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Fanelli C, Pistidda L, Terragni P, Pasero D. Infection Prevention and Control Strategies According to the Type of Multidrug-Resistant Bacteria and Candida auris in Intensive Care Units: A Pragmatic Resume including Pathogens R 0 and a Cost-Effectiveness Analysis. Antibiotics (Basel) 2024; 13:789. [PMID: 39200090 PMCID: PMC11351734 DOI: 10.3390/antibiotics13080789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024] Open
Abstract
Multidrug-resistant organism (MDRO) outbreaks have been steadily increasing in intensive care units (ICUs). Still, healthcare institutions and workers (HCWs) have not reached unanimity on how and when to implement infection prevention and control (IPC) strategies. We aimed to provide a pragmatic physician practice-oriented resume of strategies towards different MDRO outbreaks in ICUs. We performed a narrative review on IPC in ICUs, investigating patient-to-staff ratios; education, isolation, decolonization, screening, and hygiene practices; outbreak reporting; cost-effectiveness; reproduction numbers (R0); and future perspectives. The most effective IPC strategy remains unknown. Most studies focus on a specific pathogen or disease, making the clinician lose sight of the big picture. IPC strategies have proven their cost-effectiveness regardless of typology, country, and pathogen. A standardized, universal, pragmatic protocol for HCW education should be elaborated. Likewise, the elaboration of a rapid outbreak recognition tool (i.e., an easy-to-use mathematical model) would improve early diagnosis and prevent spreading. Further studies are needed to express views in favor or against MDRO decolonization. New promising strategies are emerging and need to be tested in the field. The lack of IPC strategy application has made and still makes ICUs major MDRO reservoirs in the community. In a not-too-distant future, genetic engineering and phage therapies could represent a plot twist in MDRO IPC strategies.
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Affiliation(s)
- Chiara Fanelli
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (L.P.); (P.T.)
| | - Laura Pistidda
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (L.P.); (P.T.)
| | - Pierpaolo Terragni
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (L.P.); (P.T.)
- Head of Intensive Care Unit, University Hospital of Sassari, 07100 Sassari, Italy
| | - Daniela Pasero
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (L.P.); (P.T.)
- Head of Intensive Care Unit, Civil Hospital of Alghero, 07041 Alghero, Italy
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Ehsan A, Ehsan F, Hanif H. Infection control practices in public sector hospitals of Punjab: a critical analysis. BMJ Open Qual 2024; 13:e002380. [PMID: 38719521 PMCID: PMC11086194 DOI: 10.1136/bmjoq-2023-002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/29/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) is imperative towards patient safety and health. The Infection Prevention and Control Assessment Framework (IPCAF) developed by WHO provides a baseline assessment at the acute healthcare facility level. This study aimed to assess the existing IPC level of selected public sector hospital facilities in Punjab to explore their strengths and deficits. METHODS Between October and April 2023, 11 public sector hospitals (including tertiary, secondary and primary level care) were selected. Data were collected using the IPCAF assessment tool comprising eight sections, which were then categorised into four distinct IPC levels- inadequate, basic, intermediate and advanced. Key performance metrics were summarised within and between hospitals. RESULTS The overall median IPCAF score for the public sector hospitals was 532.5 (IQR: 292.5-690) out of 800. Four hospitals each scored 'advanced' as well as 'basic' IPC level and three hospitals fell into 'intermediate level'. Most hospitals had IPC guidelines as well as IPC programme, environments, materials and equipments. Although 90% of secondary care hospitals had IPC education and training, only 2 out of 5 (40%) tertiary care and 2 out of 3 (67%) primary care hospitals have IPC or additional experts for training. Only 1 out of 5 tertiary care hospitals (20%) were recorded in an agreed ratio of healthcare workers to patients while 2 out of 5 (40%) of these hospitals lack staffing need assessment. CONCLUSION Overall the sampled public sector (tertiary, secondary and primary) hospitals demonstrated satisfactory IPC level. Challenging areas are the healthcare-associated infection surveillance, monitoring/audit and staffing, bed occupancy overall in all the three categories of hospitals. Periodic training and assessment can facilitate improvement in public sector systems.
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Affiliation(s)
| | - Fatima Ehsan
- Physiology, Riphah International University, Islamabad, Pakistan
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Harun MGD, Anwar MMU, Sumon SA, Hassan MZ, Haque T, Mah-E-Muneer S, Rahman A, Abdullah SAHM, Islam MS, Styczynski AR, Kaydos-Daniels SC. Infection prevention and control in tertiary care hospitals of Bangladesh: results from WHO infection prevention and control assessment framework (IPCAF). Antimicrob Resist Infect Control 2022; 11:125. [PMID: 36203207 PMCID: PMC9535892 DOI: 10.1186/s13756-022-01161-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) in healthcare settings is imperative for the safety of patients as well as healthcare providers. To measure current IPC activities, resources, and gaps at the facility level, WHO has developed the Infection Prevention and Control Assessment Framework (IPCAF). This study aimed to assess the existing IPC level of selected tertiary care hospitals in Bangladesh during the COVID-19 pandemic using IPCAF to explore their strengths and deficits. METHODS Between September and December 2020, we assessed 11 tertiary-care hospitals across Bangladesh. We collected the information from IPC focal person and/or hospital administrator from each hospital using the IPCAF assessment tool.. The score was calculated based on eight core components and was used to categorize the hospitals into four distinct IPC levels- Inadequate, Basic, Intermediate, and Advanced. Key performance metrics were summarized within and between hospitals. RESULTS The overall median IPCAF score was 355.0 (IQR: 252.5-397.5) out of 800. The majority (73%) of hospitals scored as 'Basic' IPC level, while only 18% of hospitals were categorized as 'Intermediate'. Most hospitals had IPC guidelines as well as environments, materials and equipments. Although 64% of hospitals had IPC orientation and training program for new employees, only 30% of hospitals had regular IPC training program for the staff. None of the hospitals had an IPC surveillance system with standard surveillance case definitions to track HAIs. Around 90% of hospitals did not have an active IPC monitoring and audit system. Half of the hospitals had inadequate staffing considering the workload. Bed occupancy of one patient per bed in all units was found in 55% of hospitals. About 73% of hospitals had functional hand hygiene stations, but sufficient toilets were available in only 37% of hospitals. CONCLUSION The majority of sampled tertiary care hospitals demonstrate inadequate IPC level to ensure the safety of healthcare workers, patients, and visitors. Quality improvement programs and feedback mechanisms should be implemented to strengthen all IPC core components, particularly IPC surveillance, monitoring, education, and training, to improve healthcare safety and resilience.
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Affiliation(s)
- Md Golam Dostogir Harun
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
| | - Md Mahabub Ul Anwar
- Centers for Disease Control and Prevention (CDC), Bangladesh Country Office, Dhaka, Bangladesh
| | - Shariful Amin Sumon
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Tahmidul Haque
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Syeda Mah-E-Muneer
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Aninda Rahman
- Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | | | - Md Saiful Islam
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- University of New South Wales, Sydney, Australia
| | - Ashley R Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, 94305, USA
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Bonsignore M, Hohenstein S, Kodde C, Leiner J, Schwegmann K, Bollmann A, Möller R, Kuhlen R, Nachtigall I. Burden of Hospital-acquired SARS-CoV-2 Infections in Germany. J Hosp Infect 2022; 129:82-88. [PMID: 35995339 PMCID: PMC9391075 DOI: 10.1016/j.jhin.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
Background Avoiding in-hospital transmissions has been crucial in the COVID-19 pandemic. Little is known on the extent to which hospital-acquired SARS-CoV-2 variants have caused infections in Germany. Aim To analyse the occurrence and the outcomes of HAI with regard to different SARS-CoV-2 variants. Methods Patients with SARS-CoV-2 infections hospitalized between March 1st, 2020 and May 17th, 2022 in 79 hospitals of the Helios Group were included. Information on patients' characteristics and outcomes were retrieved from claims data. In accordance with the Robert Koch Institute, infections were classified as hospital-acquired when tested positive >6 days after admission and if no information hinted at a different source. Findings In all, 62,875 SARS-CoV-2 patients were analysed, of whom 10.6% had HAI. HAIs represented 14.7% of SARS-CoV-2 inpatients during the Wildtype period, 3.5% during Alpha (odds ratio: 0.21; 95% confidence interval: 0.19–0.24), 8.8% during Delta (2.70; 2.35–3.09) and 10.1% during Omicron (1.10; 1.03–1.19). When age and comorbidities were accounted for, HAI had lower odds for death than community-acquired infections (0.802; 0.740–0.866). Compared to the Wildtype period, HAIs during Omicron were associated with lower odds for ICU (0.78; 0.69–0.88), ventilation (0.47; 0.39–0.56), and death (0.33; 0.28–0.40). Conclusion Hospital-acquired SARS-CoV-2 infections occurred throughout the pandemic, affecting highly vulnerable patients. Although transmissibility increased with newer variants, the proportion of HAIs decreased, indicating improved infection prevention and/or the effect of immunization. Furthermore, the Omicron period was associated with improved outcomes. However, the burden of hospital-acquired SARS-CoV-2 infections remains high.
