Nursing Workload as a Risk Factor for Healthcare Associated Infections in ICU: A Prospective Study

Author(s)

Daud-Gallotti, Renata M. ^{[1, 2]} ; Costa, Silvia F. ^{[3, 4]} ; Guimaraes, Thais ^[5] ; Padilha, Katia Grillo ^[6] ; Inoue, Evelize Naomi ; Vasconcelos, Tiago Nery ; Cunha Rodrigues, Fernanda da Silva ; Barbosa, Edizangela Vasconcelos ^[7] ; Figueiredo, Walquiria Barcelos ^[7] ; Levin, Anna S. ^{[3, 4, 5]}

Affiliation

^[1] Univ Nove Julho, Fac Med, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Humanizat Tech Div, Hosp Clin, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Dept Infect Dis, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Fac Med, LIM 54, Sao Paulo - Brazil

^[5] Univ Sao Paulo, Dept Infect Control, Hosp Clin, Fac Med, Sao Paulo - Brazil

^[6] Univ Sao Paulo, Sch Nursing, Sao Paulo - Brazil

^[7] Univ Sao Paulo, Nursing Div, Fac Med, Hosp Clin, Sao Paulo - Brazil

• Document type: Journal article
• Source: PLoS One; v. 7, n. 12 DEC 27 2012.
• Web of Science Citations: 51

Abstract

Introduction: Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI). This study aimed to evaluate the role of nursing workload in the occurrence of HAI, using Nursing Activities Score (NAS). Methods: This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009). Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses' patient care plans (NPC) was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not. Results: 195 patients were included and 43 (22%) developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019) and severity of patient's clinical condition (OR: 1.13; p: 0.015) remained as risk factors to HAI. Conclusions: Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS. (AU)

• FAPESP's process: 08/00955-2 - Patient safety in intensive care: a prospective study
• Grantee: Renata Mahfuz Daud Gallotti
• Support Opportunities: Regular Research Grants