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The Influence of the Composition of the Nursing Staff on Primary Bloodstream Infection Rates in a Surgical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Jérôme Robert ,
Scott K. Fridkin ,
Henry M. Blumberg ,
Betsy Anderson ,
Nancy White ,
Susan M. Ray ,
Jinlene Chan  and
William R. Jarvis
Jérôme Robert
Affiliation:
Laboratoire de Bactériologie et Hygiène, Hôpital Pitié-Salpêtrière, Paris, France Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Public Health Service, Department of Health and Human Services, Atlanta, Georgia
Scott K. Fridkin
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Public Health Service, Department of Health and Human Services, Atlanta, Georgia
Henry M. Blumberg
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Epidemiology Department, Grady Health System, Atlanta, Georgia
Betsy Anderson
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Nancy White
Affiliation:
Epidemiology Department, Grady Health System, Atlanta, Georgia
Susan M. Ray
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Epidemiology Department, Grady Health System, Atlanta, Georgia
Jinlene Chan
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Public Health Service, Department of Health and Human Services, Atlanta, Georgia
William R. Jarvis*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Public Health Service, Department of Health and Human Services, Atlanta, Georgia
*
Hospital Infections Program, Mailstop E-69, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
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Abstract

Objectives:

To determine the risk factors for acquisition of nosocomial primary bloodstream infections (BSIs), including the effect of nursing-staff levels, in surgical intensive care unit (SICU) patients.

Design:

A nested case-control study.

Setting:

A 20-bed SICU in a 1,000-bed inner-city public hospital.

Patients:

28 patients with BSI (case-patients) were compared to 99 randomly selected patients (controls) hospitalized ≥3 days in the same unit.

Results:

Case- and control-patients were similar in age, severity of illness, and type of central venous catheter (CVC) used. Case-patients were significantly more likely than controls to be hospitalized during a 5-month period that had lower regular-nurse-to-patient and higher pool-nurse-to-patient ratios than during an 8-month reference period; to be in the SICU for a longer period of time; to be mechanically ventilated longer; to receive more antimicrobials and total parenteral nutrition; to have more CVC days; or to die. Case-patients had significantly lower regular-nurse-to-patient and higher pool-nurse-to-patient ratios for the 3 days before BSI than controls. In multivariate analyses, admission during a period of higher pool-nurse-to-patient ratio (odds ratio [OR]=3.8), total parenteral nutrition (OR=1.3), and CVC days (OR=1.1) remained independent BSI risk factors.

Conclusions:

Our data suggest that, in addition to other factors, nurse staffing composition (ie, pool-nurse-to-patient ratio) may be related to primary BSI risk. Patterns in intensive care unit nurse staffing should be monitored to assess their impact on nosocomial infection rates. This may be particularly important in an era of cost containment and healthcare reform.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 1 , January 2000 , pp. 12 - 17
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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