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Affiliation(s)
- Marzia Bonsignore
- Department of Infectiology and Infection Prevention, Helios Klinikum Duisburg, Duisburg, Germany; Center for Clinical and Translational Research, Helios Universitätsklinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany.
| | - Sven Hohenstein
- Heart Centre Leipzig at University of Leipzig and Helios Health Institute, Berlin, Germany
| | - Cathrin Kodde
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany.
| | - Johannes Leiner
- Heart Centre Leipzig at University of Leipzig and Helios Health Institute, Berlin, Germany
| | - Karin Schwegmann
- Central Department for Hygiene, Helios Kliniken, Hildesheim, Germany
| | - Andreas Bollmann
- Heart Centre Leipzig at University of Leipzig and Helios Health Institute, Berlin, Germany
| | | | | | - Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, HELIOS Hospital Emil-von-Behring, Berlin, Germany; Charité - Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
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Boyd S, Sheng Loh K, Lynch J, Alrashed D, Muzzammil S, Marsh H, Masoud M, Bin Ihsan S, Martin-Loeches I. Elevated Rates of Ventilator-Associated Pneumonia and COVID-19 Associated Pulmonary Aspergillosis in Critically Ill Patients with SARS-CoV2 Infection in the Second Wave: A Retrospective Chart Review. Antibiotics (Basel) 2022; 11:antibiotics11050632. [PMID: 35625276 PMCID: PMC9138004 DOI: 10.3390/antibiotics11050632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 01/27/2023] Open
Abstract
Due to multiple risk factors, the rate of ventilator-associated pneumonia in critically ill COVID-19 patients has been reported in a range of 7.6% to 86%. The rate of invasive pulmonary aspergillosis in this cohort has been reported at 4% to 30%. We undertook a retrospective chart review of 276 patients who were admitted to intensive care in a large university hospital. The period studied included patients from 23 February 2014 to 12 May 2021. Four groups were collected: COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia. Clinical characteristics, outcomes, and microbiological cultures were recorded. The incidence of ventilator-associated pneumonia in COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia was 5.45%, 27.40%, 16.67%, and 3.41%, respectively (p < 0.001). The rate of invasive pulmonary aspergillosis was 0%, 9.59%, 13.33%, and 6.82%, respectively (p < 0.001). A significantly elevated rate of ventilator-associated pneumonia and invasive pulmonary aspergillosis was noted in the second wave of COVID-19 when compared to the first. This was accompanied by an increase in the mortality rate. Increased steroid use was an independent risk factor for ventilator-associated pneumonia and invasive pulmonary aspergillosis across all four groups. Despite an increased understanding of this disease, no clinical trials have shown any promising therapeutic options at present.
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Affiliation(s)
- Sean Boyd
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
- Correspondence:
| | - Kai Sheng Loh
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
| | - Jessie Lynch
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
| | - Dhari Alrashed
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
| | - Saad Muzzammil
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
| | - Hannah Marsh
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
| | - Mustafa Masoud
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
| | - Salman Bin Ihsan
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, D08 NHY1 Dublin, Ireland; (K.S.L.); (J.L.); (D.A.); (S.M.); (H.M.); (M.M.); (S.B.I.); (I.M.-L.)
- Trinity College Dublin, University of Dublin, DN02 PN40 Dublin, Ireland
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, 08036 Barcelona, Spain
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Boyd S, Nseir S, Rodriguez A, Martin-Loeches I. Ventilator-associated pneumonia in critically ill patients with COVID-19 infection, a narrative review. ERJ Open Res 2022; 8:00046-2022. [PMID: 35891621 PMCID: PMC9080287 DOI: 10.1183/23120541.00046-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/24/2022] [Indexed: 01/08/2023] Open
Abstract
COVID pneumonitis can cause patients to become critically ill. They may require intensive care and mechanical ventilation. Ventilator-associated pneumonia is a concern. This review aims to discuss the topic of ventilator-associated pneumonia in this group. Several reasons have been proposed to explain the elevated rates of VAP in critically ill COVID patients compared to non-COVID patients. Extrinsic factors include understaffing, lack of PPE and use of immunomodulating agents. Intrinsic factors include severe parenchymal damage, immune dysregulation, along with pulmonary vascular endothelial inflammation and thrombosis. The rate of VAP has been reported at 45.4%, with an ICU mortality rate of 42.7%. Multiple challenges to diagnosis exist. Other conditions such as acute respiratory distress syndrome, pulmonary oedema and atelectasis can present with similar features. Frequent growth of gram-negative bacteria has been shown in multiple studies, with particularly high rates of pseudomonas aeruginosa. The rate of invasive pulmonary aspergillosis has been reported at 4–30%. We would recommend the use of invasive techniques when possible. This will enable de-escalation of antibiotics as soon as possible, decreasing overuse. It is also important to keep other possible causes of ventilator-associated pneumonia in mind, such as COVID-19 associated pulmonary aspergillosis, cytomegalovirus, etc. Diagnostic tests such as galactomannan and B-D-glucan should be considered. These patients may face a long treatment course, with risk of re-infection, along with prolonged weaning, which carries its own long-term consequences.
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Fumagalli J, Panigada M, Klompas M, Berra L. Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients. Curr Opin Crit Care 2022; 28:74-82. [PMID: 34932525 PMCID: PMC8711306 DOI: 10.1097/mcc.0000000000000908] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW We conducted a systematic literature review to summarize the available evidence regarding the incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because of acute respiratory distress syndrome secondary to SARS-CoV-2 infection (C-ARDS). RECENT FINDINGS Sixteen studies (6484 patients) were identified. Bacterial coinfection was uncommon at baseline (<15%) but a high proportion of patients developed positive bacterial cultures thereafter leading to a VAP diagnosis (range 21-64%, weighted average 50%). Diagnostic criteria varied between studies but most signs of VAP have substantial overlap with the signs of C-ARDS making it difficult to differentiate between bacterial colonization versus superinfection. Most episodes of VAP were associated with Gram-negative bacteria. Occasional cases were also attributed to herpes virus reactivations and pulmonary aspergillosis. Potential factors driving high VAP incidence rates include immunoparalysis, prolonged ventilation, exposure to immunosuppressants, understaffing, lapses in prevention processes, and overdiagnosis. SUMMARY Covid-19 patients who require mechanical ventilation for ARDS have a high risk (>50%) of developing VAP, most commonly because of Gram-negative bacteria. Further work is needed to elucidate the disease-specific risk factors for VAP, strategies for prevention, and how best to differentiate between bacterial colonization versus superinfection.
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Affiliation(s)
- Jacopo Fumagalli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Panigada
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute
- Department of Medicine, Brigham and Women's Hospital
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA
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Rae PJL, Pearce S, Greaves PJ, Dall'Ora C, Griffiths P, Endacott R. Outcomes sensitive to critical care nurse staffing levels: A systematic review. Intensive Crit Care Nurs 2021; 67:103110. [PMID: 34247936 DOI: 10.1016/j.iccn.2021.103110] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/29/2021] [Accepted: 06/04/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine associations between variations in registered nurse staffing levels in adult critical care units and outcomes such as patient, nurse, organisational and family outcomes. METHODS We published and adhered to a protocol, stored in an open access repository and searched for quantitative studies written in the English language and held in CINAHL Plus, MEDLINE, PsycINFO, SCOPUS and NDLTD databases up to July 2020. Three authors independently extracted data and critically appraised papers meeting the inclusion criteria. Results are summarised in tables and discussed in terms of strength of internal validity. A detailed review of the two most commonly measured outcomes, patient mortality and nosocomial infection, is also presented. RESULTS Our search returned 7960 titles after duplicates were removed; 55 studies met the inclusion criteria. Studies with strong internal validity report significant associations between lower levels of critical care nurse staffing and increased odds of both patient mortality (1.24-3.50 times greater) and nosocomial infection (3.28-3.60 times greater), increased hospital costs, lower nurse-perceived quality of care and lower family satisfaction. Meta-analysis was not feasible because of the wide variation in how both staffing and outcomes were measured. CONCLUSIONS A large number of studies including several with high internal validity provide evidence that higher levels of critical care nurse staffing are beneficial to patients, staff and health services. However, inconsistent approaches to measurement and aggregation of staffing levels reported makes it hard to translate findings into recommendation for safe staffing in critical care.
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Affiliation(s)
- Pamela J L Rae
- School of Nursing & Midwifery, University of Plymouth, Plymouth PL4 8AA, UK. https://twitter.com/@DrPamelaJLRae
| | - Susie Pearce
- School of Nursing & Midwifery, University of Plymouth, Plymouth PL4 8AA, UK. https://twitter.com/@susiempearce
| | - P Jane Greaves
- School of Health and Life Sciences, University of Northumbria, Newcastle Upon Tyne, UK. https://twitter.com/@JaneGreaves4
| | - Chiara Dall'Ora
- School of Health Sciences, University of Southampton, UK. https://twitter.com/@ora_dall
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, UK. https://twitter.com/@workforcesoton
| | - Ruth Endacott
- School of Nursing & Midwifery, University of Plymouth, Plymouth PL4 8AA, UK; Royal Devon and Exeter Hospital, University of Plymouth Clinical School, Royal Devon and Exeter Hospital, Barrack Road Exeter EX2 5DW, UK; School of Nursing & Midwifery, Monash University, Melbourne, Vic 3199, Australia. https://twitter.com/@rdepu
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[S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version]. Med Klin Intensivmed Notfmed 2021; 115:37-109. [PMID: 32356041 DOI: 10.1007/s00063-020-00685-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Bae SH. Intensive care nurse staffing and nurse outcomes: A systematic review. Nurs Crit Care 2021; 26:457-466. [PMID: 33403791 DOI: 10.1111/nicc.12588] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/04/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intensive care units (ICU) are associated with significant work stress and exert continuous physical and emotional demand upon health care providers. The health and well-being of care providers, including ICU nurses, is a matter of great concern. However, to the researcher's knowledge, there have been no reviews synthesizing the evidence about the relationship between nurse staffing and nurse outcomes in the ICU. PURPOSE The purpose of this systematic review was to examine nurse staffing in the ICU and synthesize literature to examine the relationship with nurse outcomes such as job satisfaction, burnout, fatigue, and intent to leave. METHODS This review was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed articles published between January 2000 and September 2019 were identified via eight electronic bibliographic databases. Articles were included and reviewed if they were correlational studies examining the relationships between nurse staffing and nurse outcomes in the ICU, and were published in peer-reviewed journals written in either English or Korean. The Quality Assessment and Validity Tool for Correlation Studies was used for quality appraisal. RESULTS From 5086 articles, eight published between 2006 and 2019 were included in this review. Three studies found expected relationships between worse nurse staffing and adverse nurse outcomes (high burnout, fatigue state, emotional exhaustion, depersonalization, and stress). However, the relationships between nurse staffing and other adverse nurse outcomes were not significant. Perceived adequate staffing was negatively related to adverse nurse outcomes. However, a non-significant relationship also was found. CONCLUSION This study found limited evidence on relationships between nurse staffing and nurse outcomes in the ICU. More studies are needed to conduct to find a conclusive relationship. RELEVANCE TO CLINICAL PRACTICE Given high demands and workload in the ICU, nurse staffing levels should be closely monitored to prevent adverse nurse outcomes.
