University of Oulu

Miia M. Jansson, Hannu P. Syrjälä, Tero I. Ala-Kokko, Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality: a prospective, single-center cohort study, Journal of Hospital Infection, Volume 101, Issue 3, 2019, Pages 257-263, ISSN 0195-6701, https://doi.org/10.1016/j.jhin.2018.12.001

Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality : a prospective, single-center cohort study

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Author: Jansson, Miia M.1; Syrjälä, Hannu P.2; Ala-Kokko, Tero I.1,3
Organizations: 1Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
2Department of Infection Control, Oulu University Hospital, Oulu, Finland
3Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe2019042913592
Language: English
Published: Elsevier, 2019
Publish Date: 2019-12-07
Description:

Abstract

Background: Nurse understaffing and increased nursing workload have been associated with increased risk of adverse patient outcomes and even mortality.

Aim: To determine whether nurse staffing and nursing workload are associated with ventilator-associated pneumonia and mortality.

Methods: This prospective, observational cohort study was conducted in a single tertiary-level teaching hospital in Finland during 2014–2015. The association between nurse staffing, nursing workload and prognosis was determined using daily nurse-to-patient ratios, Therapeutic Intervention Scoring System and Intensive Care Nursing Scoring System scores, and Intensive Care Nursing Scoring System indices. Ventilator-associated pneumonia was defined according to the Centers for Disease Control and Prevention criteria.

Findings: Evaluable data was available for 85 patients. The overall ventilator-associated pneumonia and 28-day mortality rates were 23.5% and 35.3%, respectively. Nurse staffing, measured as the daily lowest nurse-to-patient ratio (P = 0.006) and median Intensive Care Nursing Scoring System index (P = 0.046), were significantly lower in patients with ventilator-associated pneumonia. In addition, nursing workload, measured as median scores obtained by the Therapeutic Intervention Scoring System (P = 0.009) and Intensive Care Nursing Scoring System (P = 0.03), was significantly higher in infected patients. The median (P = 0.02) and daily highest (P = 0.03) Intensive Care Nursing Scoring System scores were significantly higher in non-survivors.

Conclusions: Lower nurse staffing and increased nursing workload are associated with ventilator-associated pneumonia and mortality, demonstrating that adequate staffing is a prerequisite for the availability and quality of critical care services.

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Series: Journal of hospital infection
ISSN: 0195-6701
ISSN-E: 1532-2939
ISSN-L: 0195-6701
Volume: 101
Issue: 3
Pages: 257 - 263
DOI: 10.1016/j.jhin.2018.12.001
OADOI: https://oadoi.org/10.1016/j.jhin.2018.12.001
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
316 Nursing
Subjects:
Copyright information: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.
  https://creativecommons.org/licenses/by-nc-nd/4.0/