You can feel intuitively that these phenomena must be linked:
- If a hospital has more patients, its staff will be more stressed;
- If they are more stressed, they may neglect handwashing and other infection-control measures;
- If budget shortfalls cause staff cuts, the remaining staff will be more stressed still;
- If infection control is neglected, more patients will acquire MRSA;
- Since MRSA patients are sicker and stay longer, more beds will be full;
- Since there are more patients, staff will be more stressed;
- Since MRSA patients are more costly, budgets will be more stressed.
The citation is: Clements, A. et al. Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission. The Lancet Infectious Diseases 2008; 8:427-434.
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