistency of the included studies, overall, the results of this systematic review demonstrate that increased staffing is related to decreased risk of acquiring HAIs. More rigorous and consistent research designs, definitions, and risk-adjusted HAI data are needed in future studies exploring this area.


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