1. Wong, Bunny


Resources suffer when hospitals cut their budgets.


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Budget cuts are eating away at resources for infection control, according to a recent survey by the Association for Professionals in Infection Control and Epidemiology (APIC). Nearly half (41%) of respondents reported reductions in staffing, equipment, surveillance activities, overall budgets, and other resources for health care-associated infections, which cost $20 billion annually.

Figure. A nurse exit... - Click to enlarge in new windowFigure. A nurse exits a patient-isolation room at Mount Sinai Hospital in Toronto, Ontario, Canada. Photo (C) Nathan Denette / Canadian Press / Phototake. All rights reserved.

Posted online for a week in March, the survey drew responses from 1,943 APIC members. Education and training suffered in particular: three-quarters of those reporting downsizing in the past 18 months said their education funding had been slashed, and many cited decreases in training-related services. Cutbacks decreased surveillance for 24%, rounds for 42%, and immunizations for 10%. Overwork was another theme to emerge. "I am unable to keep up with the workload so I have to do it on my own time," wrote one respondent, perhaps one of the 59% with no clerical staffer in their department. And as staffs continue to shrink-39% reported layoffs and 35%, hiring freezes-duties are growing. Thirty states require hospitals to disclose infection rates publicly, and half of respondents said that generating mandated reports has reduced their departments' capacity to focus on infection prevention.


Although such laws bring much-needed attention to infection control (in February the government allotted $50 million of its economic stimulus money to addressing health care-associated infections), they also can mean more work. "It keeps you at the computer an inordinate amount of time," says Anne Marie Pettis, a nurse and director of infection prevention at the University of Rochester Medical Center in New York. "And studies have shown a direct correlation between the heaviness of nurses' workloads and infection rates." The irony is that increased infection rates raise costs-the very thing hospitals wish to avoid. One solution, according to the APIC, is to consider the big picture: "[P]revention costs pennies on the dollar compared to the cost of treating infections."


Pettis also worries about the recession's impact on funding for training. "Cutting education is a dangerous trend," she says. "It's easy to become outdated if you're not sent to offsite education programs." Although she hasn't seen other clinical outcomes affected by her hospital's cutbacks, she guesses that "a trickle-down effect" will likely occur. In the short term, though, she advises nurses to stay current by talking to one another. "It behooves us all to be more effective in networking," she says, "whether it be with infection preventionists, skin care experts, or people in other specialty areas. These cutbacks affect all of us." To read the survey results, go to


Bunny Wong