Burned-out nurses linked to more infections in patients

Burned-out nurses linked to more infections in patients By JoNel Aleccia, NBC News July 30, 2012, 3:49 pm

NBCNews.com

Getty Images stock Adding extra patients to nurses' already heavy loads, or logging more nurses with high levels of burnout was tied to an increase in two kinds of hospital-acquired infections.

Heavy patient loads and chronic burnout have long been among the top complaints of nurses at the nation’s hospital bedsides. But a new study shows that those problems affect not only the nurses themselves, but also the number of infections in the people they care for.

For every extra patient added to a nurse’s workload, there was roughly one additional hospital-acquired infection logged per 1,000 patients, according to researchers from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

For each 10 percent jump in the proportion of nurses who logged high levels of burnout, there was roughly one additional catheter-associated urinary tract infection per 1,000 patients and almost extra two surgical site infections per 1,000 patients, according to a study published today in the American Journal of Infection Control.

“One infection is too many,” said Jeannie P. Cimiotti, the study’s lead author, who directs the Collaborating Center for Nursing at Rutgers University. “If you’re really serious about infection control and providing the best care for patients, you have to address these issues.”

Cimiotti and her colleagues surveyed more than 7,000 registered nurses working in 161 hospitals in Pennsylvania, and then merged that with data on hospital infections from the Pennsylvania Health Care Cost Containment Council, or PCH4, and with national data on the characteristics of the nation’s hospitals.

What they found was alarming, Cimiotti said. More than a third of the nurses reported high levels of job-related burnout. That was measured by the Maslach Burnout Inventory, a recognized scale that tracks factors like emotional exhaustion, depersonalization and whether the nurses feel a sense of personal accomplishment. 

“Nurses deal with life and death every day,” Cimiotti said, explaining why burnout occurs. “How many people go to their job and say, ‘This one died and this one died and this one died?’ Often they see as much failure as they see good.”

The nurses cared for an average of 5.7 patients apiece, and when even one extra patient was added to that load, the result was an additional 1,351 infections within the hospital population studied.

That could mean additional risk of serious illness or death for patients who catch those infections while in the hospital, Cimiotti said. For people with cancer or other conditions that compromise immune system function, even a low-level bladder infection or a common infection in a surgical wound can tip them into far more serious illness.

“They’re associated with morbidity and mortality, no doubt about it,” Cimiotti said. “A bloodstream infection can kill someone.”

This study is important because it is among scant research to factor in the impact of burnout, she added. When nurses are chronically stressed and feel unsupported by the work environment, it can lead to lapses in infection control practices.

“If a patient is moaning for help over here and you’re changing the dressing over there, maybe you touch something in the sterile field,” Cimiotti said.

At the same time, the study found that reducing burnout cuts infections – and saves money.

Reducing reports of burnout by 30 percent cut urinary tract infections by more than 4,000 and surgical site infections by more than 2,200, saving between $28 million and $69 million per year in estimated costs to treat those infections.

This certainly isn’t the first time that UPenn nursing researchers have found that staffing levels have had direct effects on patient health. A 2002 study found that adding a single patient to a nurse’s caseload increased the risk of dying within a week by 7 percent. Boosting the load from six patients to eight increased the risk by 31 percent over a nurse caring for four patients.

And a 2010 study found that patient deaths would drop by 14 percent in New Jersey and 14 percent in Pennsylvania if those states adopted California’s hard-won mandated nurse-to-patient ratios of 1 to 5 in surgical units. That study was led by Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, who also collaborated on the current study.

Though it may appear very sympathetic to the nursing profession, the controlled study was conducted by experts known for the reliability of their work, said Cheryl Peterson, director of nursing practice and policy for the American Association of Nurses.

“This study does confirm what most of us have been saying within nursing,” Peterson said. “There is a direct link between staffing, the number of nurses providing patient care, and patient outcomes. What we would add is the work environment … that can have an impact on burnout.”

