Specialty nursing certifications linked to lower HAI rates

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Alexandra Pecci Wilson, for HealthLeaders Media, February 21, 2012

The challenges to infection control are great. Whether a patient develops a hospital acquired infection depends on a number of variables, not least of all adherence to safety protocols and checklists.

But did you know that new research shows that certain nursing certifications are associated with lower rates of HAI?

The research, presented last month at the American Nurses Association's Nursing Quality Conference, used data from ANA's National Database for Nursing Quality Indicators (NDNQI) to determine the relationships between HAI and nurse workforce characteristics on adult critical care units. More than one-third of the nation's hospitals participate in NDNQI, an ANA program that's administered by the University of Kansas School of Nursing.

Researchers investigated three HAIs: central line-associated blood stream infections (CLABSI); catheter-associated urinary tract infections (CAUTI); and ventilator-associated pneumonia (VAP).

Two of the study's main findings don't seem all that surprising. First, it found that higher levels of RN hours per patient day (staffing ratios) were associated with lower CAUTI and CLABSI rates. It also found that VAP rates were high in units that had higher percentages of agency RNs—that is, temporary, non-hospital employees.

But the correlation between certifications and HAI is more of a surprise, according to NDNQI program specialist Pam Hinshaw MSN, RN, CCM.

"I think it will be striking to nurse leaders out there in the world," she tells HealthLeaders. "It's not just about numbers."

The research found that critical care units with higher percentages of RNs holding national specialty certifications had lower CLABSI and CAUTI rates. Specifically, Critical Care Registered Nurse certification was associated with lower rates of CAUTI, and Cardiac Surgical Certification was associated with lower rates of CLABSI.

According to Hinshaw, the study findings should encourage nurse leaders to "think outside the box" when it comes to staffing. For example, they might want to find out how many nurses on their unit are CCRN certified and work hard to retain them. They should also consider whether nurses have certifications when they do their hiring.

Nurse leaders may also consider pushing for funding in their budgets to get nurses certified. According to Hinshaw, getting certified not only takes hard work to achieve, but also some legwork on the nurse's part to figure out how to actually do it.

In fact, one nurse leader I talked with for a different column said many of her nurses were unsure about what they wanted to become certified in and often unaware of how to become certified in the first place. Therefore increasing education about professional certifications—how and where to get them—as well as funding for them, might be beneficial for nurse leaders.

"Consider those other things that are happening on the nursing unit and how they're affecting your patient outcomes," Hinshaw says. "It may behoove them to at least consider this."

Although the new NDNQI analysis didn't delve into why certifications are associated with lower rates of HAI, Hinshaw has a few theories.

"There is a tremendous amount of further education that happens when you do certifications, and the once you complete the certification, the learning never really ends," she says, alluding certification renewal requirements.

Hinshaw also points to what she calls "the whole professionalism aspect. The more knowledgeable you are about your practice, obviously that translates into better outcomes," she says.

Also, when nurses have professional certifications, they have a sense of pride, which Hinshaw correlates with ownership and accountability.

"I think they're all linked together," she says. "You have that pride in your certification, so therefore, you're going to be accountable to the outcome."

For Hinshaw, the certification finding is "validating;" she says she knew instinctively that certifications were important, but now research shows one of the reasons why.

"It emphasizes the need to have RNs at the bedside, it emphasizes the importance of having them there," she says. "That's affirming to me."

Source: HealthLeaders Media