Impact of Exposures and Outbreaks on Staff Nurse and Infection Preventionist Workload

BACKGROUND Staff nurse and infection preventionist (IP) workload increases in response to exposures and outbreaks. The additional time required to manage these situations may differ by pathogen and role in patient care. Understanding the time burden associated with responding to specific pathogens may improve resource allocation. The purpose of this study was to evaluate workload increases reported by nurses and IPs in response to common exposures and outbreaks. METHODS Anonymous, voluntary surveys were distributed to nurses from eight units in a New York hospital network and IPs who attended the 2018 Association for Professionals in Infection Control and Epidemiology (APIC) annual conference or are members of New York/New Jersey APIC chapters. Respondents were asked to (1) rate daily workload increase as <30, 30-60, or >60 minutes in response to five exposure (lice/scabies, mumps/measles, pertussis, tuberculosis, influenza) and outbreak scenarios (methicillin-resistant Staphylococcus aureus, other multidrug-resistant organisms, non-influenza respiratory viruses, Clostridium difficile, gastrointestinal viruses), and (2) rank most time consuming activities during exposure/outbreak responses. RESULTS One hundred fifty nurses and 228 IPs responded. Among nurses, >60 minute workload increases were most commonly reported for C. difficile (76%), lice/scabies (46%), and influenza (45%). Among IPs, >60 minute increases were most commonly reported for mumps/measles (66%), tuberculosis (64%), and C. difficile (50%). Among nurses, isolation precautions, patient/family education, and staffing changes were the most frequently reported time consuming activities. Among IPs, these were chart review, exposure list compiling, and preventive measures for exposures. CONCLUSIONS Organisms that are easier to treat and more difficult to spread such as scabies/lice can contribute substantially to nursing workload. Despite requiring less care at the bedside, pathogens with airborne transmission are most time consuming for IPs. Notably, three quarters of nurses and half of IPs reported that C. difficile adds >1 hour to their daily workload. Staff nurse and infection preventionist (IP) workload increases in response to exposures and outbreaks. The additional time required to manage these situations may differ by pathogen and role in patient care. Understanding the time burden associated with responding to specific pathogens may improve resource allocation. The purpose of this study was to evaluate workload increases reported by nurses and IPs in response to common exposures and outbreaks. Anonymous, voluntary surveys were distributed to nurses from eight units in a New York hospital network and IPs who attended the 2018 Association for Professionals in Infection Control and Epidemiology (APIC) annual conference or are members of New York/New Jersey APIC chapters. Respondents were asked to (1) rate daily workload increase as <30, 30-60, or >60 minutes in response to five exposure (lice/scabies, mumps/measles, pertussis, tuberculosis, influenza) and outbreak scenarios (methicillin-resistant Staphylococcus aureus, other multidrug-resistant organisms, non-influenza respiratory viruses, Clostridium difficile, gastrointestinal viruses), and (2) rank most time consuming activities during exposure/outbreak responses. One hundred fifty nurses and 228 IPs responded. Among nurses, >60 minute workload increases were most commonly reported for C. difficile (76%), lice/scabies (46%), and influenza (45%). Among IPs, >60 minute increases were most commonly reported for mumps/measles (66%), tuberculosis (64%), and C. difficile (50%). Among nurses, isolation precautions, patient/family education, and staffing changes were the most frequently reported time consuming activities. Among IPs, these were chart review, exposure list compiling, and preventive measures for exposures. Organisms that are easier to treat and more difficult to spread such as scabies/lice can contribute substantially to nursing workload. Despite requiring less care at the bedside, pathogens with airborne transmission are most time consuming for IPs. Notably, three quarters of nurses and half of IPs reported that C. difficile adds >1 hour to their daily workload.