Robert J, Fridkin S K, Blumberg H M, Anderson B, White N, Ray S M, Chan J, Jarvis W R
Laboratoire de Bactériologie et Hygiène, Hôpital Pitié-Salpêtrière, Paris, France.
Infect Control Hosp Epidemiol. 2000 Jan;21(1):12-7. doi: 10.1086/501690.
To determine the risk factors for acquisition of nosocomial primary bloodstream infections (BSIs), including the effect of nursing-staff levels, in surgical intensive care unit (SICU) patients.
A nested case-control study.
A 20-bed SICU in a 1,000-bed inner-city public hospital.
28 patients with BSI (case-patients) were compared to 99 randomly selected patients (controls) hospitalized > or =3 days in the same unit.
Case- and control-patients were similar in age, severity of illness, and type of central venous catheter (CVC) used. Case-patients were significantly more likely than controls to be hospitalized during a 5-month period that had lower regular-nurse-to-patient and higher pool-nurse-to-patient ratios than during an 8-month reference period; to be in the SICU for a longer period of time; to be mechanically ventilated longer; to receive more antimicrobials and total parenteral nutrition; to have more CVC days; or to die. Case-patients had significantly lower regular-nurse-to-patient and higher pool-nurse-to-patient ratios for the 3 days before BSI than controls. In multivariate analyses, admission during a period of higher pool-nurse-to-patient ratio (odds ratio [OR]=3.8), total parenteral nutrition (OR=1.3), and CVC days (OR=1.1) remained independent BSI risk factors.
Our data suggest that, in addition to other factors, nurse staffing composition (ie, pool-nurse-to-patient ratio) may be related to primary BSI risk. Patterns in intensive care unit nurse staffing should be monitored to assess their impact on nosocomial infection rates. This may be particularly important in an era of cost containment and healthcare reform.
确定外科重症监护病房（SICU）患者发生医院原发性血流感染（BSI）的危险因素，包括护理人员水平的影响。
一项巢式病例对照研究。
市中心一家拥有1000张床位的公立医院中一个设有20张床位的SICU。
将28例发生BSI的患者（病例患者）与99例在同一科室住院≥3天的随机选择的患者（对照患者）进行比较。
病例患者和对照患者在年龄、疾病严重程度以及使用的中心静脉导管（CVC）类型方面相似。与对照患者相比，病例患者在5个月期间住院的可能性显著更高，该期间的常规护士与患者比例低于8个月的参考期，而储备护士与患者比例高于参考期；在SICU的住院时间更长；机械通气时间更长；接受的抗菌药物和全胃肠外营养更多；CVC留置天数更多；或者死亡。在发生BSI前3天，病例患者的常规护士与患者比例显著低于对照患者，而储备护士与患者比例则高于对照患者。在多变量分析中，储备护士与患者比例较高期间入院（比值比[OR]=3.8）、全胃肠外营养（OR=1.3）和CVC留置天数（OR=1.1）仍然是独立的BSI危险因素。
我们的数据表明，除其他因素外，护士人员配置组成（即储备护士与患者比例）可能与原发性BSI风险相关。应监测重症监护病房护士人员配置模式，以评估其对医院感染率的影响。在成本控制和医疗改革的时代，这可能尤为重要。
