Background Critically ill patients are susceptible to health care-associated infections because of their illnesses and the need for intravenous access and invasive monitoring. survey data. Nurses assessed AS-605240 the critical care work environment and provided the frequencies of ventilator-associated pneumonias urinary tract infections and infections associated with central catheters. Logistic regression models were used to determine if critical care work environments were predictive of nurse-reported frequent health care-associated infections with controls for nurse and hospital characteristics. Results The final sample consisted of 3217 critical care nurses in 320 hospitals. Compared with nurses working in poor work environments nurses working in better work environments were 36% to 41% less likely to report that health care-associated infections occurred frequently. Conclusion Health care-associated infections are less likely in favorable critical care work environments. These findings based on the largest sample of critical care nurses to date substantiate efforts to focus on the quality of the work environment as a way to minimize the frequency of health care-associated infections. Health care-associated infections (HAIs) are one of the most common complications of care.1 HAIs are of particular concern in critically ill patients; according to estimates almost half a million incidents of HAI occur each year in intensive care units (ICUs) alone.2 Increased susceptibility to HAIs in ICU patients is attributable in part to precarious clinical conditions 3 depressed immune function 4 and the need for invasive monitoring to ensure appropriate provision of care. The Centers for Disease Control and Prevention has made specific recommendations to aid in AS-605240 the prevention of central catheter-associated bloodstream infections (catheter-associated BSIs) urinary tract infections (UTIs) and ventilator-associated pneumonias (VAPs).5 The recommendations focus on specific actions to be implemented by staff members including hand hygiene aseptic insertion of catheters and placing patients in a semirecumbent position during intubation.5 As the largest group of ICU clinicians who provide direct patient care critical care nurses are well positioned to implement the recommendations and monitor patients for HAIs. Development of HAIs in acute care areas has been linked to organizational factors such as nurse staffing.6 7 In addition to staffing a quality work environment-another organizational component of hospital nursing care-presumably provides critical care nurses the time and resources necessary to bK268H5 provide HAI preventive care. Evidence on the relationship between nurse organization particularly the work environment and HAIs in critical care units is limited. The work environment is defined as the organizational characteristics of the workplace that facilitate or constrain professional nursing practice.8 Researchers have suggested that providing nurses with better resources and more time for patient care within a flat organizational management structure might improve the patient-nurse interaction and quality of care. Indeed the American Association of Critical-Care Nurses9 has endorsed the importance of a healthy work environment and the potential link between the environment and patient safety. In 2 descriptive studies 10 11 members of the association were surveyed on their perceptions of the workplace and the AS-605240 quality and safety of patient care. Approximately 86% of respondents reported that their unit AS-605240 provided excellent or good-quality care but one quarter of these nurses indicated that the quality of care in their units during the past year had become worse.10 Almost half a million health care-associated infections occur each year in intensive care units. Inconsistencies noted in critical care nurses’ reports of quality and safety are also reflected in the ICU literature. Better communication between ICU nurses and physicians has been linked to fewer nurse-reported medication errors and greater job satisfaction.12 13 Greater variation in effective communication among providers in ICUs was associated with greater rates of VAP.14 Additionally scores on the composite Practice Environment Scale of the Nursing Work Index (PES-NWI) a commonly used measure of nurses’ work environment was not predictive of nurse-assessed VAP and catheter-associated sepsis.12 However a more positive organizational.