A recent article from The Lancet Infectious Diseases, July 2008, raises the issues of overcrowding and understaffing as key contributors to the rise in MRSA rates.
- The drive towards greater efficiency by reducing the number of hospital beds and increasing patient throughput has led to highly stressed health-care systems with unwelcome side-effects
- The economic benefits of downsizing health-care systems are likely to have been offset by the increased burden of adverse events, such as MRSA infection, leading to a false economy.
- MRSA can compound problems of understaffing in hospitals through its effect on staff workloads and staff availability.
- Large outbreaks of epidemic MRSA, or those that cannot be brought under control, might result in ward closure, the consequences of which can be seen as an extreme example of bed blocking.
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Recent decades have seen the global emergence of meticillin-resistant Staphylococcus aureus (MRSA), causing substantial health and economic burdens on patients and health-care systems. This epidemic has occurred at the same time that policies promoting higher patient throughput in hospitals have led to many services operating at, or near, full capacity. A result has been limited ability to scale services according to fluctuations in patient admissions and available staff, and hospital overcrowding and understaffing. Overcrowding and understaffing lead to failure of MRSA control programmes via decreased health-care worker hand-hygiene compliance, increased movement of patients and staff between hospital wards, decreased levels of cohorting, and overburdening of screening and isolation facilities. In turn, a high MRSA incidence leads to increased inpatient length of stay and bed blocking, exacerbating overcrowding and leading to a vicious cycle characterised by further infection control failure. Future decision making should use epidemiological and economic evidence to evaluate the effect of systems changes on the incidence of MRSA infection and other adverse events.
Other key points include:
- In Australia, the requirement for hospital beds is predicted to increase by 70–130% by 2050.
- fewer people in some high-income countries seem to be choosing nursing as a career, potentially contributing further to the ageing and diminishing size of the health-care workforce.
- In the USA, these factors have led to an increase in the average age of registered nurses from 37.4 years in 1983 to 41.9 years in 1998 and 46.8 years in 2004.
From Lancet Infect Dis 2008; 8: 427–34