title: The role of nurse understaffing in nosocomial viral gastrointestinal infections on a general pediatrics ward.
abstract: OBJECTIVE
  To examine the relationship between nurse staffing levels and the rate of nosocomial viral gastrointestinal infections (NVGIs) in a general pediatrics population.
  
  
  METHODS
  Retrospective descriptive study.
  
  
  METHODS
  A general pediatrics ward at The Hospital for Sick Children in Toronto, Ontario, Canada, a 320-bed, tertiary-care pediatric institution.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Nurse understaffing contributed to an increased NVGI rate in our general pediatrics population, and should be assessed as a risk factor in outbreak investigations.
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Jacob
authors.initials: J
authors.lastname: Stegenga
authors.forename: Erica
authors.initials: E
authors.lastname: Bell
authors.forename: Anne
authors.initials: A
authors.lastname: Matlow
mesh_terms: D002648:Child; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D004196:Disease Outbreaks / Q000517:prevention & control; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006757:Hospital Units; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D009864:Ontario / Q000453:epidemiology; D010372:Pediatrics; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D012307:Risk Factors; D014777:Virus Diseases / Q000453:epidemiology* / Q000635:transmission; D000078329:Workforce