Hostname: page-component-f554764f5-qhdkw Total loading time: 0 Render date: 2025-04-18T19:52:50.573Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Pittet, D. Nosocomial bloodstream infections. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 3rd ed. Baltimore, MD: Williams & Wilkins; 1997:512–555.Google Scholar
2.Banerjee, SN, Emori, TG, Culver, DH, Gaynes, RP, Jarvis, WR, Horan, T, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. Am J Med 1991;91:86S–89S.Google Scholar
3.Craven, DE, Kunches, LM, Lichtenberg, DA, Kollisch, NR, Barry, MA, Heeren, TC, et al. Nosocomial infection and fatality in medical surgical intensive care unit patients. Arch Intern Med 1988;148:1161–1168.Google Scholar
4.Daschner, FD, Frey, P, Wolff, G, Baumann, PC, Suter, P. Nosocomial infections in intensive care wards: a multicenter prospective study. Intensive Care Med 1982;8:5–9.Google Scholar
5.Donowitz, LG, Wenzel, RP, Hoyt, JW. High risk of hospital-acquired infection in the ICU patient. Crit Care Med 1982;10:355–357.Google Scholar
6.Duggan, JM, Oldfield, GS, Ghosh, HK. Septicaemia as a hospital hazard. J Hosp Infect 1985;6:406–412.Google Scholar
7.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
8.Rose, R, Hunting, KJ, Towsend, TR, Wenzel, RP. Morbidity/mortality and economics of hospital-acquired bloodstream infections: a controlled trial. South Med J 1977;70:1267–1269.Google Scholar
9.Smith, RL, Meixler, SM, Simberkoff, MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 1991;100:164–167.Google Scholar
10.Maki, DG. Nosocomial bacteremia: an epidemiologic overview. Am J Med 1981;70:719–732.Google Scholar
11.Bjornson, HS, Colley, R, Bower, RH, Duty, VP, Schwartz-Fulton, JT, Fischer, JE. Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery 1982;92:720–726.Google Scholar
12.Kelsey, MC, Gosling, MA. A comparison of the morbidity associated with occlusive and non-occlusive dressings applied to peripheral intravenous devices. J Hosp Infect 1984;5:313–321.Google Scholar
13.Snydman, DR, Pober, BR, Murray, SA, Gorbea, HF, Majka, JA, Perry, LK. Predictive value of surveillance skin cultures in total-parenteral-nutrition-related infection. Lancet 1982;2:1385–1388.Google Scholar
14.Faubion, WC, Wesley, JR, Khalidi, N, Silva, J. Total parenteral nutrition catheter sepsis: impact of the team approach. J Parenter Enteral Nutr 1986;10:642–645.Google Scholar
15.Nehme, AE. Nutritional support of the hospitalized patient. The team concept. JAMA 1980;243:1906–1908.Google Scholar
16.Puntis, JWL, Holden, CE, Smallman, S, Finkel, Y, George, RH, Booth, IW. Staff training: a key factor in reducing intravascular catheter sepsis. Arch Dis Child 1990;65:335–337.Google Scholar
17.Fridkin, SA, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150–158.Google Scholar
18.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hugues, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140.Google Scholar
19.Greenman, RL, Schein, RM, Martin, MA, Wenzel, RP, MacIntyre, NR, Emmanuel, G, et al. A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. The XOMA Sepsis Study Group. JAMA 1991;266:1097–1102.Google Scholar
20.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1995;13:818–829.CrossRefGoogle Scholar
21.Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977;296:1305–1309.Google Scholar
22.Haley, RW, Bregman, DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982;145:875–885.Google Scholar
23.Haley, RW, Cushion, NB, Tenover, FC, Bannerman, TL, Dryer, D, Ross, J, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614–624.CrossRefGoogle ScholarPubMed
24.Garibaldi, RA, Brodine, S, Matsumiya, S. Infections among patients in nursing homes. N Engl J Med 1981;305:731–735.Google Scholar
25.Li, J, Birkhead, GS, Strogatz, DS, Coles, FB. Impact of institution size, staffing patterns, and infection control practices on communicable disease outbreaks in New York state nursing homes. Am J Epidemiol 1996;143:1042–1049.Google Scholar
26.Arnow, PM, Allyn, PA, Nichols, EM, Hill, DM, Pezzlo, M, Bartlett, RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma 1982;22:954–959.Google Scholar
27.Mayhall, CG, Lamb, VA, Gayle, WE, Haynes, BW. Enterobacter cloacae septicemia in a burn center: epidemiology and control of an outbreak. J Infect Dis 1979;139:166–171.Google Scholar
28.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG, Munn, VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
29.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.Google Scholar
30.Delgado-Rodriguez, M, Bueno-Cavanillas, A, Lopez-Gigosos, R, de Dios Luna-Castillo, J, Gufflen-Solvas, J, Moreno-Abril, O, et al. Hospital length of stay as an effect modifier of other risk factors for nosocomial infection. Eur J Epidemiol 1990;6:34–39.Google Scholar
31.Tess, BH, Glenister, HM, Rodrigues, LC, Wagner, MB. Incidence of hospital-acquired infection and length of hospital stay. Eur J Clin Microbiol Infect Dis 1993;12:81–86.Google Scholar
32.Vincent, JL, Bihari, DJ, Suter, PM, Bruining, HA, White, J, Nicolas-Chanoin, MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. EPIC International Advisory Committee. JAMA 1995;274:639–644.Google Scholar
33.Soufir, L, Timsit, J-F, Mahe, C, Carlet, J, Regnier, B, Chevret, S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol 1999;20:396–401.Google Scholar
34.Girou, E, Stephan, F, Novara, A, Safar, M, Fagon, J-Y. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998;157:1151–1158.Google Scholar
35.Gilbert, M, Gallagher, SC, Eads, M, Elmore, MF. Microbial growth patterns in a total parenteral nutrition formulation containing lipid emulsion. J Parenter Enteral Nutr 1986;10:494–497.Google Scholar
36.Jarvis, WR, Highsmith, AKBacterial growth and endotoxin production in lipid emulsion. J Clin Microbiol 1984;19:17–20.Google Scholar
37.Shiro, H, Muller, E, Takeda, S, Tosteson, TD, Goldmann, DA, Pier, GB. Potentiation of Staphylococcus epidermidis catheter-related bacteremia by lipid infusions. J Infect Dis 1995;171:220–224.Google Scholar
38.Snydman, DRMurray, SA, Kornfeld, SJ, Majka, JA, Ellis, CA. Total parenteral nutrition-related infections. Prospective epidemiologic study using semiquantitative methods. Am J Med 1982;73:695–699.Google Scholar
39.Beck-Sague, CM, Jarvis, WR, the National Nosocomial Infections Surveillance System. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. J Infect Dis 1993;167:1247–1251.Google Scholar