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Affiliation(s)
- Sung-Heui Bae
- College of Nursing, System Health & Engineering Major in Graduate School (BK21), Ewha Womans University, Seoul, South Korea
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11
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Garbey M, Joerger G, Furr S, Fikfak V. A model of workflow in the hospital during a pandemic to assist management. PLoS One 2020; 15:e0242183. [PMID: 33253323 PMCID: PMC7703995 DOI: 10.1371/journal.pone.0242183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/28/2020] [Indexed: 01/24/2023] Open
Abstract
We present a computational model of workflow in the hospital during a pandemic. The objective is to assist management in anticipating the load of each care unit, such as the ICU, or ordering supplies, such as personal protective equipment, but also to retrieve key parameters that measure the performance of the health system facing a new crisis. The model was fitted with good accuracy to France’s data set that gives information on hospitalized patients and is provided online by the French government. The goal of this work is both practical in offering hospital management a tool to deal with the present crisis of COVID-19 and offering a conceptual illustration of the benefit of computational science during a pandemic.
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Affiliation(s)
- Marc Garbey
- ORintelligence LLC, Houston, TX, United States of America
- LaSIE, UMR CNRS 7356, University of la Rochelle, La Rochelle, France
- * E-mail:
| | | | - Shannon Furr
- ORintelligence LLC, Houston, TX, United States of America
| | - Vid Fikfak
- Texas Health Sciences Center, Department of Surgery, University of Texas, El Paso, TX, United States of America
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Slekovec C, Robert J, Berthelot P, van der Mee-Marquet N, Rogues AM, Derouin V, Cholley P, Bertrand X, Gbaguidi-Haore H. Do contact precautions reduce the incidence of ICU-acquired Pseudomonas aeruginosa infections? The DPCPYO cluster-randomized crossover trial. Clin Infect Dis 2020; 73:e2781-e2788. [PMID: 33137174 DOI: 10.1093/cid/ciaa1663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Issue of contact precautions as contributory factors for reducing P. aeruginosa (Pa) infections in intensive care units (ICUs) remains questioned. We evaluated the impact of the addition of contact precautions to standard precautions for Pa-positive patients on the incidence of ICU-acquired Pa infections. METHODS In this multicenter cluster-randomized crossover trial, 10 French ICUs were randomly assigned (1:1) to sequence 0-1 (6-month control period [CP]/3-month washout period/6-month intervention period [IP]) or sequence 1-0 (6-month IP/3-month washout period/6-month CP). A surveillance screening program for Pa was implemented. Competing-risks regression models were built with death and discharge without the occurrence of ICU-acquired Pa infection (the primary outcome), as competing events. Models were adjusted for within-ICU correlation, patient- and ICU-level covariates. The Simpson diversity index (SDI) and the transmission index (TI) of Pa isolates were derived from pulsed-field gel electrophoresis typing. RESULTS Within recruited ICUs, the cumulative incidence and the incidence rate of ICU-acquired Pa infections were 3.38% (55/1625) vs 3.44% (57/1658) and 3.31 vs 3.52 per 1 000 patient-days at risk during CP and IP, respectively. Multivariable models indicated that the intervention did not significantly change the cumulative incidence (subdistribution hazard ratio 0.91, 95% confidence interval [CI] 0.49-1.67, p=0.76) and the rate (cause-specific hazard ratio 1.36, 95%CI 0.71-2.63, p=0.36) of the primary outcome. SDI and TI did not significantly differ between CP and IP. CONCLUSIONS The addition of contact precautions to standard precautions for Pa-positive patients with a surveillance screening program does not significantly reduce ICU-acquired Pa infections in non-outbreak situations.
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Affiliation(s)
- Céline Slekovec
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Jérôme Robert
- Centre d'Immunologie et des Maladies Infectieuses-Paris, Cimi-Paris, INSERM, Laboratoire de Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Sorbonne Université, Paris, France
| | - Philippe Berthelot
- Hygiène Hospitalière et Maladies Infectieuses, Centre Hospitalier Universitaire, Saint-Etienne, France
| | | | - Anne-Marie Rogues
- Hygiène Hospitalière, Centre Hospitalier Universitaire, INSERM U657, Université de Bordeaux, Bordeaux, France
| | - Véronique Derouin
- Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Paris Sud-Clamart, Le Kremlin-Bicêtre, France
| | - Pascal Cholley
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Xavier Bertrand
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Houssein Gbaguidi-Haore
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
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Lacotte Y, Årdal C, Ploy MC. Infection prevention and control research priorities: what do we need to combat healthcare-associated infections and antimicrobial resistance? Results of a narrative literature review and survey analysis. Antimicrob Resist Infect Control 2020; 9:142. [PMID: 32831153 PMCID: PMC7443818 DOI: 10.1186/s13756-020-00801-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infection prevention and control (IPC) is one of the most cost-effective interventions against antimicrobial resistance (AMR). Yet, IPC knowledge gaps often receive little prominence in AMR research agendas. In this article, we construct IPC research priorities, in order to draw attention to these critical research needs. METHODS We developed a 4-step framework to identify IPC knowledge gaps from literature (narrative review). These gaps were then translated into research priorities and sent to two groups of European IPC experts for validation and critique through an online survey. RESULTS Seventy-nine publications were retrieved from the literature review, identifying fifteen IPC research gaps. Forty-four IPC experts, clustered in two groups, vetted them. The experts classified all research gaps as medium or high priority. Overall agreement between both groups was average (Kendall's τ = 0.43), with strong alignment on the highest priorities: (i) the assessment of organizational, socio-economic, and behavioural barriers/facilitators for the implementation of IPC programmes, (ii) the impact of overcrowding on the spread of infections and (iii) the impact of infrastructural changes, at facility level, on the reduction of infections. Feedback from experts also identified an additional research gap on the interaction between the human and hospital microbiomes. CONCLUSIONS We formulated a list of sixteen research priorities and identified three urgent needs. Now, we encourage researchers, funding agencies, policymakers and relevant stakeholders to start addressing the identified gaps.
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Affiliation(s)
- Yohann Lacotte
- University of Limoges, INSERM, CHU Limoges, RESINFIT, U1092, F-87000, Limoges, France.
| | - Christine Årdal
- Antimicrobial Resistance Centre, Norwegian Institute of Public Health, Oslo, Norway
| | - Marie-Cécile Ploy
- University of Limoges, INSERM, CHU Limoges, RESINFIT, U1092, F-87000, Limoges, France
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Aghdassi SJS, Grisold A, Wechsler-Fördös A, Hansen S, Bischoff P, Behnke M, Gastmeier P. Evaluating infection prevention and control programs in Austrian acute care hospitals using the WHO Infection Prevention and Control Assessment Framework. Antimicrob Resist Infect Control 2020; 9:92. [PMID: 32571434 PMCID: PMC7309981 DOI: 10.1186/s13756-020-00761-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background Infection prevention and control (IPC) is crucial for patient safety. The World Health Organization (WHO) has released various tools to promote IPC. In 2018, the WHO released the Infection Prevention and Control Assessment Framework (IPCAF) that enables acute care healthcare facilities to evaluate IPC structures and practices. Data regarding IPC implementation in Austria are scarce. To deliver insights into this topic and promote the IPCAF within the Austrian IPC community, we decided to invite all Austrian hospitals participating in the German nosocomial infection surveillance system to conduct a self-assessment using the WHO IPCAF. Methods The IPCAF follows the eight WHO core components of IPC. A German translation of the IPCAF was sent to 127 Austrian acute care hospitals. The survey period was from October to December 2018. Participation in the survey, data entry and transfer to the German national reference center for surveillance of healthcare-associated infections was on a voluntary basis. Results Altogether, 65 Austrian hospitals provided a complete dataset. The overall median IPCAF score of all hospitals was 620 (of a possible maximum score of 800), which corresponded to an advanced level of IPC. Of the 65 hospitals, 38 achieved an advanced IPC level. Deeper analysis of the different core components yielded diverse results. Scores were lowest for core components on multimodal strategies for implementation of IPC interventions, and IPC education and training. Around 26% (n = 17) of hospitals reported that the local IPC team was not steadily supported by an IPC committee. Senior clinical staff was not present in the IPC committee in 23% (n = 15) of hospitals. Only 26% (n = 17) of hospitals reported employing at least one IPC professional per ≤250 beds. Surveillance for multidrug-resistant pathogens was not conducted in 26% (n = 17) of hospitals. Conclusions Implementation of IPC key aspects is generally at a high level in Austria. However, potentials for improvement were demonstrated, most prominently with regard to staffing, IPC education and training, effective implementation of multimodal strategies, and involvement of professional groups. Our survey demonstrated that the IPCAF is a useful tool for IPC self-assessment and can uncover deficits even in a high-income setting like Austria.
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Affiliation(s)
- Seven Johannes Sam Aghdassi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany. .,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - Andrea Grisold
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University, Graz, Austria.,Austrian Society of Hygiene, Microbiology and Preventive Medicine, Vienna, Austria
| | | | - Sonja Hansen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Peter Bischoff
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Michael Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Petra Gastmeier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
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15
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Zuazua-Rico D, Mosteiro-Diaz MP, Maestro-Gonzalez A, Fernandez-Garrido J. Nursing Workload, Knowledge about Pain, and Their Relation to Pain Records. Pain Manag Nurs 2020; 21:510-515. [PMID: 32362473 DOI: 10.1016/j.pmn.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the relationship between frequency of pain assessment and nursing workload, and also to analyze the frequency of pain assessment and its relation to knowledge and attitudes toward pain on nursing professionals in intensive care unit. METHODS An ambispective study was conducted in a Spanish tertiary-level intensive care unit between October 2017 and April 2018. For measurement of workload, the Nursing Activities Score scale was used, and for measurement of pain knowledge, the Knowledge and Attitudes Survey Regarding Pain was used. RESULTS There were 1,207 measurements among 41 nurses and 1,838 among 317 patients. The average nursing workload was high (70.97 points). We found statistically significant positive association between nursing workload and the frequency of assessment (p < .001), as well as frequency of assessment and patients with communicative capacity (p = .008). CONCLUSIONS Nursing workload affects the registration and assessment of patients' pain, resulting in a greater number of records as the workload performed by nurses increases. It is necessary to study in greater depth how the severity of pain, gender of the patients, and workload of nurses influence pain registration and assessment.