The issue of nurse-to-patient ratios is hotly debated in the U.S., where no one appears to track nationwide staffing averages. Neither the ANA nor the American Hospital Association keep such statistics, staff members say. Nursing patient loads can vary from as low as one nurse for every one or two patients in intensive care units to far higher than the 1:5 ratio mandated in surgical units in California.

“I don’t have the evidence, but I would believe, yes, some workloads are definitely higher than that,” Cimiotti said.

Some hospitals in the U.S. have worked hard to address those issues.  Nearly 400 of the nation’s 5,754 registered hospitals have achieved so-called “Magnet” status, which recognizes health care organizations that achieve structural and clinical practices that empower nurses and lead to good patient results.

But it will take more, the experts agree.

“Now that we see that burnout is playing a role in this relationship, we have to look at more than just the staffing,” said Cimiotti. “We have to look at the system, the organizational structure where the nurses provide care.”

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Sierra Leone at the 2012 Summer Olympic Games

Ola Isata Sesay Flying the Sierra Leone Flag

Earlier today, at exactly 2226 GMT Sierra Leone's track and field star Ola Isata Sesay entered the Olympic Stadium leading a two man team in the 2012 parade, proudly bearing the flag of Sierra Leone. Smiling, waving, and appearing a model of Sierra Leone beauty, she made the Sierra Leoneans in the crowd go wild with euphoria and pure unadulterated joy.

Sierra Leone was only able to send two athletes to the 2012 summer Olympic games in East London, in spite of the fact that US Athletic sensations Jeneba Tarmoh and Ibrahim Kabia (Juice) and many other popular athletes in the USA are all descended from the diamond rich West African country.

Ibrahim Turay

Sierra Leone is being represented at the 2012 East London Summer Olympic games by 200 meter sprinter Ibrahim Turay and long jumper Ola Isata Sesay. Both athletes were accommodated by the British town of Hastings in respect of the twinning arrangement between the town and the Freetown suburb of Hastings in Sierra Leone.

Sierra Leone has never won a medal in the Olympic games and though a two man team is a long shot, we will keep on praying and keep our eyes on the pride of our nation.

Ola Smiling at the crowd

Hindolo Sumanguru Trye Dies in Sierra Leone.

Hindolo Sumanguru Trye

Breaking news reaching the Segbwema blog from Sierra Leone is that the former student activist, NPRC minister and current Sierra Leone Minister of Labour and Employment, Mr.Hindolo Sumanguru Trye died  this morning in a hospital in the Sierra Leone capital Freetown.

This is breaking news and the Segbwema blog correspondent will continue to follow the story. It can be recalled that Hindolo Trye  was a major thorn in the flesh of the Siaka Stevens led APC government of the late seventies when he was a student leader at Fourah Bay College, University of Sierra Leone.

Hindolo Trye lived in exile in America during the late 70s to the 90s and returned home to Sierra Leone to give intellectual support and political legitimacy to the NPRC coup of 1992 that chased then president Joseph Saidu Momoh into exile and obscurity. Addressing a group of student at the Fourah Bay College amphitheater just some days after the NPRC coup in 1992, Hindolo Trye vowed that they would rather burn the capital Freetown and flatten it to the ground than have APC in power again. 

Hindolo Trye

As both a minister in the NPRC government and the current APC, Hindolo has kept a low key profile over the years that was a far cry from his firebrand rhetoric of his student years. Of late the minister has been looking pale and gaunt for someone his age and there have been stories of his declining health.

The Segbwema blog joins his family and the people of Sierra Leone to mourn his loss.

Sierra Leone's Attitudinal Embarrassment

International Master of Disguise

The Vice President of Sierra Leone Sam Sumana, who was last year  caught on camera soliciting bribes by investigative journalists from the Arab satellite news network Al Jazeera in a sting operation that caused considerable embarrassment for the country, has again become embroiled in another international scandal and it seems that this time round he has done it to the wrong person. Sam Sumana stands accused of defrauding hundreds of thousands of dollars from Minneapolis/Saint Paul business magnate Dave Kloeber, a young self made American Millionaire, doing so through misrepresentations and false business practices.

Dave Nash Kloeber Jr.

