Báo cáo y học: Staffing level: a determinant of late-onset ventilator-associated pneumonial

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Staffing level: a determinant of late-onset ventilator-associated pneumonia...
Nội dung trích xuất từ tài liệu:
Báo cáo y học: "Staffing level: a determinant of late-onset ventilator-associated pneumonial" Available online http://ccforum.com/content/11/4/R80Research Open AccessVol 11 No 4Staffing level: a determinant of late-onset ventilator-associatedpneumoniaStéphane Hugonnet, Ilker Uçkay and Didier PittetInfection Control Program, University of Geneva Hospitals, Rue Micheli-du-Crest, 1211 Geneva 14, SwitzerlandCorresponding author: Didier Pittet, didier.pittet@hcuge.chReceived: 9 Mar 2007 Revisions requested: 15 May 2007 Revisions received: 8 Jun 2007 Accepted: 19 Jul 2007 Published: 19 Jul 2007Critical Care 2007, 11:R80 (doi:10.1186/cc5974)This article is online at: http://ccforum.com/content/11/4/R80© 2007 Hugonnet et al.; licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction The clinical and economic burden of ventilator- Results Among 2,470 patients followed during their ICU stay,associated pneumonia (VAP) is uncontested. We conducted 262 VAP episodes were diagnosed in 209/936 patientsthe present study to determine whether low nurse-to-patient (22.3%) who underwent mechanical ventilation. Medianratio increases the risk for VAP and whether this effect is similar duration of mechanical ventilation was 3 days (interquartilefor early-onset and late-onset VAP. range 2 to 6 days) among patients without VAP and 11 days (6 to 19 days) among patients with VAP. Late-onset VAPMethods This prospective, observational, single-centre cohort accounted for 61% of all episodes. The VAP rate was 37.6study was conducted in the medical intensive care unit (ICU) of episodes per 1,000 days at risk (95% confidence interval 33.2the University of Geneva Hospitals. All patients who were at risk to 42.4). The median daily nurse-to-patient ratio over the studyfor ICU-acquired infection admitted from January 1999 to period was 1.9 (interquartile range 1.8 to 2.2). By multivariateDecember 2002 were followed from admission to discharge. Cox regression analysis, we found that a high nurse-to-patientCollected variables included patient characteristics, admission ratio was associated with a decreased risk for late-onset VAPdiagnosis, Acute Physiology and Chronic Health Evaluation II (hazard ratio 0.42, 95% confidence interval 0.18 to 0.99), butscore, co-morbidities, exposure to invasive devices, daily there was no association with early-onset VAP.number of patients and nurses on duty, nurse training level andall-site ICU-acquired infections. VAP was diagnosed using Conclusion Lower nurse-to-patient ratio is associated withstandard definitions. increased risk for late-onset VAP.Introduction use of H2 blocking agents, timing of tracheotomy, failed sub-Ventilator-associated pneumonia (VAP) is the most frequent glottic aspiration and low intracuff pressure [2,7,8]. Further-preventable adverse event affecting critically ill patients [1]. It more, the aetiopathogenesis of VAP has not been fullyoccurs in approximately 25% of patients undergoing mechan- elucidated, and there is much debate and research into the ori-ical ventilation, for a rate of 4 to 25 episodes per 1,000 venti- gin of the micro-organisms that are involved in VAP and con-lator-days. Previous research has yielded conflicting results on sequently into preventative measures [2,7-10].attributable mortality, and reports range from 0% to as high as70% [2-4]. VAP prolongs length of stay by up to 50 days, At a time of universal cost containment policies, there is grow-duration of mechanical ventilation by 5 to 7 days, and gener- ing evidence that high workload or low staffing level increasesates substantial extra costs, in the order of US$10,000 to the risk for negative patient outcomes [11,12], such as death40,000 per episode [2,5,6]. [13] and nosocomial infection [12,14-16]. In a previous study ...