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

39 Pages Posted: 2 Mar 2016 Last revised: 17 May 2017

See all articles by Adam Seth Litwin

Adam Seth Litwin

Cornell University

Ariel C. Avgar

University of Illinois at Urbana-Champaign, School of Labor & Employment Relations and College of Medicine

Edmund R. Becker

Emory University - Rollins School of Public Health

Date Written: February 24, 2016

Abstract

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

Keywords: outsourcing, externalization, employment arrangements, employment relations, labor relations, industrial relations, healthcare, hospitals, infections, healthcare-associated infections (HAIs), hospital-acquired infections (HAIs), Clostridium difficile (C. diff.)

Suggested Citation

Litwin, Adam Seth and Avgar, Ariel C. and Becker, Edmund R., Superbugs vs. Outsourced Cleaners: Employment Arrangements and the Spread of Healthcare-Associated Infections (February 24, 2016). Industrial and Labor Relations Review 70(3): 610-641, 2016. Available at SSRN: https://ssrn.com/abstract=2738770

Adam Seth Litwin (Contact Author)

Cornell University ( email )

ILR School
363 Ives Hall
Ithaca, NY 14853-3901
United States
(607) 255-7326 (Phone)

Ariel C. Avgar

University of Illinois at Urbana-Champaign, School of Labor & Employment Relations and College of Medicine

504 East Armory Avenue
Champaign, IL 61820-6297
United States

Edmund R. Becker

Emory University - Rollins School of Public Health ( email )

1518 Clifton Road NE
Suite 630
Atlanta, GA 30322
United States
404-727-9969 (Phone)

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