David Nash Kloeber Jr, is the founder and president of DNK Management Inc. in Saint Paul, which is coincidentally the city of residence of the Segbwema Blogger. DNK management is a holding company that owns and manages many companies in USA, including thrifts stores, two golf courses and JetChoice LLC, a private airline company that sells blocks of time on a fleet of Falcon jets.

Dave Kloeber manages over 45 corporations around the world with annual revenues of close to two hundred million dollars. Those Sierra Leoneans living in Minnesota would know of the Unique Thrifts Stores where most new immigrants go to buy valuable second hand items. The unique thrift stores are some of the businesses run by Dave Kloeber

Dave Donating Hundred Thousand to Philanthropy

Dave Kloeber is a self made man. He still remembers 1972 when he was just 11 years old and already working on collection trucks for a thrift business in Denver. His family was poor. He used to wake up at 5.30 am in the cold morning and walk two miles to the store to offload trucks. He did not regard his family that time as poor, because everybody in the neighborhood where he grew up was poor and as long as they had food, they were happy. Those days he was willing to do anything to make money. His father was a retail worker who moved around the country working with struggling retail businesses and though Dave was born in California, before he graduated from High school he had lived in Missouri, Colorado, Texas and Arizona. He had a very independent streak while growing up and in the last year of high school, he lived in his car because his mother told him that as long as he was in his house he had to abide by her rules.

When Dave was in high school he used to work 60 to 70 hours a week doing various chores to make ends meet. At various times he worked in a meat market, worked on cars, and loaded thrift trucks, and worked hard enough to buy his own car while still in high school.

After graduating fron high school, Dave went to work for the family owned thrift store chain that hired him when he was just 11 years old instead of going to college. He worked 16 hours a day from Monday to Saturday, leaving no time for fun or leisure. He travelled all around the country from one business outlet to the other, troubleshooting problems.Dave was so focused, devoted and hardworking that the owner of the thrift store chain decided to give him a management contract for a store in Minneapolis, Minnesota in 1984. By 1988 he had saved enough money to open his own thrift store in St. Louis Missouri and as they say, the rest is history. Slowly and steadily Dave Kloeber kept adding store after store to his business until he became a major retail entrepreneur in USA. Today, Dave is one of the youngest self  made millionaires in Minnesota who has a love for helping hardworking poor people with big dreams.  Which is exactly how he met Sierra Leones current Vice President Sam Sumana in the early 2000s. Sam  was then a parking lot attendant in Minnesota with big dreams of going back to his fatherland and investing in the exploitation of the country's diamonds.

Giving to the Needy

Dave is incredibly accessible for a millionaire. After the war in Sierra Leone he happened to befriend a young African park attendant called Sam Sumana. Sam told Dave about the poverty and diamonds in Sierra Leone and told the businessman that his dream was to go back to Sierra Leone and start a business with the intention of helping the local people. Given the suffering in Sierra Leone at the time Dave,  was reminded of his own humble days and seeing this as a legitimate business opportunity, he decided to help Sam Sumana realize his dreams as it would be a worthwhile venture, but more importantly it would be a business that would provide sustenance to the poor, which has always been the focus of most of Dave's businesses.

Dave decided that he would not just give small money to Sam Sumana to go and buy diamonds and bring to sell, but he would invest in heavy machinery and set up an African Mining company that would help employ the locals. He invested $740,000.00 in heavy equipment and gave $300,00.00 in used clothing as a loan to the company for Sam to sell to finance the day to day operations of the business. This was a loan that was expected to be paid back. Sam had graduated from Metro State University with a degree in business management and Dave had been convinced that he had the acumen and will power to run the business. Mark Heiligman who had introduced Sam to the businessman was the point man to coordinate the activities of the diamond business as Dave was too busy with his other businesses to get intimately involved in the Sierra Leone operation. So the United Diamond Mining Company with headquarters in Minneapolis Minnesota was born, in good faith, by hardworking businessmen from humble origins willing to help a fellow human help his people out of destitution and poverty. Sam Sumana's race or color did not matter to the businessman who has spent hundreds of thousands of his money over the years in direct help to poor communities in USA. Little did they know that Sam Sumana was not what they expected him to be, but a mere crook with big dreams.

