Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Information and Communication Technology, University Hospital Zurich, Zurich, Switzerland.
Antimicrob Resist Infect Control. 2021 Jun 6;10(1):90. doi: 10.1186/s13756-021-00958-z.
Understaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question.
In January 2016, a semiautomatic surveillance system for CLABSI was implemented at the University Hospital Zurich, a 940 bed tertiary care hospital in Switzerland. Monthly incidence rates (CLABSI/1000 catheter days) were calculated and correlations with human resources management-derived data on employee turnover of HCWs (defined as number of leaving HCWs per month divided by the number of employed HCWs) investigated.
Over a period of 24 months, we detected on the hospital level a positive correlation of CLABSI incidence rates and turnover of nursing personnel (Spearman rank correlation, r = 0.467, P = 0.022). In more detailed analyses on the professional training of nursing personnel, a correlation of CLABSI incidence rates and licensed practical nurses (Spearman rank correlation, r = 0.26, P = 0.038) or registered nurses (r = 0.471, P = 0.021) was found. Physician turnover did not correlate with CLABSI incidence (Spearman rank correlation, r = -0.058, P = 0.787).
Prospectively determined CLABSI incidence correlated positively with the degree of turnover of nurses overall and nurses with advanced training, but not with the turnover of physicians. Efforts to maintain continuity in nursing staff might be helpful for sustained reduction in CLABSI rates.
人员配备不足先前被报道为中心静脉相关血流感染（CLABSI）的一个风险因素。以前没有研究解决人员配备波动是否对 CLABSI 发病率有影响的问题。我们分析了前瞻性收集的 CLABSI 监测数据和卫生保健工作者（HCW）离职数据，以解决这一研究问题。
2016 年 1 月，在瑞士苏黎世大学医院实施了半自动化 CLABSI 监测系统，该医院是一家拥有 940 张床位的三级保健医院。计算每月发病率（CLABSI/1000 导管天数），并研究其与 HCW 离职数据（定义为每月离职 HCW 人数除以在职 HCW 人数）的相关性。
在 24 个月的时间内，我们在医院层面上发现 CLABSI 发病率与护理人员离职率呈正相关（Spearman 等级相关，r=0.467，P=0.022）。在对护理人员专业培训的更详细分析中，CLABSI 发病率与持照护士（Spearman 等级相关，r=0.26，P=0.038）或注册护士（r=0.471，P=0.021）的相关性更高。医师离职率与 CLABSI 发病率不相关（Spearman 等级相关，r=−0.058，P=0.787）。
前瞻性确定的 CLABSI 发病率与护理人员总体离职率和受过高级培训的护士离职率呈正相关，但与医师离职率无关。努力保持护理人员的连续性可能有助于持续降低 CLABSI 率。