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Affiliation(s)
- David Zuazua-Rico
- Medicine Department, Nursing Area, University Of Oviedo, Oviedo, Spain
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Mynaříková E, Jarošová D, Janíková E, Plevová I, Polanská A, Zeleníková R. Occurrence of hospital-acquired infections in relation to missed nursing care: a literature review. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2020. [DOI: 10.15452/cejnm.2020.11.0007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Intensive care unit occupancy and premature discharge rates: A cohort study assessing the reporting of quality indicators. J Crit Care 2019; 55:100-107. [PMID: 31715526 DOI: 10.1016/j.jcrc.2019.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE ICU occupancy fluctuates. High levels may disadvantage patients. Currently, occupancy is benchmarked annually which may inaccurately reflect strained units. Outcomes potentially sensitive to occupancy include premature (early) ICU discharge and non-clinical transfer (NCT). This study assesses the association between daily occupancy and these outcomes, and evaluates benchmarking care across Scotland using daily occupancy. MATERIALS AND METHODS Population: all Scottish ICU patients, 2006-2014. EXPOSURE bed occupancy per unit-day; Outcomes: proportion of early discharges and NCTs. DESIGN Retrospective cohort study. Outcome rates were calculated above various occupancy thresholds. Polynomial regression visualised associations, and inflection points between occupancy and outcomes. Spearman's rho correlations between occupancy measures and outcomes were reported. RESULTS 65,472 discharges occurred over 57,812 unit-days. 1954(3.0%) discharges were early; 429 (0.7%) were NCTs. Early discharge rates above 70%, 80% and 90% occupancy were 3.9%, 5.0% and 7.5% respectively. Occupancies at which outcome rates greatly increased were near 80% for early discharge, and 90% for NCT. Mean annual occupancy was not correlated with outcomes; annual proportion of days ≥90% occupancy correlated most strongly (early discharge rho = 0.46,p < .001; NCT rho = 0.31, p < .001). CONCLUSIONS We demonstrate a clear association between daily ICU occupancy and early discharge/NCT. Daily occupancy may better benchmark care quality than mean annual occupancy.
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Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:608-626. [PMID: 29671025 DOI: 10.1007/s00103-018-2718-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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Aghdassi SJS, Hansen S, Bischoff P, Behnke M, Gastmeier P. A national survey on the implementation of key infection prevention and control structures in German hospitals: results from 736 hospitals conducting the WHO Infection Prevention and Control Assessment Framework (IPCAF). Antimicrob Resist Infect Control 2019; 8:73. [PMID: 31080588 PMCID: PMC6505265 DOI: 10.1186/s13756-019-0532-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background Healthcare-associated infections (HAI) pose a burden on healthcare providers worldwide. To prevent HAI and strengthen infection prevention and control (IPC) structures, the WHO has developed a variety of tools and guidelines. Recently, the WHO released the Infection Prevention and Control Assessment Framework (IPCAF), a questionnaire-like tool designed for assessing IPC structures at the facility level. The IPCAF reflects the eight WHO core components of IPC. Data on the implementation of IPC measures in German hospitals are scarce. Therefore, it was our objective to utilize the IPCAF in order to gather information on the current state of IPC implementation in German hospitals, as well as to promote the IPCAF to a broad audience. Methods The National Reference Center for Surveillance of Nosocomial Infections (NRZ) sent a translated version of the IPCAF to 1472 acute care hospitals in Germany. Data entry and transfer to the NRZ was done electronically between October and December 2018. The IPCAF was conceived in a way that depending on the selected answers a score was calculated, with 0 being the lowest possible and 800 the highest possible score. Depending on the overall score, the IPCAF allocated hospitals to four different “IPC levels”: inadequate, basic, intermediate, and advanced. Results A total of 736 hospitals provided a complete dataset and were included in the data analysis. The overall median score of all hospitals was 690, which corresponded to an advanced level of IPC. Only three hospitals (0.4%) fell into the category “basic”, with 111 hospitals (15.1%) being “intermediate” and 622 hospitals (84.5%) being “advanced”. In no case was the category “inadequate” allocated. More profound differences were found between the respective core components. Components on multimodal strategies and workload, staffing, ward design and bed occupancy revealed the lowest scores. Conclusions IPC key aspects in general are well established in Germany. Potentials for improvement were identified particularly with regard to workload and staffing. Insufficient implementation of multimodal strategies was found to be another relevant deficit. Our survey represents a successful attempt at promoting the IPCAF and encouraging hospitals to utilize WHO tools for self-assessment. Electronic supplementary material The online version of this article (10.1186/s13756-019-0532-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seven Johannes Sam Aghdassi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Sonja Hansen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Peter Bischoff
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Michael Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Petra Gastmeier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
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Fischer D, Schlößer RL, Kempf VAJ, Wichelhaus TA, Klingebiel T, Philippi S, Falgenhauer L, Imirzalioglu C, Dahl U, Brandt C, Reinheimer C. Overcrowding in a neonatal intermediate care unit: impact on the incidence of multidrug-resistant gram-negative organisms. BMC Infect Dis 2019; 19:357. [PMID: 31035966 PMCID: PMC6489334 DOI: 10.1186/s12879-019-3981-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overcrowding, reduced nurse to patient ratio, limited distance between incubators and absence of microbiological surveillance have been shown to promote spread of multidrug-resistant gram-negative organisms (MDRGN) in patients with birthweight < 1500 g. Patients > 1500 g treated on an intermediate care unit are unrepresented in recent literature. We therefore intended to present data obtained from a short-term overcrowded neonatal intermediate care unit (NIMCU) at a level III (international categorization) perinatal center at University Hospital Frankfurt, Germany. METHODS During a 25 day overcrowding (OV) and 28 day post-overcrowding period (POST-OV) on NIMCU, epidemiological data obtained from continuously hold microbiological surveillance were investigated and compared to the last 12 months of ward-regular bed occupancy preceding OV (PRAE-OV). RESULTS During OV, the number of patients simultaneously treated at the NIMCU increased from 18 to 22, resulting in a reduced bed-to-bed space. Nurse: patient ratio was 4:22 during OV compared to 3:18 during PRAE-OV. Cumulative incidence of MDRGN was 4.7% in OV and 2.4% POST-OV compared to 4.8% to PRAE-OV, respectively, without any significant variations. During OV and POST-OV, septic episodes due to MDRGN were not observed. In one case, potential nosocomial transmission of Enterobacter cloacae resistant to Piperacillin and 3rd/4th generation cephalosporins was observed. CONCLUSIONS Prevention of nosocomial spread of MDRGN in an overcrowded NIMCU is based on staff's diligent training and adequate staffing. Concise microbiological surveillance should be guaranteed to escort through overcrowding periods. In our setting, impact of bed-to-bed distance on MDRGN transmission seemed to be less strong.
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Affiliation(s)
- Doris Fischer
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany.
| | - Rolf L Schlößer
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Thomas Klingebiel
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Sabine Philippi
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Linda Falgenhauer
- Justus Liebig University, Institute of Medical Microbiology, and German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Giessen, Germany
| | - Can Imirzalioglu
- Justus Liebig University, Institute of Medical Microbiology, and German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Giessen, Germany
| | - Udo Dahl
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Christian Brandt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
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Kouatly IA, Nassar N, Nizam M, Badr LK. Evidence on Nurse Staffing Ratios and Patient Outcomes in a Low-Income Country: Implications for Future Research and Practice. Worldviews Evid Based Nurs 2018; 15:353-360. [PMID: 30129163 DOI: 10.1111/wvn.12316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Conclusive evidence on the effect of nurse staffing ratios on nurse-sensitive outcomes (NSOs) has not yet been achieved worldwide. AIMS To describe the relationship between nurse staffing and NSOs at a Magnet designated, university hospital a low-income country. METHODS A 48-month prospective study assessed the relationship between nurse staffing and six patient outcomes or NSOs in medical-surgical units and critical care units (CCUs). Nurse staffing was measured by nursing hours per patient day (NHPPD) and skill mix, whereas NSOs were total falls and injury falls per 1,000 patient days, percent of surveyed patients with hospital-acquired pressure injuries (HAPI), catheter-associated urinary tract infections, ventilator-associated pneumonia, and central line-associated bloodstream infections (CLABSI) per 1,000 central line days. RESULTS The odds for total falls, injury falls, HAPI, and CLABSI in the medical-surgical units were higher with lower NHPPD ratios, OR = 4.67, p = .000; OR = 4.33, p = .001; OR = 3.77, p = .004 and OR = 2.61, p = .006, respectively. For the CCUs, lower rates of NHPPD increased the odds for total falls, OR = 6.25, p = .0007, HAPIs OR = 3.91, p = .001 and CLABSI, OR = 4.78, p = .000. Skill mix was associated with total falls, OR = 2.40, p = .005 and HAPIs OR = 2.07, p = .03 in the medical-surgical units but had no effect in any NSOs in the CCUs. LINKING EVIDENCE TO ACTION Higher rates of nurses per patient were effective in improving some NSOs but not others. Skill mix had no effect on any of the six NSOs in the CCUs. As such, the results remain inconclusive as the benefits of the higher nurse to patient ratios in this low-income country warranting further multisite studies in different settings and countries.
