Hey Hey, My My - Nurse burnout associated with HAI?

There is an interesting new paper out in this month's AJIC getting some press.  The authors completed an ecological study using a 2006 survey of nurses working in Pennsylvania hospitals to a 2006 PA hospital report on HAIs and AHA hospital characteristic data. Burnout was defined using a validated survey instrument for exhaustion and anyone over the "norm" (median/mean?) was considered burned out. When they put both nurse-patient staffing ratios and "burnout" into linear regression models they found that burnout was associated with higher rates of both healthcare associated UTIs and surgical site infections.

This is a fun paper, as it's important to keep thinking about ways we can structurally prevent HAIs.  Just a few caveats. I would only report the model that included either nurse staffing or burnout since I suspect they're colinear and shouldn't be included in the same model (ie avoid Model #3).  Another concern is that this is an ecological study; there is no way to show that specific nurses with higher reported "burnout" actually took care of patients with higher infection rates; the truth could actually be the opposite of what was reported.  A better study would link individual nurses to individual patients.  Still, all nurses deserve a good masseuse - can't you see they're burned out!