Dave Giving One Hundred Thousand to Poor Communities

When Sam was settled in Sierra Leone, he suddenly ceased communications with his Minneapolis partners who had already invested so much in his dreams. When they contacted his wife who was Working as a nursing assistant at St. Therese, a nursing home in New Hope Minneapolis, she told the businessmen that her husband was also not communicating with her and she did not know what had become of him. The business men were sympathetic and even began helping the family. Sometime passed and it was heard that Sam Sumana was leasing the equipment for road construction. It was at the time that he called again and asked for more funds for daily operation. They responded by sending the used clothes to sell, making it explicit to him that it was a loan to the company. The clothes were valued at 300 thousand dollars. Sam Sumana again ceased communications until news went around that he was now the vice presidential candidate for opposition APC party in Sierra leone. He had apparently used the money to buy the Vice Presidential slot,as the then  APC pilitical party was highly strapped for cash in 2007. 

When the 2007 elections went into a runoff Sam Sumana once again turned to his cash cows seeking a loan for 34000 dollars for the APC. The investors reluctantly agreed as they could see the potential of the position for their business if their man became vice president, but had already lost hope in him. When the money got to Freetown, Ernest Koroma or someone claiming to be him called the businessmen, thanking them profusely. 

However Sam Sumana's new position did not in anyway help the businessmen get back their monies, as he was now very hard to get. A former  parking lot attendant who was now an important "big man". Around 2010, the businessmen attempted to contact EBK directly threatening to reveal the VPs thieving ways, causing Sam Sumana to write them a check for twenty thousand dollars, end of story. All honest attempts to get the money have been futile and the businessmen have decided to use their considerable influence in US to make the world a miserable place for Sam Sumana. There are currently plans in motion to seek redress through the US legal system. If Sam Sumana does not pay, the plan is to have him arrested like a common criminal anytime he sets foot in America. Plans are also in the works to publicize the VPs criminal tendencies to the international investment community, which will be a big blow to a nation so baly in need of foreign investment to resuscitate the struggling economy. A website is being set up to expose the Vice President of Sierra Leone as a petty crook.

The Envy of Nigerian 419ers VP Sam Sumana

Sam's only indirect response to these allegations is to once again call on his stooge Sylvia Blyden to go on social media and insult Mark Heiligman, calling him "Mark The Clown", just as she destroyed or attempted to destroy the reputation of Sorious Samura of Al Jazeera.  Dave Koeler states that he is an honest businessman who got his money through hard work, personal sacrifice and dedication. He is not ready to have anybody play him for a clown or a fool. He invested in Sierra Leone as a honest business decision, not because he was a fool. He is determined that Sam Sumana will pay hell if he thinks that a vice presidential position in Sierra Leone will somehow allow him to defraud him and go scot free.

Sam Sumana's embarrassing criminal tendency is once again a substantial blow to a government that has been embroiled in one scandal after another since they gained power in 2007. From involvement in the West African cocaine trade, to illegal logging, bribery and now downright thieving, the attitudinal change mantra and rebranding effort of the government is proving to be mere window dressing, a juvenile political farce of monumental proportions.

The only advice that will be good for the Freetown criminal cabal is to easily pay the money and hope that this terrible breaking news just goes away with time. Sam Sumana's activities have always been questionable. From buying an expensive home in America barely months after coming to the presidency to the Aljazeera scandal to the current one, the Vice president is not only a liability to his APC party, but a deep embarrassment to all of us Sierra Lonens who have to refer to him as our vice president. If Joseph Saidu Momoh were alive today, he would love Sam Sumana, as the current vice president's legacy of a master of international intrigue is now extending beyond state borders, a feat that even Momoh was never able to achieve.

A new website is about to be launched by the businessmen to educate the world about the crimes of Sam Sumana. It can be accessed at http://justiceforsierraleone.us/

Ghanian President's Sudden Demise

John Atta Mills died on Tuesday at a military hospital, according to Information Minister Fritz Baffour. He was 68.

