成人重症监护病房中的医疗保健相关性感染：一项多源研究，调查护士的安全态度、护理质量、护理疏忽和护士人力配置。
Healthcare-associated infections in adult intensive care units: A multisource study examining nurses' safety attitudes, quality of care, missed care, and nurse staffing.
机构信息
School of Nursing, University of Wollongong, Wollongong, NSW 2500 Australia.
School of Nursing, University of Wollongong, Wollongong, NSW 2500 Australia; Discipline of Nursing, Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia.
出版信息
Intensive Crit Care Nurs. 2023 Oct;78:103480. doi: 10.1016/j.iccn.2023.103480. Epub 2023 Jun 26.
OBJECTIVES
This study examined the association between safety attitudes, quality of care, missed care, nurse staffing levels, and the rate of healthcare-associated infection (HAI) in adult intensive care units (ICUs).
METHODS
A cross-sectional study was conducted in five hospitals. Nurses completed a validated survey on safety attitudes, quality of care, missed care, nurse staffing levels, and the frequency of HAIs. Secondary data were collected on the incidence of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) in participating units. Descriptive analysis and generalized linear models were performed.
RESULTS
A total of 314 nurses from eight ICUs participated in this study. The mean safety culture score was 60.85 (SD = 3.53). ICUs with strong job satisfaction had lower incidence and nurse-reported frequency of CLABSI, CAUTI, and VAP. Missed care was common, with 73.11% of nurses reporting missing at least one required care activity on their last shift. The mean patient-to-nurse ratio was 1.95. Increased missed care and higher workload were associated with higher HAIs. Nurses' perceptions of CLABSI and VAP frequency were positively associated with the actual occurrence of CLABSI and VAP in participating units.
CONCLUSION
Positive safety culture and better nurse staffing levels can lower the rates of HAIs in ICUs. Improvements to nurse staffing will reduce nursing workloads, which may reduce missed care, increase job satisfaction, and, ultimately, reduce HAIs.
IMPLICATIONS FOR CLINICAL PRACTICE
Higher levels of job satisfaction among ICU nurses, lower proportions of missed nursing care and higher nurse staffing are associated with lower rates of HAIs. Nurse-reported HAI frequency was positively associated with the incidence of HAIs; therefore, nurses provide reliable data on infection control outcomes in ICU settings.
目的
本研究旨在探讨成人重症监护病房（ICU）中安全态度、护理质量、护理差错、护士人力配置水平与医疗相关感染（HAI）发生率之间的关系。
方法
在五家医院进行了一项横断面研究。护士们完成了一份关于安全态度、护理质量、护理差错、护士人力配置水平以及 HAI 发生频率的经过验证的调查问卷。参与单位的中心静脉导管相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）和呼吸机相关性肺炎（VAP）的发病率数据则通过二次数据收集。进行了描述性分析和广义线性模型分析。
结果
共有来自八个 ICU 的 314 名护士参与了这项研究。安全文化评分的平均值为 60.85（SD=3.53）。工作满意度高的 ICU 发生 CLABSI、CAUTI 和 VAP 的比例和护士报告的频率均较低。护理差错较为常见，73.11%的护士在上次轮班时至少漏报了一项必要的护理活动。患者与护士的比例平均为 1.95。护理差错的增加和工作量的增加与 HAI 的发生率增加有关。护士对 CLABSI 和 VAP 频率的感知与参与单位 CLABSI 和 VAP 的实际发生情况呈正相关。
结论
积极的安全文化和更好的护士人力配置水平可以降低 ICU 中 HAI 的发生率。改善护士人力配置将减少护理工作量，从而可能减少护理差错、提高工作满意度，并最终降低 HAI 的发生率。
临床意义
ICU 护士的工作满意度较高、护理差错比例较低、护士人力配置较高与 HAI 发生率较低有关。护士报告的 HAI 频率与 HAI 的发生率呈正相关；因此，护士在 ICU 环境中提供了可靠的感染控制结果数据。
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