The correlation between nursing workload and bloodstream infection from central venous catheter in ICU

Abstract

Introduction: Bloodstream infection associated with the presence of central venous catheters is the second most common hospital infection in the Intensive Care Unit (ICU). The nursing stuff is an essential part of the human resources of the ICU which contributes substantially to provide holistic and effective care to critically ill patients. The level of the nursing workload and its possible influence on the clinical course and outcome of critically ill ICU patients has been systematically studied in recent years. Mainly, was studied the connection with the care quality indicators such as mortality and infections Aim: The purpose of this study was to estimate the nursing workload in the ICU and to investigate the impact of bloodstream infection from Central Venous Catheter (CLABSI). Methods: The study sample consisted of 39 patients who were hospitalized in a multidisciplinary ICU in a 3 month period. For the detection of bloodstream infections we used the surveillance definition of CDC/NHSN for in vitro confirmed bloodstream infection (CLABSI). Measurement of nursing workload was via the NAS scale and the calculation was performed for each patient once existed or entering the ICU from baseline and constantly on a daily basis. A comparison of the quantitative variables was done with the statistical criterion Pearson’s x 2 , to compare the bisectors qualitative variables selected quantitative variables was used the t-test analysis and MannWhitney test. Results: Of the total sample, 74,4% (n = 29) were male, with a mean age 59 ± 21 years. The duration of ICU stay was 24 ± 23 days and mortality was 41%. The duration of hospitalization was 28 ± 24 days and the corresponding mortality of 46.2%. All correlations presented no statistically significant difference than the first day’s NAS in which appears the biggest difference between the values (p=0,046) but the NAS of the patients who did not develop bacteremia be more increased over those experienced. Conclusions: The nursing workload in our study did not prove as a risk factor for the occurrence of bloodstream infection in the ICU.

Assessment of Nursing Workload as a Mortality Predictor in Intensive Care Units (ICU) Using the Nursing Activities Score (NAS) Scale

“…Regarding NW of patients’ first-day admission in the ICU, it was 65.15 ± 13.05, where there is a significant increase in the average value of NAS. Similar values were found in Michali et al’s study [ 3 ]. The average time of nursing care was calculated in minutes and this was found to correspond to 789.26 ± 33.7 min, a value much lower than in Dede et al’s study [ 4 ], which was 948.89 ± 103.60 min.…”

“…The above measurements were compared with those recommended by the Federal Council of Nursing (COFEN Resolution 293/2004) and correspond to the 17.9-h minimum average percentage of NAS that seems to belong to the established parameters. The present study therefore revealed a relatively low NW on a daily basis [ 3 , 4 , 21 , 26 ].…”

“…A NAS value of 50% indicates that a nurse can treat two patients simultaneously. A total NAS value of 350% means that during the period under consideration, 3.5 nurses must work in the ICU without interruption for a break [ 3 , 8 , 11 , 16 , 19 ]. Each grade of NAS corresponds to 14.4 min of work per 24 h and does not count time spent on non-nursing activities, such as personal activities (breaks or hand hygiene = 11.2% of working time), activities not directly related to the patient or not included in the health interventions, such as organizational issues, supervision of trainees, or supply of materials (= 6.3% of working time), and activities that are not included in the above categories (= 2.1% of working time).…”

“…Each grade of NAS corresponds to 14.4 min of work per 24 h and does not count time spent on non-nursing activities, such as personal activities (breaks or hand hygiene = 11.2% of working time), activities not directly related to the patient or not included in the health interventions, such as organizational issues, supervision of trainees, or supply of materials (= 6.3% of working time), and activities that are not included in the above categories (= 2.1% of working time). The sum of the time available for the above activities is estimated to correspond to 1 h and 34.08 min per 8-h shift [ 3 , 14 ]. The scale is considered valid and has been widely used internationally for the evaluation of NW in ICUs.…”

“…The evaluation of nursing workload (NW) is the subject of many studies, especially in recent years where health care providers try to reduce the cost of nursing and increase the quality of health care. Studies show that low nursing staffing rates are associated with a negative effect on patients’ health [ 3 , 4 ]. The development of NW monitoring and measurement systems is necessary to document the quality of health services provided, increase the professional satisfaction of nurses, and reduce the stress and burnout that are experienced frequently [ 5 , 6 ].…”