Skip to main content Accessibility help

The Role of Nurse Understaffing in Nosocomial Viral Gastrointestinal Infections on a General Pediatrics Ward

  • Jacob Stegenga (a1), Erica Bell (a1) and Anne Matlow (a1) (a2)



To examine the relationship between nurse staffing levels and the rate of nosocomial viral gastrointestinal infections (NVGIs) in a general pediatrics population.


Retrospective descriptive study.


A general pediatrics ward at The Hospital for Sick Children in Toronto, Ontario, Canada, a 320-bed, tertiary-care pediatric institution.


Forty-three NVGIs were detected in 37 patients of 2,929 admissions (1.3%). The monthly NVGI rate correlated significantly with the monthly night patient-to-nurse ratio (r = 0.56) and the monthly day patient-to-nurse ratio (r = 0.50). The nursing hours per patient-day during the preinfection period (PIP) were significantly lower than those during the nonpreinfection period (NPIP; 12.5 vs 13.0). There was no difference between the PIP and the NPIP day patient-to-nurse ratios (3.31 vs 3.32), but there was a significant difference between the PIP and the NPIP night patient-to-nurse ratios (3.26 vs 3.16). The incidence of NVGIs in the 72-hour period after any day when the nursing hours per patient-day were less than 10.5 was 6.39 infections per 1,000 patient-days, compared with 2.17 infections per 1,000 patient-days in periods with more than 10.5 nursing hours per patient-day (rate ratio, 2.94; 95% confidence interval, 2.16 to 4.01).


Nurse understaffing contributed to an increased NVGI rate in our general pediatrics population, and should be assessed as a risk factor in outbreak investigations.


Corresponding author

Infection Prevention and Control Program, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8 Ontario, Canada


Hide All
1.Haley, RW, Bregman, DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982;145:875885.
2.Heseltine, P. Too many or too few hands? Infect Control Hosp Epidemiol 1999;20:595597.
3.Duncan, RA, Levine, A, Willey, S, et al. Nursing staffing and central venous catheter-related bloodstream infections (CVC-BSIs) in a changing surgical intensive care unit (SICU). Presented at the Ninth Annual Meeting of the Society for Healthcare Epidemiology of America; April 18-20,1999; San Francisco, CA Abstract.
4.Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150158.
5.Archibald, LK, Manning, ML, Bell, LM, Banerjee, S, Jarvis, WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 1997;16:10451048.
6.Kovner, C, Gergen, PJ. Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image J Nurs Sch 1998;30:315321.
7.Harbarth, S, Sudre, P, Dharan, S, Cadenas, M, Pittet, D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding and poor hygiene practices. Infect Control Hosp Epidemiol 1999;20:598603.
8.Loeb, M, Salama, S, Armstrong-Evans, M, et al. Nursing workload was not an independent risk factor for nosocomial colonization with VRE. Presented at the Ninth Annual Meeting of the Society for Healthcare Epidemiology of America; April 18-20,1999; San Francisco, CA Abstract 3.
9.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.
10.Rosner, BA. Fundamentals of Biostatistics, 4th ed. Scarborough, Ontario, Canada: Wadsworth Publishing; 1995:592597.
11.Albert, RF, Condie, F. Handwashing patterns in medical intensive-care units. N Engl J Med 1981;304:14651466.
12.Larson, E. Compliance with isolation techniques. Am J Infect Control 1981;11:221225.
13.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital: infection control program. Ann Intern Med 1999; 130:126130.
14.Preston, GA, Larson, EL, Stamm, WE. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641645.
15.Haley, RW, Cushion, NB, Tenover, FC, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614624.
16.Trundle, CM, Farrington, M, Anderson, L, Redpath, CK. GRASPing infection: a workload measurement tool for infection control nurses. J Hosp Infect 2001;49:215221.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed