A recent study published in the May issue of the American Journal of Infection Control found the correlation between low staffing levels in a nursing home and failure to follow infection control protocols. It has long been argued in nursing home neglect cases that having sufficient numbers of qualified staff is the most important factor in ensuring good patient outcomes. This study provides further proof of that position. Since infections are the leading cause of death in nursing homes, responsible for nearly 400,000 deaths per year according to a news release relating to this publication, the importance of having sufficient staff and nursing home environment cannot be overstated.
Why would nursing homes fail to provide sufficient staff to meet the needs of that its residents? The plain truth is that because staffing is the number one most expensive line item on any nursing home budget. Increasing staffing makes nursing homes less profitable.
How does low staffing cause breach of infection control protocol? The answer is that nurses and nurse's aides who are well-meaning and (hopefully) properly trained simply do not have enough time to meet the needs of all the residents they are assigned to care for and they are more likely to be hurried and skimp on infection control measures. To illustrate, when providing care to too many residents in an environment of chronic short-staffing, the floor nurses and aids are often put in the position of having to make the uncomfortable choice of letting the patients' call bells ring unanswered or taking a few extra minutes to wash their hands between caring for patients.
Avoidable poor outcomes such as the spread of nosocomial (facility acquired) urinary tract, wound, and respiratory infections are often the direct result of such tragic "short-cuts" taken by staff members pressed to let the simple rules of basic hygiene such as hand washing after caring for each patient and changing gloves between direct patient care to be abandoned. If families observe closely, one can see harried caregivers rushing from patient room to patient room without washing their hands or changing their gloves. This is one of the most devastatingly effective ways to spread organisms from one patient to another.
In a nursing home, due to illness, the aging process, frailty and confined, close living quarters, all infection control measures must be rigorously adhered to - provided one has the time to do so. Different medical conditions increase susceptibility to infection among the elderly, but nothing can impact the spread of disease more effectively than understaffing which provokes and promotes the failures of staff to comply with basic infection control measures associated with high infection rates in nursing homes. Allowing staff the time and opportunity to comply with these basic measures, fostered by adequate numbers of properly trained staff, and whose techniques can be readily ascertained by observant family and visitors can go a long way to minimize the pathways by which infection is acquired and spread in long-term care settings. Forcing staff to choose between the basics of simple hygiene and feeling as though they are taking precious minutes from patient care is a Hobson's choice no compassionate care-giver should feel they must make.
