Hospitals today spend a lot of time and effort to protect their patients from developing new infections while they're hospitalized - especially the most dangerous types that can threaten their health even more than the problem that sent them to the hospital in the first place. They also carefully track these hospital-acquired infections (HAIs), and even get paid more by the Medicare system if they achieve lower rates.
But this massive effort has been missing a key element, according to University of Michigan and RAND researchers. None of the tracking measures take into account how full a hospital was during the hospitalization that the patient acquired the infection - that is, what percentage of its available beds had patients in them, and therefore how thinly stretched the staff were.
Now, the team has developed an approach that they hope will lead to more uniform tracking of this important factor in patient safety.
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In a new paper in the Journal of Hospital Medicine, they share the first results from using the approach on real-world data, related to the digestive tract infection known as "C. diff" or Clostridium difficile.
While it might seem obvious that a fuller hospital would mean higher risk of C. diff among its patients, the study finds the opposite to be true.
A patient's C. diff infection risk was highest when the hospital was in the middle range of occupancy on the day the patient was admitted. And when the researchers looked at the average occupancy over the patient's stay, the risk of C. diff infection was more than three times higher when the hospital was between 25 percent and 75 percent full, compared with less than 25 percent or more than 75 percent occupancy.
The study used data from 558,829 patient discharges at 327 hospitals across California, between 2008 and 2012. It focused on patients who had come to the hospitals' emergency rooms for care for a heart attack, heart failure or pneumonia.
In all, 2,045 patients developed a C. diff infection after they reached the hospital. The researchers adjusted for many factors that differed among all the patients, including age, gender, income, education and more.
The data for the study came from California's Office of Statewide Health Planning and Development Patient Discharge Data set, which tracks hospital discharge records for all licensed general acute care hospitals in California.
The study was done after the state instituted minimum nurse-to-patient ratios in 2006, to ensure nurse staffing was adequate.