Hospital support staff cuts raise risk of infection, delays in care

Editor's Note

Although health system layoffs so far involve mostly non-clinical staff, the cuts nonetheless threaten both hospital operations and patient safety, according to a May 21 article in Modern Healthcare.

As detailed in the article, thousands of nonclinical workers—such as those working in nutrition, janitorial, and sterile processing—have been laid off in recent months, with many hospitals targeting contract labor to reduce costs in anticipation of federal funding cuts. Specifically, the pressure stems from anticipated cuts to Medicaid and National Institutes of Health (NIH) funding as Congress weighs federal spending reductions.

Although providers are generally shielding physicians, nurses, and other bedside clinicians from layoffs, experts cited in the article point out these support staff cuts directly impact critical functions that sustain clinical care. For example, Stephanie Mercado, CEO of the National Association of Healthcare Quality, cautioned that removing environmental service and food staff can degrade quality and safety. Likewise, University of Washington health economist Bianca Frogner emphasized that delays in cleaning, food delivery, or equipment processing can compromise both care efficiency and patient outcomes.

The article notes that while hospitals are reluctant to reduce clinical staff due to shortages and training costs, a narrow definition of bedside care overlooks the frontline contributions of support workers. Jill Ryan, quality executive at UNC Health Blue Ridge, argued that environmental services workers can influence patient outcomes as directly as nurses or physicians. Cuts to these roles could increase hospital-acquired infections and slow patient throughput, especially in emergency departments.

As an example of where support staff can be instrumental, the article highlights the response to a recent measles outbreak at Covenant Health in Texas. Environmental service managers reportedly coordinated cleaning protocols around airborne isolation guidelines, while facilities managers adjusted patient flow and created negative pressure rooms. Without them, said Covenant CMO Dr. Lara Johnson, the system’s outbreak response “would come to a screeching halt.”

Another source quoted in the article, Rebecca Crapanzano-Sigafoos, executive director of the Center for Research, Practice and Innovation at the Association for Professionals in Infection Control and Epidemiology, added that sterile processing and cleaning staff are essential for infection prevention—an area already facing staffing challenges. She warned that any Medicaid spending reductions could further strain this capacity.

Financially, providers are attempting to delay or avoid job cuts by renegotiating vendor contracts. Mark Pascaris, senior director at Fitch Ratings, told Modern Healthcare that hospitals may try bringing outsourced staff in-house or shifting support service models to preserve headcount. Still, he warned that no strategy is off the table as health systems fight to maintain financial margins amid mounting economic pressure.