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Médecine du travail du personnel hospitalier

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

Auteur     Renata M Daud-Gallotti
Auteur     Silvia F Costa
Auteur     Thais Guimarães
Auteur     Katia Grillo Padilha
Auteur     Evelize Naomi Inoue
Auteur     Tiago Nery Vasconcelos
Auteur     Fernanda da Silva Cunha Rodrigues
Auteur     Edizângela Vasconcelos Barbosa
Auteur     Walquíria Barcelos Figueiredo
Auteur     Anna S Levin
Résumé     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.
Publication     PloS one
Volume     7
Numéro     12
Pages     e52342
Date     2012

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