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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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