The effect of workload on infection risk in critically ill patients
The effect of workload on infection risk in critically ill patients
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DOI：
10.1097/01.ccm.0000251125.08629.3f
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发表时间：
2007-01-01
影响因子：
8.8
通讯作者：
Pittet, Didier
中科院分区：
文献类型：
--
作者：
Hugonnet, Stephane;Chevrolet, Jean-Claude;Pittet, Didier
目的：越来越多的证据表明，护士人员配备不足会危及患者护理质量。该研究的目的是确定人员配置水平低是否会增加重症监护中的感染风险。设计：观察性、单中心、前瞻性队列研究。地点：瑞士日内瓦大学医院重症监护室。患者。所有患者均在 4 年期间入院。干预措施：无。测量和主要结果。研究变量包括重症监护中获得的所有感染、每日护士与患者的比例、人口统计学特征、入院诊断和严重程度评分、合并症、每日个人接触侵入性设备和所选药物。在总共 10,637 个患者日的 1,883 名患者队列中，415 名患者 (22%) 在重症监护期间至少出现一种与医疗保健相关的感染。总体感染率为每 1000 个患者日 64.5 次。与非感染患者相比，感染患者在重症监护室和医院的住院时间更长，死亡率更高（感染风险均降低 30%（发病率比，0.69；95% 置信区间，0.50-0.95）。我们估计，如果护士与患者的比例保持 > 2.2，则可以避免 26.7% 的感染。结论。人员配备是医疗保健相关感染的关键决定因素假设重症患者存在因果关系，如果护士人员配置保持在较高水平，则很大一部分感染是可以避免的。
Objective: There is growing evidence that low nurse staffing jeopardizes quality of patient care. The objective of the study was to determine whether low staffing level increases the infection risk in critical care.Design: Observational, single-center, prospective cohort study.Setting: Medical intensive care unit of the University of Geneva Hospitals, Switzerland.Patients. All patients admitted over a 4-yr period.Interventions: None.Measurements and Main Results. Study variables included all infections acquired in critical care, daily nurse-to-patient ratio, demographic characteristics, admission diagnosis and severity score, comorbidities, daily individual exposure to invasive devices, and selected drugs. Of a cohort of 1,883 patients totaling 10,637 patient-days, 415 (22%) developed at least one healthcare-associated infection while in critical care. Overall infection rate was 64.5 episodes per 1000 patient-days. Infected patients experienced higher mortality with a longer duration of stay both in critical care and in the hospital than noninfected patients (all p 30% infection risk reduction (incidence rate ratio, 0.69; 95% confidence interval, 0.50-0.95). We estimated that 26.7% of all infections could be avoided if the nurse-to-patient ratio was maintained > 2.2.Conclusions. Staffing is a key determinant of healthcare-associated infection in critically ill patients. Assuming causality, a substantial proportion of all infections could be avoided if nurse staffing were to be maintained at a higher level.