Nurse staffing and healthcare-associated infections in a national healthcare system that implemented a nurse staffing directive: multi-level interrupted time series analyses

Abstract Background In 2010, the Veterans Health Administration Office of Nursing Services (VHA ONS) issued a Staffing Methodology (SM) Directive, standardizing the method of determining appropriate nurse staffing for VHA facilities. Objectives To assess associations between the Directive, nurse staffing trends, and healthcare-associated infections. Research design We conducted multi-level interrupted time series analyses of nurse staffing trends and the rates of two healthcareassociated infections before and after implementation of the Directive, October 1, 2008 - June 30, 2014. Subjects Acute care, critical care, mental-health acute care, and longterm care nursing units (called Community Living Centers, CLC in VHA) among 285 VHA facilities were included in nurse staffing trends analyses, while acute and critical care units in 123 facilities were used in the analysis of infection rates. Measures Monthly rates were calculated at the facility-unit level and included Nursing Hours Per Patient Day (NHPPD) for all nursing personnel and number of catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) per 1000 device days. Results Nursing hours per patient day increased in both time periods. However, the differential change in rate of nursing hours per patient day following implementation of the Directive was not statistically significant. On average, we found statistically significant decreases of .05 in the post-Directive central line-associated bloodstream infection rates associated with a unit increase in nursing hours per patient day. Conclusions System-wide implementation of Staffing Methodology may be one contributing factor impacting patient outcomes.