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The Role of Understaffing in Central Venous Catheter-Associated Bloodstream Infection

Published online by Cambridge University Press:  02 January 2015

Scott K. Fridkin ,
Suzanne M. Pear ,
Theresa H. Williamson ,
John N. Galgiani  and
William R. Jarvis
Scott K. Fridkin
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Public Health Service, Department of Health and Human Services, Atlanta, Georgia
Suzanne M. Pear
Affiliation:
Nursing and Medical Services, Veterans Affairs Medical Center, Tucson, Arizona
Theresa H. Williamson
Affiliation:
Nursing and Medical Services, Veterans Affairs Medical Center, Tucson, Arizona
John N. Galgiani
Affiliation:
Nursing and Medical Services, Veterans Affairs Medical Center, Tucson, Arizona Department of Medicine, University of Arizona, Tucson, Arizona
William R. Jarvis*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Public Health Service, Department of Health and Human Services, Atlanta, Georgia
*
Hospital Infections Program, Mailstop E-69, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
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Abstract

Objective:

To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.

Design:

Case-control and cohort studies of surgical intensive care unit (SICU) patients.

Setting:

A university-affiliated Veterans Affairs medical center.

Patients:

Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).

Measurements:

CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.

Results:

When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence inter val, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the out-break period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.

Conclusions:

Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (ie, nosocomial infection) needs to be critically assessed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 3 , March 1996 , pp. 150 - 158
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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References

1. Maki, DG. Infections due to infusion therapy. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little, Brown and Co; 1992:849–898.Google Scholar
2. Banerjee, SN, Emori, TG, Culver, DH, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. Am J Med 1991;91:86S–89S.CrossRefGoogle ScholarPubMed
3. Smith, RL, Meixler, SM, Simberkoff, MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 1991;100(1):164–167.Google Scholar
4. Martin, MA, Pfaller, MA, Wenzel, RP. Coagulase-negative staphylococcal bacteremia: mortality and hospital stay. Ann Intern Med 1989;110:9–16.Google Scholar
5. Rose, R, Hunting, KJ, Townsend, TR, et al. Morbidity, mortality and economics of hospital-acquired bloodstream infections; a controlled trial. South Med J 1977;70:1267–1269.CrossRefGoogle Scholar
6. Townsend, TR, Wenzel, RP. Nosocomial bloodstream infections in a newborn intensive care unit: a case-matched control study of morbidity, mortality, and risk. Am J Epidemiol 1981;114:73–80.Google Scholar
7. Miller, PJ, Farr, BM. Morbidity and mortality associated with multiple episodes of nosocomial bloodstream infection: a cohort study. Infect Control Hosp Epidemiol 1989;10:216–219.10.2307/30144336CrossRefGoogle ScholarPubMed
8. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
9. Maki, DG. Pathogenesis, prevention, and management of infections due to intravascular devices used for infusion therapy. In: Bisno, Al, Walduogel, FA, eds. Infections Associated With Indwelling Medical Devices. Washington, DC: American Society for Microbiology; 1989:161–177.Google Scholar
10. Moro, ML, Viganò, EF, Cozzi Lepri, A. Risk factors for central venous catheter-related infections in surgical and intensive care units—the Central Venous Catheter-Related Infection Study Group. Infect Control Hosp Epidemiol 1994;15:253–264.10.2307/30145577CrossRefGoogle Scholar
11. Cheesbrough, JS, Finch, RG, Burden, RP. A prospective study of the mechanisms of infection associated with hemodialysis catheters. J Infect Dis 1986;154:579–589.Google Scholar
12. Bertone, SA, Fisher, MC, Mortensen, JE. Quantitative skin cultures at potential catheter sites in neonates. Infect Control Hosp Epidemiol 1994;15:315–318.10.2307/30146561Google Scholar
13. Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339–343.Google Scholar
14. Soifer, NE, Edlin, BR, Weinstein, RA, MRH IV Study Group. A randomized IV team trial. Programs and abstracts of the 29th Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology; 1989:1076.Google Scholar
15. Faubion, WC, Wesley, JR, Khaldi, N, et al. Total parenteral nutrition catheter sepsis: impact of the team approach. J Parenter Enteral Nutr 1986;10:642–645.CrossRefGoogle ScholarPubMed
16. Nehme, AE. Nutritional support of the hospitalized patient: the team concept. JAMA 1980;243:1906–1908.Google Scholar
17. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
18. Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous catheter-related infection. N Engl J Med 1977;296:1305–1309.Google Scholar
19. Jarvis, WR, Edwards, JR, Culver, DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(suppl 3B):185S–191S.CrossRefGoogle ScholarPubMed
20. Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1995;13:818–829.CrossRefGoogle Scholar
21. Kleinbaum, DG, Kupper, LL, Morgenstern, H, eds. Epidemiologic Research: Principles and Quantitative Methods. Belmont, CA: Lifetime Learning; 1982.Google Scholar
22. Armstrong, CW, Mayhall, CG, Miller, KB, et al. Clinical predictors of infection of central venous catheters used for total parenteral nutrition. Infect Control Hosp Epidemiol 1990;11:71–78.Google Scholar
23. Haley, RP, Bregman, DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982;145:875–885.Google Scholar