A statement from President's office said: "It is with a heavy heart...that we announce the sudden and untimely death of the President of the Republic of Ghana."

Chief of Staff of the Presidency Henry Martey Newman said that the 68-year-old President died at 37 Military Hospital in Accra after being rushed there when his health deteriorated.

Newman gave no details about the cause of Atta Mills' death.

Mills, 68, was inaugurated in January 2009. He returned home on June 25 from the US where he had undergone gone a medical check-up.

Mills ran three times for president before being elected in the closest vote in the country's history on a platform vowing to reform the West African country.

Information Minister Baffour also declined to elaborate. "Yes, I can confirm (his death), but I can't say more," he said.

The President celebrated his 68th birthday on Saturday. Atta Mills was elected in a 2008 runoff vote and was to run for a second term in December. He campaigned on a platform of change, arguing that the western African country's growth had not been felt in people's wallets.

Atta Mills even put up posters of himself standing next to a photoshopped cutout of US President Barack Obama in an effort to emphasise that the Ghanaian stood for change.

The 2008 election was the third time that Atta Mills had run for president.

He spent much of his career teaching at the University of Ghana. He earned a doctorate from London's School of Oriental and African Studies before becoming a Fulbright scholar at Stanford University in Palo Alto, California.

Don't Humiliate This Man Any further

Have Mercy!

Ex-Ambassador John Leigh has been very active in his retirement; well at least on Facebook. As Chairman of the SLPP wing of the APC, John Leigh has had a hard time convincing some APC folks that he is genuinely interested in their party and has not just joined them because of anger at his defeat for the SLPP flagbearership by Julius Maada Bio, his rejection as a potential running mate, his search for a job to replenish his repleted retirement savings and simple political opportunism.

Of all the other members of the SLPP wing of the APC, John Leigh has been the most vocal in condemning SLPP because he was particularly nasty in his condemnation of APC when he still maintained the fantasy of leading the main opposition SLPP. John Leigh then accused APC of being rapists, morons, charlatans, traitors and murderers and the SLPP opposition has the tapes and forum records to prove it. So the only way Pa Leigh is going to convince APC folks that he is genuine is to become twice as abusive to the SLPP as he was to the APC, hoping that the more he insults SLPP and Maada Bio on the Internet, the greater will be his chances of acceptance. He has encountered a classic traitors dilemma. How do you trust a betrayer? At your own peril!

Ernest Leigh's self appointed status as the premier Judas of Sierra Leone politics reveals a political naivety that is seldom found in a politician who claims to have so much experience. In the first place there have been many defectors before him who have gone over to other parties and still managed to maintain their sanity. J. B. Dauda and others defected with some element of political maturity. Even Judas Iscariot did not go about publicly hugging the Pharisees and dancing on the streets of Jerusalem when he betrayed Jesus, but John Leigh never learnt the art and principles of defection and he is trying so hard to convince APC folks of his loyalty, that it has become painful to watch. Now we learn that he has been looking for a job, some sort of appointment, but has been told to wait until the elections are over. John Leigh's current dilemma? If APC loses the next elections he is screwed, if they somehow manage to scrape a victory, his future is uncertain, as he has yet to hand over all the SLPP files in his position they are asking for, in order to complete his betrayal.

Don't Do This To Pa Leigh

There are rumors circulating around Freetown that some APC folks intend to tell Ernest Koroma that because of all the nasty things John Leigh has said about him in the past, he should have him crawl on the floor of his office at State House, begging for forgiveness before he can even be made Ambassador of Uzbekistan, a country where the staple meat is a daily ration of camel. I plead with President Ernest Koroma not to humiliate this man further. When a man has sold his loyalty and come begging to you, please do not kick him in the rear.

Heart Attack is no Joke

There are many reasons why John Leigh should not be made to crawl on his stomach. The man may pretend to be young, but he is an old man, with weak muscles. Even  though crawling may seem easy when children are doing, it is a very difficult thing for old men to do, so please spare him this sweat. If any old man does not believe what i am saying just try it in the privacy of your living room.

