1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Division of Acute Care Surgery Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
2 Robert Wood Johnson University Hospital, Barnabas Health, New Brunswick, New Jersey.
Surg Infect (Larchmt). 2019 May/Jun;20(4):332-337. doi: 10.1089/sur.2018.240. Epub 2019 Feb 15.
Hospital over-capacity often forces boarding patients outside of their designated intensive care unit (ICU). Anecdotal evidence suggested medical intensive care unit (MICU) patients boarding in the surgical intensive care unit (SICU) were responsible for increases in healthcare-associated infection (HAI) rates. We studied the effect of ICU boarding on rates of SICU HAIs. This single-center, retrospective two-year database study compared primary SICU patients (Home) to MICU patients boarding in the SICU (Boarders). Variables studied included age, gender, Acute Physiology and Chronic Health Evaluation III (APACHE III) scores, and comorbidities. Healthcare-associated infections included infection, catheter-associated urinary tract infections, central line-associated blood stream infection, and ventilator-associated pneumonia. Student t-test, Fisher exact testing, and a multivariable regression model were used to determine the significance of associations. A total of 2,562 patients were included in the study; 328 (12.8%) were Boarders and 2,234 (87.2%) were Home. Univariable analysis demonstrated that Boarders were older (64.0 ± 16.9 vs. 60.2 ± 17.4), more severely ill (APACHE III score 70.5 ± 31.1 vs. 53.4 ± 21.9), more likely to have cirrhosis, coronary artery disease, and asthma/chronic obstructive pulmonary disease, but less likely to have hypertension. On univariable analysis boarding was associated with an increase HAI rate (19 HAI/1,000 patient days vs. 6.2, p < 0.001). Multivariable regression modeling demonstrated boarding status remained independently associated with HAI (odds ratio [OR] 1.83 95% confidence interval [CI] 1.02-3.27). Cost estimates demonstrated an additional cost of $83,303 per 1,000 patient days. The practice of hospital boarding is associated with development of HAI and increased hospital costs. Efforts at determining the cause of this increase and then reducing HAIs will improve patient care and help hospital budgets.
医院容量过剩常常迫使患者在重症监护病房（ICU）外加床。有传闻称，在外科重症监护病房（SICU）加护的内科重症监护病房（MICU）患者导致了医疗相关感染（HAI）率的上升。我们研究了 ICU 加床对 SICU HAI 发生率的影响。这项单中心、回顾性的两年数据库研究比较了主要 SICU 患者（Home）和在 SICU 加床的 MICU 患者（Boarders）。研究的变量包括年龄、性别、急性生理学和慢性健康评估 III（APACHE III）评分和合并症。医疗相关感染包括肺部感染、导管相关尿路感染、中心静脉相关血流感染和呼吸机相关性肺炎。采用学生 t 检验、Fisher 确切检验和多变量回归模型来确定关联的显著性。共有 2562 名患者纳入研究；328 名（12.8%）为 Boarders，2234 名（87.2%）为 Home。单变量分析表明，Boarders 年龄较大（64.0±16.9 岁 vs. 60.2±17.4 岁），病情更重（APACHE III 评分 70.5±31.1 分 vs. 53.4±21.9 分），更有可能患有肝硬化、冠心病和哮喘/慢性阻塞性肺疾病，但不太可能患有高血压。单变量分析表明，加床与 HAI 发生率增加相关（1000 个患者日发生 19 例 HAI 与 6.2 例，p<0.001）。多变量回归模型显示，加床状态与 HAI 仍独立相关（比值比 [OR] 1.83，95%置信区间 [CI] 1.02-3.27）。成本估算表明，每 1000 个患者日增加 83303 美元的额外成本。医院加床的做法与 HAI 的发生和医院成本的增加有关。努力确定这种增加的原因，并随后降低 HAI，将改善患者的护理，并帮助医院的预算。