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Affiliation(s)
- Iman Al Kouatly
- Nursing Director, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Nassar
- Nurse Quality Manager, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Nizam
- Executive Assistant, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Kurdahi Badr
- Professor, School of Nursing, Azusa Pacific University, Asuza, CA, USA
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Myers H, Pugh JD, Twigg DE. Identifying nurse-sensitive indicators for stand-alone high acuity areas: A systematic review. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitchell BG, Gardner A, Stone PW, Hall L, Pogorzelska-Maziarz M. Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature. Jt Comm J Qual Patient Saf 2018; 44:613-622. [PMID: 30064955 DOI: 10.1016/j.jcjq.2018.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous literature has linked the level and types of staffing of health facilities to the risk of acquiring a health care-associated infection (HAI). Investigating this relationship is challenging because of the lack of rigorous study designs and the use of varying definitions and measures of both staffing and HAIs. METHODS The objective of this study was to understand and synthesize the most recent research on the relationship of hospital staffing and HAI risk. A systematic review was undertaken. Electronic databases MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for studies published between January 1, 2000, and November 30, 2015. RESULTS Fifty-four articles were included in the review. The majority of studies examined the relationship between nurse staffing and HAIs (n = 50, 92.6%) and found nurse staffing variables to be associated with an increase in HAI rates (n = 40, 74.1%). Only 5 studies addressed non-nurse staffing, and those had mixed results. Physician staffing was associated with an increased HAI risk in 1 of 3 studies. Studies varied in design and methodology, as well as in their use of operational definitions and measures of staffing and HAIs. CONCLUSION Despite the lack of consistency of the included studies, overall, the results of this systematic review demonstrate that increased staffing is related to decreased risk of acquiring HAIs. More rigorous and consistent research designs, definitions, and risk-adjusted HAI data are needed in future studies exploring this area.
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Driscoll A, Grant MJ, Carroll D, Dalton S, Deaton C, Jones I, Lehwaldt D, McKee G, Munyombwe T, Astin F. The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2017; 17:6-22. [DOI: 10.1177/1474515117721561] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Nurses are pivotal in the provision of high quality care in acute hospitals. However, the optimal dosing of the number of nurses caring for patients remains elusive. In light of this, an updated review of the evidence on the effect of nurse staffing levels on patient outcomes is required. Aim: To undertake a systematic review and meta-analysis examining the association between nurse staffing levels and nurse-sensitive patient outcomes in acute specialist units. Methods: Nine electronic databases were searched for English articles published between 2006 and 2017. The primary outcomes were nurse-sensitive patient outcomes. Results: Of 3429 unique articles identified, 35 met the inclusion criteria. All were cross-sectional and the majority utilised large administrative databases. Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within 90 minutes. A meta-analysis involving 175,755 patients, from six studies, admitted to the intensive care unit and/or cardiac/cardiothoracic units showed that a higher nurse staffing level decreased the risk of inhospital mortality by 14% (0.86, 95% confidence interval 0.79–0.94). However, the meta-analysis also showed high heterogeneity (I2=86%). Conclusion: Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality. More studies need to be conducted on the association of nurse-to-patient ratios with nurse-sensitive patient outcomes to offset the paucity and weaknesses of research in this area. This would provide further evidence for recommendations of optimal nurse-to-patient ratios in acute specialist units.
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Affiliation(s)
- Andrea Driscoll
- Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Australia
| | - Maria J Grant
- School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford, UK
| | - Diane Carroll
- Munn Center for Nursing Research, Massachusetts General Hospital, USA
| | | | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Ian Jones
- School of Nursing and Allied Health, Liverpool John Moores University, UK
| | - Daniela Lehwaldt
- Department of Nursing and Human Sciences, Dublin City University, Ireland
| | - Gabrielle McKee
- School of Nursing & Midwifery, Trinity College Dublin, Ireland
| | | | - Felicity Astin
- Research and Development Department, University of Huddersfield and Calderdale and Huddersfield NHS Foundation Trust, UK
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[Evaluation of care conditions in intensive care units : Results of an online questionnaire of critical care nurses]. Med Klin Intensivmed Notfmed 2017; 112:543-549. [PMID: 28466290 DOI: 10.1007/s00063-017-0292-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/13/2017] [Accepted: 03/13/2017] [Indexed: 01/24/2023]
Abstract
In the following article, selected results of a descriptive study on personnel staffing and patients' care in intensive care units in Germany are presented and discussed. The main focus is laid on comparing features of personnel staffing with indicators of job satisfaction and patients' care. The study is based on an online questionnaire of critical care nurses run in 2017. The article represents the data of 2233 included German critical care nurses. The main results are the following: a low nurse patient ratio (≥1:3) in intensive care units has the tendency to cause higher risks in patients' care and shows lower job satisfaction than nurses with higher nurse-patient ratio (≤1:2).
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Dickmann P, Keeping S, Döring N, Schmidt AE, Binder C, Ariño-Blasco S, Gil J. Communicating the Risk of MRSA: The Role of Clinical Practice, Regulation and Other Policies in Five European Countries. Front Public Health 2017; 5:44. [PMID: 28367432 PMCID: PMC5355491 DOI: 10.3389/fpubh.2017.00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The threat posed by Meticillin-resistant Staphylococcus aureus (MRSA) has taken on an increasingly pan-European dimension. This article aims to provide an overview of the different approaches to the control of MRSA adopted in five European countries (Austria, Germany, Netherlands, Spain, and the UK) and discusses data and reporting mechanisms, regulations, guidelines, and health policy approaches with a focus on risk communication. Our hypothesis is that current infection control practices in different European countries are implicit messages that contribute to the health-related risk communication and subsequently to the public perception of risk posed by MRSA. A reporting template was used to systematically collect information from each country. DISCUSSION Large variation in approaches was observed between countries. However, there were a number of consistent themes relevant to the communication of key information regarding MRSA, including misleading messages, inconsistencies in content and application of published guidelines, and frictions between the official communication and their adoption on provider level. SUMMARY The variability of recommendations within, and across, countries could be contributing to the perception of inconsistency. Having inconsistent guidelines and practices in place may also be affecting the level at which recommended behaviors are adopted. The discrepancy between the official, explicit health messages around MRSA and the implicit messages stemming from the performance of infection control measures should, therefore, be a key target for those wishing to improve risk communication.
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Affiliation(s)
- Petra Dickmann
- London School of Economics and Political Science (LSE), LSE Health, London, UK; dickmann risk communication (drc), London, UK; Department for Anaesthesiology and Critical Care Medicine, Jena University Hospital, Jena, Germany
| | - Sam Keeping
- London School of Economics and Political Science (LSE), LSE Health , London , UK
| | - Nora Döring
- Department of Health Services Research, School for Public Health and Primary Care (Caphri) of the Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Claudia Binder
- European Centre for Social Welfare Policy and Research , Vienna , Austria
| | - Sergio Ariño-Blasco
- Universitat Internacional de Catalunya Hospital General Granollers , Granollers , Spain
| | - Joan Gil
- Universitat Internacional de Catalunya Hospital General Granollers, Granollers, Spain; Department of Economics and BEAT Research Institute, University of Barcelona, Barcelona, Spain
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[Infection control and safety culture in German hospitals]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:908-15. [PMID: 27306879 DOI: 10.1007/s00103-016-2373-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAI) are the most frequent adverse events in the healthcare setting and their prevention is an important contribution to patient safety in hospitals. OBJECTIVES To analyse to what extent safety cultural aspects with relevance to infection control are implemented in German hospitals. METHODS Safety cultural aspects of infection control were surveyed with an online questionnaire; data were analysed descriptively. RESULTS Data from 543 hospitals with a median of [IQR] 275 [157; 453] beds were analysed. Almost all hospitals (96.6 %) had internal guidelines for infection control (IC) in place; 82 % defined IC objectives, most often regarding hand hygiene (HH) (93 %) and multidrug resistant organisms (72 %) and less frequently for antibiotic stewardship (48 %) or prevention of specific HAI. In 94 % of hospitals, a reporting system for adverse events was in place, which was also used to report low compliance with HH, outbreaks and Clostridium difficile-associated infections. Members of the IC team were most often seen to hold daily responsibility for IC in the hospital, but rarely other hospital staff (94 versus 19 %). CONCLUSIONS Safety cultural aspects are not fully implemented in German hospitals. IC should be more strongly implemented in healthcare workers' daily routine and more visibly supported by hospital management.
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Oliveira ACD, Garcia PC, Nogueira LDS. Nursing workload and occurrence of adverse events in intensive care: a systematic review. Rev Esc Enferm USP 2017; 50:683-694. [PMID: 27680056 DOI: 10.1590/s0080-623420160000500020] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/02/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identifyevidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU). METHOD A systematic literature review was conducted in the databases MEDLINE, CINAHL, LILACS, SciELO, BDENF, and Cochrane from studies in English, Portuguese, or Spanish, published by 2015. The analyzed AE were infection, pressure ulcer (PU), patient falls, and medication errors. RESULTS Of 594 potential studies, eight comprised the final sample of the review. TheNursing Activities Score (NAS; 37.5%) and the Therapeutic Intervention Scoring System(TISS; 37.5%) were the instruments most frequently used for assessing nursing workload. Six studies (75.0%) identified the influence of work overload in events of infection, PU, and medicationerrors. An investigation found that the NAS was a protective factor for PU. CONCLUSION The nursing workload required by patients in the ICU influenced the occurrence of AE, and nurses must monitor this variable daily to ensure proper sizing of staff and safety of care. OBJETIVO Identificar evidências sobre a influência da carga de trabalho de enfermagem na ocorrência de eventos adversos (EA) em pacientes adultos internados em Unidade de Terapia Intensiva (UTI). MÉTODO Revisão sistemática da literatura realizada nas bases de dados MEDLINE, CINAHL, LILACS, SciELO, BDENF e Cochrane deestudosem inglês, português ou espanhol, publicados até 2015. Os EA analisados foram infecção, úlcera por pressão (UPP), quedas e erros associados a medicamentos. RESULTADOS Das 594 pesquisas potenciais identificadas, oito compuseram a amostra final da revisão. O NursingActivities Score -NAS (37,5%) e o TherapeuticInterventionScoring System -TISS (37,5%) foram os instrumentos mais utilizados para avaliação da carga de trabalho de enfermagem. Seis pesquisas (75,0%) identificaram influência da sobrecarga de trabalho na ocorrência de infecção, UPP e uso de medicamentos. Uma investigação identificou que o NAS foi fator de proteção para UPP. CONCLUSÃO A carga de trabalho de enfermagem requerida por pacientes na UTI influenciou a ocorrência de EA, e os enfermeiros devem monitorar diariamente esta variável para garantir o correto dimensionamento da equipe e a segurança da assistência prestada.