John Leigh may also be suffering from some heart ailment. For a man who has spent so much money on a quixotic mission to become SLPP flagbearer, John Leigh has endured many heartbreaks and heartache. His heart may not be healthy as it once was. What about if he suddenly gets a heart attack right on his stomach on a carpet in State House? Sierra Leone has already lost a deputy Parliamentary speaker to heart attack, God bless his soul. Do we want another heart attack in such a short a time? So please APC do not make ambassador Leigh crawl on his stomach for a job. Show some mercy

As we all age, our bowels age. When you are young, your bowel is regular like clockwork. You eat, the food digests, you go to the toilet, easy, no drama. For those of us who are growing old, we love some of that regularity...the hazards of aging. Old men like me go through an irregular bowel cycle of constipation and diarrhea. So to adk an old man to crawl on his stomach while decked out in a suit and a red tie is not a biologically sound thing to do. What about if he is on his diarrhea phase of his bowel cycle, won't it just create more work for the already underpaid cleaning staff at State House? Please APC, have mercy on this poor man.

President Koroma, if you want to help this man do so. Do not listen to all the people around you who want to see him sweat. He is frustrated, confused, disappointed and needs help. Don't kick him in the rear.

Encouraging The Vote: Sierra Leone Style

Lungi Airport

Thousands of Sierra Leoneans in the diaspora who are still enthralled at the fact of democracy in their native country traveled last year to the country to register in order to vote in the forthcoming 2012 Presidential and Legislative elections. Those who were unable to register to vote are planning to go to the country in their thousands to help their respective campaigns and parties turn out the vote and make the election a festive affair, as was the case under President Ahmed Tejan Kabbah,  rather than one characterized by violence and strife, as has been promised by Interior Minister Tarawallie.

The All People's Congress led government of President Ernest Bai Koroma has decided to encourage diaspora participation in the election by imposing a new $24.00 security fee at the airport. No individual, regardless of what passport you hold, will be able to get on any plane out of Sierra Leone without the payment of the twenty four dollars. It has to be in dollars, the Leone equivalency is a no no. It is a fee for security in Sierra Leone, but sorry, no Leones accepted. Don't you just love APC?

Do not forget to keep 24

Walk from Conakry to Freetown

A friend of mine who traveled from Freetown at the weekend was angry at this sudden charge, but there was nothing he could do about it. When he questioned the payment, he was simply told it was security fees. Now this is what it truly means to run a country like a business. True businessmen do not go about explaining their prices, they just impose them and if you want, you can buy if you don't its up to you. Same as the new 24 dollar fee; pay if you go to Sierra Leone. If you do not want to pay it, try walking by road from Conakry to Freetown and maybe next time you will change your mind.

APC's Gravy Train

A positive news from Sierra Leone is that the proposed lump sum contribution demanded by the secretary to the president's cabinet and head of the civil service S. G. Pessima as a forced financial contribution to the president for the death of his mother, has been rejected by the family, after some grumbling by civil servants that bereavement contributions should be an act of goodwill, not a directive from government. Though the country is being run like a business, there was no business sense in making money from this kind of sad event, when people were genuinely grieving with the president over the loss of his dear mother. Government moved swiftly to put the breaks on this unholy affair.

Thorpe Laughing all the way to the Bank

Another positive news is that the All Peoples Congress has just decided to motivate Electoral Commissioner Christiana Thorpe to do her job well by giving her a salary of 30 million Leones, with benefits. This makes the happy hardworking woman one of the highest paid electoral commissioners in the world, in a country where a lecturer with two PhDs is paid chicken change and the average employee goes for months on end without a single month's salary. Given the acute shortage of money in the banks that is forcing APC councillors to engage in highway robbery, one can only wonder what the true motive for this astronomical increase is in an election year. But as I do not begrudge anybody making an honest living, I congratulate Sister Thorpe on her salary increase and hope that it motivates her to conduct free and fair elections, especially in my home district Kailahun, as I say this is the Segbwema Blog and Segbwema is in Kailahun

Is Sierra Leone develping another Robert Mugabe?

APC's role model?