Nurse–patient ratios and infection control practices: A cross-sectional study

Background: Substantial research evidence supports the link between nurse staffing and patient outcomes. Low nurse staffing and high workloads have been linked to poor hand hygiene, ineffective equipment cleaning, and incorrect use of personal protective equipment (PPE), with potential outcomes of intravenous cannula infections, wound infections, urinary tract infections, and pneumonia. Research is limited regarding the impact of staffing models on specific infection control practices (ICP) such as wound dressing, oral hygiene, or patient education. Aim: To describe nurses’ perceptions of the impact of nurse–patient ratios on ICP. Methods: A cross-sectional survey using a questionnaire with items drawn from pertinent research was distributed via QR code. Data were collected from 51 nurses on 12 units in a large tertiary referral hospital where a minimum 1:4 patient ratio had been recently introduced. Analysis was comparative and descriptive. Findings: Most participants were female registered nurses with less than 10 years’ experience in nursing. More than half had experienced a 1:4 ratio on their most recent shift. Nurses in this group indicated that they could complete infection control care in a timely manner, were more likely to provide infection control-related patient education, and had more time to communicate with the treating team about infection control matters. Hand hygiene and the use of PPE were not associated with the 1:4 staffing model. Discussion: ICP included patient education, effective communication, and support appears to be strengthened by ratio staffing. These actions, together with more timely completion of activities such as oral hygiene and wound dressings, may significantly impact hospital-acquired infections and enhance patient safety. Conclusion: ICP may be strengthened by staffing consistent with the 1:4 ratio framework. This suggests that ratio-based staffing can have an early and important impact on practice. Findings regarding foundational practices, teamwork, and team support warrant further investigation.