Any parent whose newborn has spent time in the neonatal intensive care unit (NICU) has felt helpless and frightened seeing their tiny baby swathed in more medical paraphernalia than you’d think he or she could withstand. They’ve probably also felt grateful and in awe of the medical army charged with nurturing delicate new life into viability.
Neonatal nurses are truly on the front lines of their babies’ survival. And a recent study published in JAMA Pediatrics concludes that the warriors fighting for your kid are under serious attack from a lack of numbers. Depleted staffs raise the risk of infection in critically ill babies.
The study, as interpreted on MedPageToday, shows that infection rates for very low birth weight infants were 40% higher in NICUs that were understaffed with nurses.
The problem seems to be widespread: The researchers found that hospitals understaffed nearly 1 in 3 of their NICU infants and more than 9 in 10 of their high-acuity NICU infants, relative to staffing guidelines. (“High-acuity” patients are seriously ill and require medical interventions of an emergency and/or specialized or complex nature.)
National guidelines spell out optimal nurse-to-patient ratios. They’re based on acuity. Staffing for low-acuity infants is supposed to be one nurse per three or four babies; levels for the highest-acuity patients are at least 1 to 1.
When these levels aren’t maintained, studies show, the patients have a higher rate of nosocomial infections, especially infants with very low birth weights. “Nosocomial” means the infection was contracted as a result of the hospital setting—from a treatment or other exposure.
The study examined data from 67 NICUs from the Vermont Oxford Network, a nonprofit collaboration of health-care professionals working in more than 900 NICUs around the world. Measured by the national guidelines, hospitals understaffed nearly 1 in 3 NICUs infants in 2009 and nearly 5 in 10 in 2008, but the levels varied by acuity. Hospitals understaffed more than 8 in 10 high-acuity infants in 2008 and more than 9 in 10 in 2009.
The study did have limitations—it might not represent all hospitals with a NICU or consider other factors that might be important in NICU staffing decisions, including non-nursing personnel.
But the researchers’ conclusion was unequivocal: The "most vulnerable hospitalized patients, unstable newborns requiring complex critical care, do not receive recommended levels of nursing care."
Usually, parents don’t choose the NICU in which their ailing babies are assigned. So if yours is a NICU patient, find out if your child is considered a low- or high-acuity patient, and let the staff know you’re aware of the staffing recommendation for each. If the facility is understaffed, be extra vigilant about monitoring its infection-control measures. Find out more on our blog, “Controlling Infections in Pediatric ICUs.”