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Affiliation(s)
- Andrea Carvalho de Oliveira
- Universidade de São Paulo, Escola de Enfermagem, Programa de Residência em Enfermagem na Saúde do Adulto e do Idoso, São Paulo, SP, Brazil
| | - Paulo Carlos Garcia
- Universidade de São Paulo, Hospital Universitário, Unidade de Terapia Intensiva Adulto, São Paulo, SP, Brazil
| | - Lilia de Souza Nogueira
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, SP, Brazil
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Chacko B, Thomas K, David T, Paul H, Jeyaseelan L, Peter JV. Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study. World J Crit Care Med 2017; 6:79-84. [PMID: 28224111 PMCID: PMC5295173 DOI: 10.5492/wjccm.v6.i1.79] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/27/2016] [Accepted: 11/21/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To study the impact of hospital-acquired infections (HAIs) on cost and outcome from intensive care units (ICU) in India. METHODS Adult patients (> 18 years) admitted over 1-year, to a 24-bed medical critical care unit in India, were enrolled prospectively. Treatment cost and outcome data were collected. This cost data was merged with HAI data collected prospectively by the Hospital Infection Control Committee. Only infections occurring during ICU stay were included. The impact of HAI on treatment cost and mortality was assessed. RESULTS The mean (± SD) age of the cohort (n = 499) was 42.3 ± 16.5 years. Acute physiology and chronic health evaluation-II score was 13.9 (95%CI: 13.3-14.5); 86% were ventilated. ICU and hospital length of stay were 7.8 ± 5.5 and 13.9 ± 10 d respectively. Hospital mortality was 27.9%. During ICU stay, 76 (15.3%) patients developed an infection (ventilator-associated pneumonia 50; bloodstream infection 35; urinary tract infections 3), translating to 19.7 infections/1000 ICU days. When compared with those who did not develop an infection, an infection occurring during ICU stay was associated with significantly higher treatment cost [median (inter-quartile range, IQR) INR 92893 (USD 1523) (IQR 57168-140286) vs INR 180469 (USD 2958) (IQR 140030-237525); P < 0.001 and longer duration of ICU (6.7 ± 4.5 d vs 13.4 ± 7.0 d; P < 0.01) and hospital stay (12.4 ± 8.2 d vs 21.8 ± 13.9 d; P < 0.001)]. However ICU acquired infections did not impact hospital mortality (31.6% vs 27.2%; P = 0.49). CONCLUSION An infection acquired during ICU stay was associated with doubling of treatment cost and prolonged hospitalization but did not significantly increase mortality.
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Koulenti D, Tsigou E, Rello J. Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study. Eur J Clin Microbiol Infect Dis 2016; 36:1999-2006. [DOI: 10.1007/s10096-016-2703-z] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/29/2016] [Indexed: 11/25/2022]
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Boyer A, Couallier V, Clouzeau B, Lasheras A, M'zali F, Kann M, Rogues AM, Gruson D. Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis. Am J Infect Control 2015; 43:1296-301. [PMID: 26364520 DOI: 10.1016/j.ajic.2015.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study was undertaken to determine the temporal relationship between implementation of different interventions in an intensive care unit (ICU) and control of endemic nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE). METHODS This was a prospective observational study with time-series analysis of the monthly incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline period, an intervention consisting of restriction of third-generation cephalosporins (3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008, an increased health care worker (HCW):patient ratio was also implemented. In March 2010, the ICU was closed, and patients were moved to a clean ICU. RESULTS The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based hand rub. A significant change in ESBLE incidence was observed in a full segmented univariate regression analysis (mean change in level, -0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition. According to the multivariate model, the ICU closure was the main protective factor. Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence interval, 0.06-1.25; P = .09). CONCLUSIONS This study shows that ICU closure was associated with, but not necessarily the reason for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE sources may play a role in cross-transmission.
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Bischoff P, Geffers C, Gastmeier P. [Hygiene measures in the intensive care station]. Med Klin Intensivmed Notfmed 2015; 109:627-39. [PMID: 25388301 DOI: 10.1007/s00063-014-0438-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Medical personnel in intensive care units (ICU) deal with critically ill patients and a high work load. Patients face a higher risk of acquiring a nosocomial infection during their ICU stay. Especially, invasively ventilated patients are threatened. A catheter-related bloodstream infection might even lead to more severe complications. The number of multiresistant pathogens continues to rise; thus, comprehensive infection control measures are crucial to avoid pathogen transmission and infection. The most important measure is hand disinfection. With a proper personnel-patient ratio, educational programs, and infection control bundles, it is possible to reduce infection rates and enhance compliance among health care workers.
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Affiliation(s)
- P Bischoff
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland,
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Mutters NT, Neubert TR, Nieth R, Mutters R. The role of Octenidol(®), Glandomed(®) and chlorhexidine mouthwash in the prevention of mucositis and in the reduction of the oropharyngeal flora: a double-blind randomized controlled trial. GMS HYGIENE AND INFECTION CONTROL 2015. [PMID: 25699228 DOI: 10.3205/dgkh000248.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The oropharyngeal flora is of importance for the development of oral mucositis, which is a frequent complication in oncologic practice. It also plays a role in the pathogenesis of ventilator-associated pneumonia. Mucositis is associated with significantly worse clinical and economic outcomes. The aim of our study was to assess the efficacy of Octenidol(®), Glandomed(®) and chlorhexidine mouthwash in the prevention of mucositis and reduction of the oropharyngeal flora. METHODS A prospective, double-blinded RCT including two strata was conducted between October 2008 and November 2010. Stratum i consisted of ventilated cardiothoracic surgical patients. Stratum ii consisted of medical patients with haemato-oncological malignancies requiring stem cell transplantation. The primary outcome measures were development of mucositis regarding to OMAS/WHO score and reduction of the oropharyngeal flora. RESULTS Both strata showed low OMAS/WHO scores which did not differ significantly between the groups. The overall mean reduction of colony forming units was significantly higher in the Octenidol(®) group compared to the chlorhexidine and the Glandomed(®) groups. CONCLUSIONS No significant differences in the development of mucositis were found, thus all solutions proved successful in the prevention of mucositis. However, Octenidol(®) was superior in the reduction of the oropharyngeal flora. Hence, the preventive effect on nosocomial infections might be higher in patients using Octenidol(®) rather than chlorhexidine or Glandomed(®).
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Affiliation(s)
- Nico T Mutters
- Heidelberg University Hospital, Department of Infectious Diseases, Heidelberg, Germany
| | - Thomas R Neubert
- Marburg University Hospital, Wound and Pain Unit, Coordination Centre for Clinical Trials, Marburg, Germany
| | - Rudolf Nieth
- Marburg University Hospital, Department of Haemato-Oncology, Marburg, Germany
| | - Reinier Mutters
- Marburg University Hospital, Institute for Medical Microbiology and Hygiene, Marburg, Germany
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Mutters NT, Neubert TR, Nieth R, Mutters R. The role of Octenidol(®), Glandomed(®) and chlorhexidine mouthwash in the prevention of mucositis and in the reduction of the oropharyngeal flora: a double-blind randomized controlled trial. GMS HYGIENE AND INFECTION CONTROL 2015; 10:Doc05. [PMID: 25699228 PMCID: PMC4332271 DOI: 10.3205/dgkh000248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM The oropharyngeal flora is of importance for the development of oral mucositis, which is a frequent complication in oncologic practice. It also plays a role in the pathogenesis of ventilator-associated pneumonia. Mucositis is associated with significantly worse clinical and economic outcomes. The aim of our study was to assess the efficacy of Octenidol(®), Glandomed(®) and chlorhexidine mouthwash in the prevention of mucositis and reduction of the oropharyngeal flora. METHODS A prospective, double-blinded RCT including two strata was conducted between October 2008 and November 2010. Stratum i consisted of ventilated cardiothoracic surgical patients. Stratum ii consisted of medical patients with haemato-oncological malignancies requiring stem cell transplantation. The primary outcome measures were development of mucositis regarding to OMAS/WHO score and reduction of the oropharyngeal flora. RESULTS Both strata showed low OMAS/WHO scores which did not differ significantly between the groups. The overall mean reduction of colony forming units was significantly higher in the Octenidol(®) group compared to the chlorhexidine and the Glandomed(®) groups. CONCLUSIONS No significant differences in the development of mucositis were found, thus all solutions proved successful in the prevention of mucositis. However, Octenidol(®) was superior in the reduction of the oropharyngeal flora. Hence, the preventive effect on nosocomial infections might be higher in patients using Octenidol(®) rather than chlorhexidine or Glandomed(®).
