Superbugs vs.Outsourced Cleaners: Employment Arrangements and the Spread of Healthcare-Associated Infections

On any given day, about one in 25 hospital patients in the U.S. has a healthcare-associated<br>infection (HAI) that the patient contracts as a direct result of his or her treatment. Fortunately,<br>the spread of most HAIs can be halted through proper disinfection of surfaces and equipment.<br>Consequently, cleaners—“environmental services” (EVS) in hospital parlance—must take on the<br>important task of defending hospital patients (as well as employees and the broader community)<br>from the spread of HAIs. Nevertheless, despite the importance of this task, hospitals frequently<br>outsource this function, increasing the likelihood that these workers are under-rewarded,<br>undertrained, and detached from the organization and the rest of the care team. As a result, the<br>outsourcing of EVS workers could have the unintended consequence of increasing the incidence<br>of HAIs. We demonstrate this relationship empirically, finding support for our theory by using<br>a self-constructed dataset that marries infection data to structural, organizational, and workforce<br>features of California’s general acute care hospitals. The study thus advances the literature on<br>nonstandard work arrangements—outsourcing, in particular—while sounding a cautionary note<br>to hospital administrators and healthcare policymakers.