Effect of Nursing Practice Environment, Nurse Staffing, Overtime and Hand Hygiene on Hospital-Acquired Infections in a Tertiary Teaching Hospital

Aims: To investigate the impact of the nursing practice environment, nurse staffing, working overtime and compliance with hand hygiene standards on hospital-acquired infections.

Design: A multi-source quantitative study.

Methods: Nursing data were collected from selected wards in one hospital between 18 January 2021 and 15 March 2021. Hand hygiene compliance data were obtained retrospectively from Hand Hygiene Australia Audits between July 2018 and June 2021. Patient data were gathered from July 2018 to June 2021. Data from the three sources were linked together at the episode of care level. Descriptive statistics were used to summarise participant characteristics, and multiple logistic regression was employed to assess associations between the nursing practice environment, nurse staffing, overtime and hand hygiene with hospital-acquired infections.

Results: A total of 361 nurses participated in the nursing survey. There were 13,440 hand hygiene moments assessed, and 10,924 (81.3%) correct practices were observed. There were 71,257 patient care episodes, including 2037 with hospital-acquired infections. The odds of hospital-acquired infections decreased by 19% for every 10% increase in nurses' compliance with hand hygiene and decreased by 7% for each one standard deviation increase in the nursing practice environment scale. Each additional patient per nurse was associated with a 42% increase in the odds of a hospital-acquired infection.

Conclusion: This study found evidence that a favourable nursing practice environment, reduced nurse workload and compliance with hand hygiene are linked to a lower risk of hospital-acquired infections.

Impact: A favourable nursing practice environment contributes to fewer hospital-acquired infections. Monitoring of hand hygiene compliance provides important local information to support improvements in practice. Findings from this study can be used to support the implementation of safe nurse staffing policies that guide implementation of nurse-to-patient ratios.

Reporting method: RECORD Checklist.

Patient or public contribution: No Patient/Public Contribution.