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Affiliation(s)
- Nico T Mutters
- Heidelberg University Hospital, Department of Infectious Diseases, Heidelberg, Germany
| | - Thomas R Neubert
- Marburg University Hospital, Wound and Pain Unit, Coordination Centre for Clinical Trials, Marburg, Germany
| | - Rudolf Nieth
- Marburg University Hospital, Department of Haemato-Oncology, Marburg, Germany
| | - Reinier Mutters
- Marburg University Hospital, Institute for Medical Microbiology and Hygiene, Marburg, Germany
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Nogueira LDS, Ferretti-Rebustini REDL, Poveda VDB, Silva RDCGE, Barbosa RL, Oliveira EMD, Andolhe R, Padilha KG. Nursing workload: is it a predictor of healthcare associated infection in intensive care unit? Rev Esc Enferm USP 2015; 49 Spec No:36-42. [PMID: 26761690 DOI: 10.1590/s0080-623420150000700006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/14/2015] [Indexed: 01/10/2023] Open
Abstract
Objective To analyze the influence of nursing workload on the occurrence of healthcare associated infection (HAI) in patients in the intensive care unit (ICU), according to type of treatment. Method Retrospective cohort study developed in nine ICUs in São Paulo, Brazil, from September to December 2012. Nursing workload was measured by the Nursing Activities Score (NAS). The Student's t and Fisher's exact tests and logistic regressions were used in the analyses. Results The sample was composed of 835 patients (54.3±17.3 years; 57.5% male), of which 12.5% acquired HAI in the ICU. The NAS of the patients admitted for clinical treatment was 71.3±10.9, and for surgery 71.6±9.2. Length of stay in ICU and severity were predictive factors for occurrence of HAI in patients admitted to the unit for clinical or surgical treatment, and male sex only for surgical patients. When considering the admissions independent of type of treatment, in addition to the variables mentioned above, index of comorbidities also remained in the regression model. The NAS was not a predictive factor of HAI. Conclusion Nursing workload did not influence occurrence of HAI in the patients included in this study.
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Affiliation(s)
- Lilia de Souza Nogueira
- Departamento de Enfermagem Médico Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Vanessa de Brito Poveda
- Departamento de Enfermagem Médico Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rita de Cassia Gengo E Silva
- Departamento de Enfermagem Médico Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | - Rafaela Andolhe
- Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
| | - Kátia Grillo Padilha
- Departamento de Enfermagem Médico Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
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Bae SH, Brewer CS, Kelly M, Spencer A. Use of temporary nursing staff and nosocomial infections in intensive care units. J Clin Nurs 2014; 24:980-90. [PMID: 25430655 DOI: 10.1111/jocn.12718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the nature and prevalence of the use of temporary nursing staff in intensive care units and relationships between the use of temporary nursing staff and the occurrence of nosocomial infections (central line-associated blood stream infections and ventilator-associated pneumonia). BACKGROUND Hiring temporary nurses raises controversial issues with respect to nurse staffing, care processes and patient outcomes, yet empirical findings regarding the use of temporary nurses are mixed. Whether adverse patient outcomes in intensive care units are related to the use of temporary nursing staff remains unexamined. DESIGN A retrospective longitudinal design was used. METHODS Data were collected monthly from 12 intensive care units at six hospitals; 144 ICU-month data points were used for the analysis. Chi-square, anova and logit regression models were used to examine the research questions. RESULTS The intensive care units used higher levels of temporary nursing staff, but the use of temporary nursing staff was not significantly associated with nosocomial infections. Nurses' perceptions regarding staffing and resource adequacy were significantly associated with nosocomial infections. CONCLUSIONS No evidence was found to link the use of temporary nursing staff and nosocomial infections. Instead, nurses' perceptions of staffing adequacy were related to nosocomial infections. RELEVANCE TO CLINICAL PRACTICE Given the greater use of temporary nursing staff in intensive care units, nurse managers in intensive care units need to monitor the levels of temporary nurse staffing and develop a systematic approach for hospitals to assist in these nurses' adjustment, which can reduce the burden of both temporary and permanent intensive care unit nurses. In addition to quantitative measures of nurse staffing, nurses' perceptions regarding staffing adequacy can be used to measure nurse staffing in relation to adverse patient outcomes.
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Affiliation(s)
- Sung-Heui Bae
- School of Nursing, University of Texas at Austin, Austin, TX, USA
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Volpe FM, Magalhães ACDM, Rocha AR. High bed occupancy rates: Are they a risk for patients and staff? INT J EVID-BASED HEA 2014; 11:312-6. [PMID: 24298926 DOI: 10.1111/1744-1609.12046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM In order to produce empirical evidence on the relationship between high bed occupancy and its potential hazards, this study correlates bed occupancy rates with hospital patient safety and staff overload indicators. METHODS Data from nine medium to large scale public hospitals, all pertaining to the Hospital Foundation of Minas Gerais, Brazil, were gathered for the period January 2007 to June 2011. Indicators were aggregated by month, resulting in 486 observations (54 months × 9 hospitals). Bivariate linear regressions were performed, aiming to estimate the effect of bed occupancy rates on each response variable (hospital infection rates, institutional mortality and sick leave incidence). In addition, to directly test the hypothesis that bed occupancy rates over 85% are unsafe, it was included in the models as a categorical instead of continuous variable, using 85% as the cut-off value. RESULTS Bed occupancy rates showed an inverse correlation to mortality rates (b = -0.056; P < 0.001) and presented no significant correlation to the nosocomial infection rates (P = 0.512). High bed occupancy (>85%) was associated with a slight increment of short sick leaves, especially short leaves (<7 days) (+0.14%; P = 0.008). CONCLUSIONS The increase in hospital loading was unexpectedly associated with reduced institutional mortality and was not related to nosocomial infection incidences. High bed occupancy was associated to a slight increment of short sick leaves.
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Venier AG, Leroyer C, Slekovec C, Talon D, Bertrand X, Parer S, Alfandari S, Guerin JM, Megarbane B, Lawrence C, Clair B, Lepape A, Perraud M, Cassier P, Trivier D, Boyer A, Dubois V, Asselineau J, Rogues AM, Thiébaut R. Risk factors for Pseudomonas aeruginosa acquisition in intensive care units: a prospective multicentre study. J Hosp Infect 2014; 88:103-8. [PMID: 25155240 DOI: 10.1016/j.jhin.2014.06.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is a major nosocomial pathogen in intensive care units (ICUs); however, endogenous versus exogenous origin of contamination remains unclear. AIM To identify individual and environmental ICU risk factors for P. aeruginosa acquisition. METHODS A five-month prospective multicentric study was performed in ten French ICUs. Adult patients hospitalized in ICU for ≥ 24 h were included and screened for P. aeruginosa colonization on admission, weekly and before discharge. P. aeruginosa acquisition was defined by a subsequent colonization or infection if screening swabs on admission were negative. Water samples were obtained weekly on water taps of the ICUs. Data on patient characteristics, invasive devices exposure, antimicrobial therapy, P. aeruginosa water and patient colonization pressures, and ICU characteristics were collected. Hazard ratios (HRs) were estimated using multivariate Cox model. FINDINGS Among the 1314 patients without P. aeruginosa on admission, 201 (15%) acquired P. aeruginosa during their ICU stay. Individual characteristics significantly associated with P. aeruginosa acquisition were history of previous P. aeruginosa infection or colonization, cumulative duration of mechanical ventilation and cumulative days of antibiotics not active against P. aeruginosa. Environmental risk factors for P. aeruginosa acquisition were cumulative daily ward 'nine equivalents of nursing manpower use score' (NEMS) [hazard ratio (HR): 1.47 for ≥ 30 points; 95% confidence interval (CI): 1.06-2.03] and contaminated tap water in patient's room (HR: 1.76; CI: 1.09-2.84). CONCLUSION Individual risk factors and environmental factors for which intervention is possible were identified for P. aeruginosa acquisition.
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Affiliation(s)
- A-G Venier
- CHU, CCLIN Sud-Ouest, Bordeaux, France; INSERM U657, Université de Bordeaux, Bordeaux, France.
| | - C Leroyer
- CHU, Hygiène hospitalière, Bordeaux, France
| | - C Slekovec
- CHU, Hygiène hospitalière, Besançon, France
| | - D Talon
- CHU, Hygiène hospitalière, Besançon, France
| | - X Bertrand
- CHU, Hygiène hospitalière, Besançon, France
| | - S Parer
- CHU, Hygiène hospitalière, Montpellier, France
| | - S Alfandari
- CH DRon, Réanimation et maladies infectieuses, Tourcoing, France
| | - J-M Guerin
- CHU Lariboisière, AP-HP, Hygiène hospitalière, Paris, France
| | - B Megarbane
- CHU Lariboisière, AP-HP, Réanimation médicale, Paris, France
| | - C Lawrence
- CHU Poincaré, AP-HP, Hygiène hospitalière, Garches, France
| | - B Clair
- CHU Poincaré, AP-HP, Réanimation médicale, Garches, France
| | - A Lepape
- CHU Lyon Sud, Réanimation médicale, Lyon, France
| | - M Perraud
- CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France
| | - P Cassier
- CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France
| | - D Trivier
- CH Lens, Hygiène hospitalière, Lens, France
| | - A Boyer
- CHU, Réanimation médicale, Bordeaux, France
| | - V Dubois
- CHU, Laboratoire de bactériologie, Bordeaux, France; UMR 5234 CNRS, Université de Bordeaux, Bordeaux, France
| | - J Asselineau
- CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France
| | - A-M Rogues
- INSERM U657, Université de Bordeaux, Bordeaux, France; CHU, Hygiène hospitalière, Bordeaux, France
| | - R Thiébaut
- CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France; INSERM, U897 Epidemiologie et Biostatistique, Bordeaux, France; Univ Bordeaux, ISPED, Bordeaux, France
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Ferrer J, Boelle PY, Salomon J, Miliani K, L'Hériteau F, Astagneau P, Temime L. Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit. Epidemics 2014; 9:62-9. [PMID: 25480135 DOI: 10.1016/j.epidem.2014.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/11/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Studies provide evidence that reduced nurse staffing resources are associated to an increase in health care-associated infections in intensive care units, but tools to assess the contribution of the mechanisms driving these relations are still lacking. We present an agent-based model of pathogen spread that can be used to evaluate the impact on nosocomial risk of alternative management decisions adopted to deal with transitory nurse shortage. MATERIALS AND METHODS We constructed a model simulating contact-mediated dissemination of pathogens in an intensive-care unit with explicit staffing where nurse availability could be temporarily reduced while maintaining requisites of patient care. We used the model to explore the impact of alternative management decisions adopted to deal with transitory nurse shortage under different pathogen- and institution-specific scenarios. Three alternative strategies could be adopted: increasing the workload of working nurses, hiring substitute nurses, or transferring patients to other intensive-care units. The impact of these decisions on pathogen spread was examined while varying pathogen transmissibility and severity of nurse shortage. RESULTS The model-predicted changes in pathogen prevalence among patients were impacted by management decisions. Simulations showed that increasing nurse workload led to an increase in pathogen spread and that patient transfer could reduce prevalence of pathogens among patients in the intensive-care unit. The outcome of nurse substitution depended on the assumed skills of substitute nurses. Differences between predicted outcomes of each strategy became more evident with increasing transmissibility of the pathogen and with higher rates of nurse shortage. CONCLUSIONS Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.
