The Role of Understaffing in Central Venous Catheter-Associated Bloodstream Infection
Роль недостаточной укомплектованности персоналом в развитии инфекций кровотока, связанных с центральным венозным катетером
1996-03-01
SCID: 54.1/hdbnydhy
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central venous catheter-associated bloodstream infectionpatient-to-nurse ratiosurgical intensive care unittotal parenteral nutritionunderstaffing
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Abstract (AI)
OBJECTIVE: To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak. DESIGN: Case-control and cohort studies of surgical intensive care unit (SICU) patients. SETTING: A university-affiliated Veterans Affairs medical center. PATIENTS: Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993). MEASUREMENTS: CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio. RESULTS: When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence interval, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the outbreak period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients. CONCLUSIONS: Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (i.e., nosocomial infection) needs to be critically assessed.
Key Findings
1
After adjustment for TPN, CVC-BSI remained associated with increasing illness severity and longer duration of assisted ventilation.
2
Central venous catheter-associated bloodstream infections increased significantly in the surgical intensive care unit during the outbreak period, unlike other hospital locations.
3
Nursing staff reductions below a critical level may have impaired adequate catheter care, particularly during increased TPN use, contributing to the outbreak.
4
The SICU patient-to-nurse ratio increased significantly during the outbreak and independently predicted CVC-BSI after controlling for TPN, assisted ventilation, and hospitalization period.
5
The findings indicate that staffing reductions during healthcare restructuring may adversely affect patient outcomes through increased nosocomial infection risk.
6
Total parenteral nutrition was strongly associated with CVC-BSI among SICU patients (odds ratio, 16; 95% confidence interval, 4 to 73).
Research Object
Central venous catheter-associated bloodstream infections in surgical intensive care unit patients during a prolonged outbreak
Research Subject
Risk factors and the contribution of patient-to-nurse understaffing to CVC-BSI incidence, particularly in relation to total parenteral nutrition, illness severity, and assisted ventilation
Author Information
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