Widely known as nosocomial infections, hospital-acquired infections are diseases that patients acquire due to infections during their hospital stays when receiving healthcare services. These conditions include iatrogenic complications, healthcare-associated infections, and other adverse situations that occur during treatment for other health problems (Wolters Kluwer Health, 2015). Many people in health care facilities suffer from these diseases. According to Cimiotti et al. (2012), the Centers for Disease Control and Prevention asserts that around 1.7 million hospitalized patients acquire these infections every year when undergoing treatment for other conditions, with more than 98,000 of them dying as a result of the nosocomial illnesses. Patients admitted when staffing shortages are looming is the most vulnerable to acquiring these infections. Potera (2012) also explains that the prevalence of nosocomial infections when there is an increased level of burnout among healthcare providers happens because the patients receive substandard care. The level of staffing varies depending on the time of the week with high levels of staffing occurring during weekdays as compared to the weekends. There have been variations in the trends of hospital-acquired infections among patients admitted during weekdays and weekends. This review of literature seeks to answer the question: why is the level of hospital-acquired infections among patients admitted during weekends is higher as compared to the patients admitted during weekdays?
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Prevalence of Hospital Acquired Infections among Patients and the Weekend Factor
Scholars have found a high prevalence rate of the occurrence of hospital-acquired infections during weekends as compared to weekdays. Attenello et al. (2015) conducted a research study to determine the prevalence rates of hospital-acquired infections among patients admitted during weekends and weekdays, as well as the factors that cause the disparities in the occurrence of this condition between the two groups of patients. The study analyzed 351 million hospital admissions in the United States between 2002 and 2010, 19% of which were admitted during weekends, a sample that is big enough to make generalizing remarks of the findings (Attenello et al., 2015). Out of the sample, 4.8% of the hospital admissions during this time had at least one infection acquired from the hospital, which translates to 16.7 million inpatient stays. These rates in the prevalence rates of nosocomial infections are congruent with other research findings. For instance, Phu et al. (2016) found that in the United States and Europe hospital-acquired infection prevalence rates are 4.5% and 7.1%, and these numbers are far higher in developing economies (15.5%) than in the developed ones. Such figures show that the menace of these infections is a threat to any patient seeking healthcare services since the acquisition of these complications worsens the treatment outcomes.
The results from the study of Attenello et al. revealed a significant difference in the prevalence of these infections, which indicates that patients admitted during weekends are more likely to acquire nosocomial infections than their colleagues admitted during weekdays. Do the results show that 14?269?706 admissions (4.1%) had at least one nosocomial infection, with about 81% of them being inpatient admissions that occurred during the weekends, while 19% were admitted on weekdays (Attenello et al., 2015). Although many patients were admitted during weekdays, the frequency of hospital-acquired infections was higher for those admitted on weekends (5.7%) than their colleagues admitted on weekdays (3.7%) (Attenello et al., 2015). The results are similar to what Barba et al. (2012) found among chronic obstructive pulmonary disease patients. In their cases, weekend hospital admissions resulted in higher mortality rates (12.9%) as compared to the weekday admissions (12.1%). Hospital-acquired complications are the primary cause of the variations in the prevalence rates.
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The prevalence of nosocomial infections in weekend and weekday hospital admissions vary depending on the type of complications. Falls are the most common complications that account for most of the hospital-acquired infections [85%] followed by catheter-associated infections and pressure ulcers (Attenello et al., 2015). Such a thing reveals that hospital falls are a significant occurrence during weekends. The study conducted by Attenello et al. (2015) further revealed that weekend admissions were associated with more than a 21% increase in the probability of incurring hospital-acquired infections even after adjusting for the hospital, patient, and severity of admission characteristics. Barba et al. (2012) reiterate that weekend admission is a major risk factor for nosocomial infections even when other variables are under control. This occurrence indicates that the weekend factor plays a crucial role in determining the prevalence rates of nosocomial infections in hospital admissions.