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Affiliation(s)
- Jordi Ferrer
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire national des Arts et Métiers, Paris, France.
| | | | - Jérôme Salomon
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire national des Arts et Métiers, Paris, France
| | - Katiuska Miliani
- Regional Coordinating Centre for Nosocomial Infection Control (C-CLIN Paris Nord), Paris, France
| | - François L'Hériteau
- Regional Coordinating Centre for Nosocomial Infection Control (C-CLIN Paris Nord), Paris, France
| | - Pascal Astagneau
- Regional Coordinating Centre for Nosocomial Infection Control (C-CLIN Paris Nord), Paris, France; EHESP School of Public Health, Paris, France
| | - Laura Temime
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire national des Arts et Métiers, Paris, France
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Borg MA, Hulscher M, Scicluna EA, Richards J, Azanowsky JM, Xuereb D, Huis A, Moro ML, Maltezou HC, Frank U. Prevention of meticillin-resistant Staphylococcus aureus bloodstream infections in European hospitals: moving beyond policies. J Hosp Infect 2014; 87:203-11. [PMID: 24973016 DOI: 10.1016/j.jhin.2014.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 05/19/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is evidence that meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia can be reduced with improved infection control and antibiotic stewardship. AIM To survey infection control and antibiotic stewardship practices within European hospitals and to identify initiatives that correlate with reduced MRSA prevalence. METHODS Online questionnaires were sent to European hospitals about their surveillance, hand hygiene, intravenous device management, admission screening, isolation, antibiotic prescribing, hospital demographics and MRSA blood culture isolates during 2010. FINDINGS In all, 269 replies were received from hospitals in 29 European countries. Lower MRSA prevalence showed significant association with presence of incidence surveillance, performance of root cause analysis, mandatory training requirements for hand hygiene, accountability measures for persistent non-compliance, and multi-stakeholder teamwork in antibiotic prescribing. Presence of policies on intravenous catheter insertion and management showed no variation between different MRSA prevalence groups. However, low-prevalence hospitals reported more competency assessment programmes in insertion and maintenance of peripheral and central venous catheters. Hospitals from the UK and Ireland reported the highest uptake of infection control and antibiotic stewardship practices that were significantly associated with low MRSA prevalence, whereas Southern European hospitals exhibited the lowest. In multiple regression analysis, isolation of high-risk patients, performance of root cause analysis, obligatory training for nurses in hand hygiene, and undertaking joint ward rounds including microbiologists and infectious disease physicians remained significantly associated with lower MRSA prevalence. CONCLUSION Proactive infection control and antibiotic stewardship initiatives that instilled accountability, ownership, teamwork, and validated competence among healthcare workers were associated with improved MRSA outcomes.
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Affiliation(s)
- M A Borg
- Mater Dei Hospital and University of Malta, Msida, Malta.
| | - M Hulscher
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - J Richards
- International Federation of Infection Control, Norwich, UK
| | | | - D Xuereb
- Mater Dei Hospital, Msida, Malta
| | - A Huis
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M L Moro
- Agenzia Sanitaria e Sociale Regione, Emilia-Romagna, Bologna, Italy
| | - H C Maltezou
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - U Frank
- Freiburg University Hospital, Freiburg, Germany
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Gupta A, Kapil A, Kabra SK, Lodha R, Sood S, Dhawan B, Das BK, Sreenivas V. Assessing the impact of an educational intervention on ventilator-associated pneumonia in a pediatric critical care unit. Am J Infect Control 2014; 42:111-5. [PMID: 24485367 DOI: 10.1016/j.ajic.2013.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ongoing educational programs targeting health care professionals have shown positive outcomes by reducing the morbidity and mortality associated with health care-associated infections (HAIs). We undertook this study to measure the impact of such a program in a pediatric critical care unit of a developing country. METHODS This prospective study was conducted in 2 time periods of 6 months each, with an educational intervention for resident doctors and nurses in between. The rates of ventilator-associated pneumonia (VAP) during the preintervention and postintervention periods were estimated by active surveillance. RESULTS The incidence density of VAP was reduced by 28% (20.2 vs 14.6 per 1,000 ventilator-days; P = .21, Z test) despite a significant increase in the ventilator utilization ratio during the postintervention period (0.64 vs 0.88; P < .0001, Pearson's χ² test). There was a statistically significant reduction in mortality among patients who received mechanical ventilation for ≥48 hours in the postintervention period (49.3% vs 31.4%; P = .029, Pearson's χ² test). CONCLUSIONS Educational programs have a positive impact on reducing the morbidity and mortality associated with HAIs. Incidence rates based on device-days should be compared by keeping the variations in device utilization ratio in mind.
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Affiliation(s)
- Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal K Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Honda CKY, Freitas FGR, Stanich P, Mazza BF, Castro I, Nascente APM, Bafi AT, Azevedo LCP, Machado FR. Nurse to bed ratio and nutrition support in critically ill patients. Am J Crit Care 2013; 22:e71-8. [PMID: 24186828 DOI: 10.4037/ajcc2013610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Inadequate nutrition support is common among critically ill patients, and identification of risk factors for such inadequacy might help in improving nutrition support. OBJECTIVE To determine how often daily calorie goals are met and the factors responsible for inadequate nutrition support. Methods A single-center prospective cohort study. Each patient's demographic and clinical characteristics, the need for ventilatory support, the use and dosage of medications, the number of nursing staff per bed, the time elapsed from admission to the intensive care unit until the effective start of enteral feeding, and the causes for nonadministration were recorded. Achievement of daily calorie goals was determined and correlated with risk factors. RESULTS A total of 262 daily evaluations were done in 40 patients. Daily calorie goal was achieved in only 46.2% of the evaluations (n = 121), with a mean of 74.8% of the prescribed volume of enteral nutrition infused daily. Risk factors for inadequate nutrition support were the use of midazolam (odds ratio, 1.58; 95% CI, 1.18-2.11) and fewer nursing professionals per bed (odds ratio, 2.56; 95% CI, 1.43-4.57). Conclusion Achievement of daily calorie goals was inadequate, and the main factors associated with this failure were the use and dosage of midazolam and the number of nurses available.
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Affiliation(s)
- Carolina Keiko Yamamoto Honda
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
| | - Flávio Geraldo Rezende Freitas
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
| | - Patricia Stanich
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Franco Mazza
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
| | - Isac Castro
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Paula Metran Nascente
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
| | - Antonio Toneti Bafi
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
| | - Luciano Cesar Pontes Azevedo
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
| | - Flávia Ribeiro Machado
- Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil
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Prävention der nosokomialen beatmungsassoziierten Pneumonie. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013. [DOI: 10.1007/s00103-013-1846-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hughes RG, Bobay KL, Jolly NA, Suby C. Comparison of nurse staffing based on changes in unit-level workload associated with patient churn. J Nurs Manag 2013; 23:390-400. [DOI: 10.1111/jonm.12147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Nicholas A. Jolly
- Department of Economics; College of Business Administration; Marquette University; Milwaukee WI USA
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Querschnittstudie der Strukturqualität deutscher Intensivstationen. Med Klin Intensivmed Notfmed 2013; 108:497-506. [DOI: 10.1007/s00063-013-0251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 01/26/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
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Trevisanuto D, Arnolda G, Chien TD, Xuan NM, Thu LTA, Kumara D, Lincetto O, Moccia L. Reducing neonatal infections in south and south central Vietnam: the views of healthcare providers. BMC Pediatr 2013; 13:51. [PMID: 23570330 PMCID: PMC3626723 DOI: 10.1186/1471-2431-13-51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 04/05/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Infection causes neonatal mortality in both high and low income countries. While simple interventions to prevent neonatal infection are available, they are often poorly understood and implemented by clinicians. A basic understanding of healthcare providers' perceptions of infection control provides a platform for improving current practices. Our aim was to explore the views of healthcare providers in provincial hospitals in south and south central Vietnam to inform the design of programmes to improve neonatal infection prevention and control. METHODS All fifty-four participants who attended a workshop on infection prevention and control were asked to complete an anonymous, written questionnaire identifying their priorities for improving neonatal infection prevention and control in provincial hospitals in south and south central Vietnam. RESULTS Hand washing, exclusive breastfeeding and safe disposal of medical waste were nominated by most participants as priorities for preventing neonatal infections. Education through instructional posters and written guidelines, family contact, kangaroo-mother-care, limitation of invasive procedures and screening for maternal GBS infection were advocated by a smaller proportion of participants. CONCLUSIONS The opinions of neonatal healthcare providers at the workshop accurately reflect some of the current international recommendations for infection prevention. However, other important recommendations were not commonly identified by participants and need to be reinforced. Our results will be used to design interventions to improve infection prevention in Vietnam, and may be relevant to other low-resource countries.
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Affiliation(s)
- Daniele Trevisanuto
- Children and Women’s Health Department, Medical School, University of Padua, Azienda Ospedaliera Padova, Via Giustiniani, 3, 35128 Padua, Italy
- Amici della Neonatologia Trentina, Trento, Italy
| | | | | | | | | | | | - Ornella Lincetto
- World Health Organization, Country Office for Vietnam, Hanoi, Vietnam
| | - Luciano Moccia
- Amici della Neonatologia Trentina, Trento, Italy
- East Meets West Foundation, Oakland, CA, USA
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Kiekkas P. Nurse understaffing and infection risk: current evidence, future research and health policy. Nurs Crit Care 2013; 18:61-2. [DOI: 10.1111/nicc.12014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Overkamp F, Thiele KP, Wilhelm M. (Fehl-)Steuerung im Gesundheitswesen. Oncol Res Treat 2013; 36 Suppl 5:20-7. [DOI: 10.1159/000352001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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