Staffing level: a determinant of late-onset ventilator-associated pneumonia.
Staffing level: a determinant of late-onset ventilator-associated pneumonia.
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DOI：
10.1186/cc5974
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Pittet D
中科院分区：
文献类型：
--
作者：
Hugonnet S;Uçkay I;Pittet D
呼吸机相关性肺炎(VAP)的临床和经济负担是毋庸置疑的。我们进行了这项研究，以确定低护士/患者比例是否会增加VAP的风险，以及这种影响是否与早发和晚发VAP相似。这项前瞻性、观察性、单中心队列研究是在日内瓦大学医院的重症监护病房(ICU)进行的。对1999年1月至2002年12月入院的所有有ICU获得性感染风险的患者进行了从入院到出院的随访。收集的变量包括患者特征、入院诊断、急性生理学和慢性健康评估II评分、合并症、接触侵入性设备、每天值班患者和护士的数量、护士培训水平和全部位ICU获得性感染。VAP的诊断采用标准定义。在ICU期间随访的2,470名患者中，209/936名接受机械通气的患者(22.3%)诊断出262次VAP发作。无VAP组和VAP组的中位机械通气时间分别为3天(4分位数2~6天)和11天(6~19天)。晚发型VAP占所有发作的61%。VAP发生率为每1000天发生37.6次(95%可信区间为33.2~42.4)。在研究期间，每日护士与患者的中位数比率为1.9(四分位数范围为1.8至2.2)。通过多因素COX回归分析，我们发现护患比越高，晚发VAP的风险越低(危险比0.42，95%可信区间0.18-0.99)，但与早发VAP无关。较低的护士与患者比例与晚发性VAP的风险增加相关。
The clinical and economic burden of ventilator-associated pneumonia (VAP) is uncontested. We conducted the present study to determine whether low nurse-to-patient ratio increases the risk for VAP and whether this effect is similar for early-onset and late-onset VAP. This prospective, observational, single-centre cohort study was conducted in the medical intensive care unit (ICU) of the University of Geneva Hospitals. All patients who were at risk for ICU-acquired infection admitted from January 1999 to December 2002 were followed from admission to discharge. Collected variables included patient characteristics, admission diagnosis, Acute Physiology and Chronic Health Evaluation II score, co-morbidities, exposure to invasive devices, daily number of patients and nurses on duty, nurse training level and all-site ICU-acquired infections. VAP was diagnosed using standard definitions. Among 2,470 patients followed during their ICU stay, 262 VAP episodes were diagnosed in 209/936 patients (22.3%) who underwent mechanical ventilation. Median duration of mechanical ventilation was 3 days (interquartile range 2 to 6 days) among patients without VAP and 11 days (6 to 19 days) among patients with VAP. Late-onset VAP accounted for 61% of all episodes. The VAP rate was 37.6 episodes per 1,000 days at risk (95% confidence interval 33.2 to 42.4). The median daily nurse-to-patient ratio over the study period was 1.9 (interquartile range 1.8 to 2.2). By multivariate Cox regression analysis, we found that a high nurse-to-patient ratio was associated with a decreased risk for late-onset VAP (hazard ratio 0.42, 95% confidence interval 0.18 to 0.99), but there was no association with early-onset VAP. Lower nurse-to-patient ratio is associated with increased risk for late-onset VAP.
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影响因子：
38.9
作者：
Eggimann, P;Hugonnet, S;Pittet, D
通讯作者：
Pittet, D
影响因子：
2
作者：
Hodge, MB;Asch, SM;Sauvé, MJ
通讯作者：
Sauvé, MJ
影响因子：
9.6
作者：
Rello, J;Ollendorf, DA;Kollef, MH
通讯作者：
Kollef, MH
影响因子：
158.5
作者：
Needleman, J;Buerhaus, P;Zelevinsky, K
通讯作者：
Zelevinsky, K
影响因子：
8.8
作者：
Hugonnet, Stephane;Chevrolet, Jean-Claude;Pittet, Didier
通讯作者：
Pittet, Didier