Impact of staffing on bloodstream infections in the neonatal intensive care unit

Objective: To examine the association between registered nurse staffing and healthcare-associated bloodstream infections in infants in the neonatal intensive care unit (NICU). Design: Prospective cohort study. Setting: Two level III-IV NICUs in New York, NY, from March 1, 2001, through January 31, 2003. Participants: A total of 2675 infants admitted to the NICUs for more than 48 hours and all registered nurses who worked in the same NICUs during the study period. Intervention: Hours of care provided by registered nurses. Main Outcome Measure: Time to first episode of healthcare-associated bloodstream infection. Results: A total of 224 infants had an infection that met the study definition of healthcare-associated bloodstream infection. In a multivariate analysis, after controlling for infants' intrinsic and extrinsic risk factors, a greater number of hours of care provided by registered nurses in NICU 2 was associated with a decreased risk of bloodstream infection in these infants (hazard ratio, 0.21; 95% confidence interval, 0.06-0.79). Conclusion: Our findings suggest that registered nurse staffing is associated with the risk of bloodstream infection in infants in the NICU.