title: Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections.
abstract: To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates.
  
  
  
  Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (<1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects.
  
  
  
  We found variable prevalence of burnout across the NICUs surveyed (mean 25.2±10.1%). Healthcare-associated infection rates were 8.3±5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28±11% vs 17±19% physicians), day shift workers (30±3% vs 25±4% night shift) and workers with 5 or more years of service (29±2% vs 16±6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r=-0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04-1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r=0.34).
  
  
  
  Burnout is most prevalent among non-physicians, daytime workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive.
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Tawfik
authors.affiliation: Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA.|Duke Patient Safety Center, Duke University Health System, Durham, NC, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Sexton
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.|California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Kan
authors.affiliation: California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.|Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA, USA.|Division of Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Sharek
authors.affiliation: California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.|Division of Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Nisbet
authors.affiliation: Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rigdon
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.|California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.
authors.forename: H C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.|California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Profit
mesh_terms: D002055:Burnout, Professional / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D000073577:Shift Work Schedule; D011795:Surveys and Questionnaires