Hospitals where higher numbers of nurses report burn out, as measured by the Maslach survey, also had higher rates of surgical site and urinary tract infections than hospitals with fewer burned out nurses, according to a report in the American Journal of Infection Control.
"When nurses feel high levels of burnout, they emotionally, psychologically, or cognitively detach from their work and from their patients," and lapses in infection control occur, said lead author Jeannie P. Cimiotti, of the New Jersey Collaborating Center for Nursing at Rutgers University.
The survey found that hospitals where nurses reported 30% lower levels of burnout had 6,329 fewer surgical site and catheter-associated urinary tract infections, which researchers estimated saved those hospitals $68 million a year.
The report was drawn from a 2006 survey of 7,027 registered nurses working in 161 hospitals in Pennsylvania.
Cimiotti says that the nurses were asked to fill out the survey designed by UC Berkeley psychology professor Christina Maslach, which asks how much they agreed with some 22 statements about "emotional exhaustion." They could answer on a scale from 0 to 6, in which the feeling never happens, or it happens every day.
For example, the statements included these: "I feel emotionally drained from my work," "I feel used up at the end of the work day," "I don't really care what happens to some patients," and "I feel I treat some patients as if they were impersonal objects."
Initially, Cimiotti explains, the researchers looked at nurse-patient ratio at each of the hospitals and found that hospitals with more nurses and lower patient-nurse ratios had fewer infections than hospitals with fewer nurses.
But that wasn't the strongest link to infection rates when patients' co-morbidities and hospital characteristics were risk adjusted. Levels of burnout, however, were.
Cimiotti was asked if the survey were administered today, in an era where infection prevention bundles, checklists, hand washing compliance and environmental services are much higher on the hospital pecking order, whether the results would be different.
She replied "I don't think so, especially when it comes to catheter-associated urinary tract infections.
When caregivers get burned out, "they emotionally and cognitively detach. They're going through the motions but they're not really there. Maybe during a busy schedule she looks at a patient and says "cleaning out that urinary catheter is not a priority today. I have other things to worry about, and other patients."
"I hypothesize that in hospitals that still have a high proportion of nurses with job-related burnout, their infection rates would be higher than in hospitals where nurses do not report high levels of burnout. Although rates might be different, we'll see the same type of things."
What's needed, Cimiotti says, are "organizational climate" changes in hospitals that prevent nurse burnout.
"We have to foster a climate where there is a good inter-professional relationship between nurses and nurses and between nurses and doctors. We need an organizational climate where nurses are well respected within in the facility that they have a voice in the organization and are autonomous and are allowed to practice to full extent.
Fellow author Linda Aiken of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, says that "Nurses are responsible for everybody else's infection control as well as their own. They have to remind everyone in the clinical area, families and doctors," who come near the patient. "And if they're burned out, it erodes their vigilance and capacity to provide surveillance on everybody else."
In conclusion, the authors wrote, "Healthcare-associated infections are associated with morbidity, mortality, and enormous costs to healthcare facilities, and insurance providers nationwide are denying payment for costs associated with these infections.
"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."