Reasons for Increased Nosocomial Infections on Weekends
The major cause of the high prevalence rates of hospital-acquired infections among patients admitted on weekends revolves around the inadequacy of healthcare providers to cater for the large numbers of patients compared to the situation during weekdays. Staff volume that includes nurses, physicians, and ancillary staff, as well as the medical expertise, is reduced during weekends since most of the healthcare providers take days off to relax, leaving only a few of their colleagues on the job (Attenello et al., 2015). Although the number of staff may reduce, hospital admissions over the weekend remain the same, which means that the workload over weekends is higher for the available workers that for those who work on weekdays. Reduced staffing of care professionals results in the delivery of low-quality healthcare services and many disease complications.
Inadequate staffing is associated with high prevalence rates of hospital-related complications that include nosocomial infections. Increased workload due to insufficient staffing during weekends increases mortality rates among admitted patients because of the increased development of hospital infections and other preventable complications (Van den Heede et al., 2009; Lucero, Lake, & Aiken, 2010). When the staffing levels increase, the rate of these complications reduces, resulting in low levels of morbidity and mortality. Such findings are similar to the assertions of Aiken et al. (2013). They reiterate that once health care professionals face acute shortages of staff, they start rationing care due to the increased workloads, something that erodes the quality of care. Such a thing leads to insufficient priority for patient safety.
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As a result of increased workloads and healthcare provider shortages during weekends, burnout increases among the professionals, which reduces their attention to patients. Reduced staffing levels over weekends compel professionals to limit their attention to every patient from admission to discharge on weekend shifts (Attenello et al., 2015). Furthermore, burnout increases over the weekends due to the increased workload, which further enhances the risks of developing hospital-acquired infections. An increase in workload by one patient for every nurse results in one nosocomial infection per 1,000 patients (Wolters Kluwer Health, 2015). Having many nurses on a weekend shift worsens the state of hospital-related health complications among patients. According to Wolters Kluwer Health (2015), increasing the number of nurses with high levels of burnout by 10% adds two surgical site infections and one catheter-associated urinary tract infection for every 1,000 patients. Due to the increased burnout, related to increased workload for weekend shift providers of care, the risk of hospital-acquired infections increases.
Other factors increase the risk of acquiring nosocomial infections in patients admitted over weekends as compared to those admitted on weekdays. For instance, weekends are accompanied by reduced evidence-based practices among healthcare professionals. Evidence-based practice is associated with better treatment outcomes including low medication errors, nosocomial infections, and increased patient safety, all of which reduce morbidity and mortality rates (Chang, Jones, & Russell, 2013). For instance, due to the increased burnout and workload among nurses and other care professionals, asepsis may not be upheld while providing care, since many professionals may fail to wash their hands when moving from one patient to the other, increasing the transmission of infections among patients. Findings have shown reduced handwashing practices among professionals who face acute shortages of staff and increased workload alongside other practices that increase the likelihood of developing hospital-related complications among patients (Cimiotti et al., 2012). Such a thing is a huge challenge during weekends.
Inadequate resources to advance patient care and the tendency of professionals to cover the duties of others are also more common over weekends than during weekdays, all of which are associated with high levels of hospital-acquired infections. In their study, Attenello et al. (2015) found that it is common for medical staff to provide weekend coverage for their colleagues even if they are less familiar with chronic and acute conditions of patients requiring admission. Such a thing increases the risk of infections because these staff members may be lacking the knowledge to prevent nosocomial infections in addition to having an increased workload. Moreover, the allocation of resources towards operative and diagnostic testing interventions reduces during the weekends, something that exacerbates the occurrence of hospital complications (Attenello et al., 2015). Therefore, weekends pose many challenges that increase the probability of acquiring hospital complications that increase the prevalence of nosocomial infections.
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Hospital-acquired infections are more common among patients admitted on weekends as compared to weekdays due to many reasons. First, the weekends register high levels of healthcare provider shortages. As a result, the workload on the shift increases, resulting in high levels of burnout that reduces evidence-based practices. Increased workload and burnout reduce the attention the professionals give patients, as well as exacerbates problems like medication errors, patient falls, and septic performance of procedures. Additionally, weekend coverage for professional colleagues is high, with some of those who cover shifts for others lacking the necessary knowledge and experience to enhance patient safety and improve patient outcomes. Inadequate allocation of operative and diagnostic testing resources that are common during weekends also increases the prevalence of these infections among weekend admissions.