The Critical Care Work Environment and Nurse-Reported Health Care-Associated Infections

Abstract

Background Critically ill patients are susceptible to health care–associated infections because of their illnesses and the need for intravenous access and invasive monitoring. The critical care work environment may influence the likelihood of infection in these patients. Objective To determine whether or not the critical care nurse work environment is predictive of nurse-reported health care–associated infections. Methods A retrospective, cross-sectional design was used with linked nurse and hospital survey data. Nurses assessed the critical care work environment and provided the frequencies of ventilator-associated pneumonias, urinary tract infections, and infections associated with central catheters. Logistic regression models were used to determine if critical care work environments were predictive of nurse-reported frequent health care–associated infections, with controls for nurse and hospital characteristics. Results The final sample consisted of 3217 critical care nurses in 320 hospitals. Compared with nurses working in poor work environments, nurses working in better work environments were 36% to 41% less likely to report that health care–associated infections occurred frequently. Conclusion Health care–associated infections are less likely in favorable critical care work environments. These findings, based on the largest sample of critical care nurses to date, substantiate efforts to focus on the quality of the work environment as a way to minimize the frequency of health care–associated infections.

Critical Care Nurse Work Environments 2013: A Status Report

“…Better practice environments were positively and significantly associated with error interception. Kelly and colleagues 10 investigated the relationship between critical care work environments and nurse-reported health care-associated infections (HAIs), using a sample of 3217 critical care nurses in 32 hospitals. There was a significant association between the health of the work environment and the occurrence of HAIs; in better work environments, nurse-reported HAIs were less likely to occur.…”

Carga de trabalho de enfermagem: preditor de infecção relacionada à assistência à saúde na terapia intensiva?

“…Recent studies that analyzed more than 300 ICUs reported that work environments with higher nurse-patient ratios are associated with decreased rates of HAI and mortality. It is also significant that the greater the number of nursing professionals with higher education in nursing, the greater the impact on patient survival (5,7) . In fact, the nursing workload has been shown to be an important factor in the development of adverse events in patients admitted to the ICU.…”

“…Despite being the most frequent adverse event in hospitals, the low quality of records, difficulty in obtaining reliable data and lack of standardization of terms hinder surveillance of HAI (3) . HAI acquired in intensive care units (ICU) represent almost 20% of all hospital acquired infections diagnosed among hospitalized patients, with significant morbidity and mortality rates and high costs for the health care system, patients and their families (3)(4)(5) . Because they are critically ill and require various invasive procedures, patients admitted to ICU are often affected by various types of HAI.…”

“…Because they are critically ill and require various invasive procedures, patients admitted to ICU are often affected by various types of HAI. It is estimated that about 30% of patients admitted to ICU have at least one episode of infection, especially urinary tract infection (UTI), ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) (3)(4)(5) . The occurrence of these infections is associated with an aging population and the increasing complexity of patients treated in the ICU, combined with the presence, type and duration of many invasive procedures such as vesical and venous catheterization, orotracheal intubation for mechanical ventilation, and failures related to the use of antimicrobial agents (1) .…”

The Association of Nursing Workloads, Organizational, and Individual Factors with Adverse Patient Outcome

“…Those adverse outcomes result in injuries affecting one or several patients, or can be potentially dangerous (7,8). When adverse events are not controlled or prevented, they lead to long-term hospitalization, death, disability at discharge time, or changes in primary treatments (9,10). In developed countries, the incident ranges from 3.5% in the U.S. (11), 9.2% in Canada (12), to 12.3% in Sweden (13).…”