title: Work hours, work stress, and collaboration among ward staff in relation to risk of hospital-associated infection among patients.
abstract: OBJECTIVE
  To examine the association between work hours, work stress, and collaboration among the ward personnel, and the risk of hospital-associated infection among patients.
  
  
  METHODS
  Cross-sectional data on hospital infections were collected between March and June 2004. These data were linked with ward-level responses to a personnel survey collected during the same time period.
  
  
  METHODS
  Medical records of patients in 60 non-psychiatric bed wards in 6 Finnish hospitals.
  
  
  METHODS
  One thousand ninety-two patients and 1159 staff survey responses.
  
  
  METHODS
  Prevalence surveillance was performed by 4 infection control nurses, using standard criteria. Data on several potential risk factors for infection were collected: sex, age, patient type (surgical vs. other), hospital type (university vs. regional hospital), unit type, number of patients in the ward, exposure to invasive devices, International Classification of Diseases version 10 diagnosis, chemotherapy, radiotherapy, and use of corticosteroids. Staff working conditions were measured by survey scales.
  
  
  RESULTS
  Ninety-nine cases (9.1%) of hospital-associated infection were found. Multilevel logistic regression analyses, adjusted for hospital factors and patient-related risk factors, showed that long work hours among staff were associated with increased risk of infection [odds ratio (OR) 2.74, 95% confidence interval (CI): 1.07-7.04]. Other staff-related correlates of infection were high work stress, as indicated by high imbalance between efforts and rewards (OR: 2.47; 95% CI: 1.38-4.42), low trust between work unit members (OR: 2.37; 95% CI: 1.27-4.43), injustice in the distribution of work (OR: 1.81; 95% CI: 1.04-3.16), and poor collaboration between ward supervisors (OR: 2.46; 95% CI: 1.38-4.38).
  
  
  CONCLUSIONS
  Long work hours, high work stress, and poor collaboration among the ward staff are associated with hospital-associated infection among patients.
authors.affiliation: Finnish Institute of Occupational Health, Work and Organizations, Helsinki, Finland. marianna.virtanen@ttl.fi
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Tiina
authors.initials: T
authors.lastname: Kurvinen
authors.forename: Kirsi
authors.initials: K
authors.lastname: Terho
authors.forename: Tuula
authors.initials: T
authors.lastname: Oksanen
authors.forename: Reijo
authors.initials: R
authors.lastname: Peltonen
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Marianne
authors.initials: M
authors.lastname: Routamaa
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002055:Burnout, Professional / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006757:Hospital Units / Q000145:classification / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D010348:Patient Care Team; D010561:Personnel Staffing and Scheduling; D010564:Personnel, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D018571:Sentinel Surveillance; D035502:Trust; D014940:Work Schedule Tolerance; D016526:Workload / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult