NURSE STAFFING, BURNOUT,

AND
HEALTHCARE-ASSOCIATED
INFECTION

Numbi Mediatmapratia
NIM 101414453026

Pendahuluan
Setiap tahun pasien rawat inap memperoleh
infeksi saat dirawat untuk kondisi lain.
Perawat telah terlibat dalam penyebaran
infeksi nosokomial di rumah sakit, namun
sedikit bukti yang tersedia untuk menjelaskan
hubungan ini.
CDC memperkirakan sekitar 1,7 juta pasien
rawat inap di RS mendapatkan infeksi
nosokomial selama masa perawatan di RS,
dan lebih dari 98.000 pasien tersebut
meninggal sebagai akibat dari infeksi
nosokomial tersebut.

 Bukti terbaru menerangkan bahwa nursing

care berhubungan dengan kejadian infeksi
nosokomial.
Nurse staffing, dalam bentuk perbandingan
jumlah perawat-pasien dan total waktu
nursing care per hari yang berlebihan,
terlibat dalam penyebaran infeksi
nosokomial.
Job-related burnout berhubungan dengan
pelayanan medis dan kepuasan pasien
yang kurang optimal.

 Teori Maslach yang berpendapat

bahwa komponen utama dari burnout
di tenaga kesehatan adalah kelelahan
emosional, yang berhubungan dengan
emotional dan cognitive detachment
dari pekerjaan sebagai cara untuk
mengatasi tuntutan pekerjaan.
Beberapa bukti menunjukkan bahwa
perawat di rumah sakit mengalami job
related burnout yang tinggi.

Tujuan penelitian
Penelitian ini bertujuan untuk melihat
pengaruh nurse staffing dan burnout
perawat dengan kejadian infeksi
nosokomial di rumah sakit di
Pennsylvania

Metode Penelitian
1. Penelitian deskriptif, cross sectional
2. Jangka waktu penelitian (?) - 2006
3. Sumber Informasi: (data sekunder)
a) Nurse survey data
b) The 2006 Pennsylvania Health Care Cost
Containment Council (PHC4) report on
hospital infections
c) The American Hospital Association (AHA)
Annual Survey on hospital
characteristics.

Instrumen Penelitian
Kuesioner : Maslach Burnout
Inventory- Human Services Survey
(MBI-HSS) emotional exhaustion
subscales
Used the emotional exhaustion
subscale of the MBI-HSS, because
emotional exhaustion has been
identified as the key component of
burnout syndrome (Maslach,1996)

Objek Penelitian
7,076 perawat yang bekerja di 161
rumah sakit di Pennsylvania.
Rumah sakit sampel adalah rumah sakit
yang melaporkan data tentang infeksi
nosokomial kepada PHC4 di tahun 2006.
Penelitian pada 2 tipe infeksi nosokomial
yaitu, catheter-associated urinary
tract infections dan surgical site
infections.

 Karakteristik RS (AHAs Annual Survey)

termasuk jumlah tempat tidur, status RS
pendidikan, dan teknologi.
Status RS pendidikan (teaching hospital)
ditentukan dari jumlah residen, minor
teaching hospitals (dengan rasio residenbed 1:4) dan major teaching hospitals
(dengan rasio residen-bed >1:4).
Rumah sakit dikatakan berteknologi tinggi
bila memiliki fasilitas untuk open-heart
surgery, major organ transplants, atau
keduanya.

 Data demografi perawat dan burnout

diperoleh dari survei perawat.
Menggunakan daftar yang disediakan
oleh dewan negara keperawatan.
Survey dikirimkan ke rumah dengan
sampel acak dari perawat terdaftar
berlisensi dan tinggal di Pennsylvania
Survei dilakukan dua (untuk
mengurangi bias, dan mencapai 92%
respon)

Uji Statistik
3 linear regression models

for both types of hospital

infections to assess the individual effect of nurse staffing on infection
rate, and the extent to which nurse burnout could explain that effect.
In first model, we regressed the hospital infection rate on nurse
staffing. With nurse burnout excluded, the staffing coefficient in this
simple model can be interpreted as the sum of the direct effect of
staffing on the infection rate and the indirect effect of staffing on the
infection rate as a result of its effect on nurse burnout.
In second model, we estimated the effect of nurse burnout on the
rates of the 2 types of health care-associated infection rates,
with staffing excluded.
In third model included both nurse staffing and burnout as
covariates. We used this model to examine whether nurse burnout
could account for the effect of staffing on infection rates, that is,
whether or not the infection rate differences between hospitals of
differing staffing levels could be attributed to nurse burnout, controlling
for nurse age and years of experience and hospital teaching status,
technology status, bed size, and patient acuity.

Result

 significant staffing coefficient of 0.86 (P

= .02); that is, an additional patient assigned
to each nurse in a hospital was associated with
a 0.86-unit increase (or an increase of nearly 1
per 1,000) in the rate of urinary tract infection.
Using the same model for surgical site
infection, we obtained a significant staffing
coefficient of 0.93 (P = .04).

 the association between nurse burnout and

infection rate, nurse burnout was highly
associated with both urinary tract infections
(b = 0.85; P = .02). And surgical site
infections (b =1.58; P < .01).
nurse burnout was highly associated with
both urinary tract infections and surgical site
infections In other words

 In third model combining burnout and

staffing, for both urinary tract and
surgical site infections, the staffing
effect was no longer significant after
adjusting for nurse burnout.

Conclusion &
Recommendation
The findings confirm an association
between nurse staffing and health careassociated infection rates
Based on our finding that the staffinginfection relationship is mediated by jobrelated 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.