[Bacterial colonization due to increased nurse workload in an intensive care unit]

Relationship between mental workload and hospital infection in the ICU

BACKGROUND: Nursing is among the most stressful professions. Studies that examine possible factors that influence the mental workload (MWL) of nurses are of fundamental importance, because through these results, efforts can be concentrated on improving their working conditions more efficiently. OBJECTIVE: To investigate the influence of hospital infection on the MWL of nurses in an intensive care unit (ICU). METHOD: Cross-sectional and descriptive study, with a quantitative approach. Three research instruments were used: a sociodemographic questionnaire, the NASA Task Load Index (NASA-TLX) and the Nursing Work Index-Revised Brazilian version (B-NWI-R). The sample consisted of 30 nurses from the ICU of a public hospital in João Pessoa city, Brazil, during the daytime period, and the Spearman correlation test (α= 0,05) was applied to verify associations. RESULTS: There was a high MWL among nurses, with a NASA-TLX weighted average of 66.38 (SD±15.0). Correlations were found between the levels of hospital infection in the ICU and the MWL of the nurses (r = 0.654, p <  0.01); in the nurses’ care of patients with urinary tract infection, the correlation is 0.546, p <  0.01; if care is provided to patients with lung problems, the correlation is 0.563, p <  0.01 The ICU presented a favorable environment to nursing practices, with means lower than 2.5, according to the B-NWI-R. CONCLUSION: The MWL of the nurses was associated with the hospital infection levels of the intensive care sector studied. It was found that the MWL of nurses in relation to hospital infection in the ICU increased by 42.8% . This MWL is impacted by 29.8% when nurses’ care is linked to patients with urinary infection. But if care is provided to patients with lung problems, this percentage rises to 31.7%

Impact of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries: a systematic review

OBJECTIVE

The objective of this review was to determine the effect of nurse staffing on patient and nurse workforce outcomes in acute care settings within low- and middle-income countries.

INTRODUCTION

Health care systems in low- and middle-income countries experience a high proportion of the global burden of disease, which is aggravated by several health care constraints. The high rates of both communicable and non-communicable diseases, low numbers in the workforce, poor distribution of qualified professionals, and constraints in medical supplies and resources make the provision of quality health care challenging in low- and middle-income countries. Health care systems in low- and middle-income countries, however, are still expected to address universal health care access and provide high-quality health care. Systematic reviews examining nurse staffing and its effect on patient and nurse workforce outcomes are largely from the perspective of high-income countries. There is a need to understand the evidence on nurse staffing and its impact in the context of low- and middle-income countries.

INCLUSION CRITERIA

Empirical studies that addressed acute care nurse staffing levels, such as nurse-to-patient ratio or nurses' qualifications, experience, and skill mix, and their influence on patient and nurse workforce outcomes were included in the review. Studies conducted in a low- or middle-income country were included. Outcomes must have been measured objectively using validated tools.

METHODS

Studies published until July 2019 were identified from CINAHL, PubMed, Scopus, Embase, PsycINFO, Cochrane Library, Web of Science, and ProQuest Dissertations and Theses. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis was used for this review. Narrative synthesis was conducted due to high heterogeneity of included studies. The level of evidence was determined using GRADEpro.

RESULTS

Twenty-seven studies were included in this review and the level of evidence was low, mainly due to the design of included studies. Low nurse-to-patient ratio or high nurse workload was associated with higher rates of in-hospital mortality, hospital-acquired infection, medication errors, falls, and abandonment of treatment. Findings on the effect of nurse staffing on length of hospital stay and incidence of pressure ulcers were inconsistent. Extended work hours, less experience, and working night or weekend shifts all significantly increased medication errors. Higher nurse workload was linked to higher levels of nurses' burnout, needlestick and sharps injuries, intent to leave, and absenteeism.

CONCLUSIONS

Lower nurse-to-patient ratios and higher nurse workload are linked to in-hospital mortality, hospital-acquired infections, and medication errors among patients, and high levels of burnout, needlestick and sharps injuries, absenteeism, and intention to leave their job among nurses in low- and middle-income countries. The results of this review show similarities with the evidence from high-income countries regarding poor outcomes for patients and nurses. These findings should be considered in light of the lower nurse-to-patient ratios in most low- and middle-income countries.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018119428.

A Healthcare-Associated Outbreak of Urinary Tract Infections Due to Myroides odoratimimus

Myroides spp. are low-grade opportunistic pathogens. Outbreaks due to Myroides spp. have rarely been described in the literature to date. We report a healthcare-associated outbreak of urinary tract infections (UTIs), caused by Myroides odoratimimus, in a Turkish hospital. As of March 2019 until May 2019, 6 strains of M. odoratimimus were isolated from the urine samples of patients, all of whom were hospitalized in intensive care units. After identification and antibiotic susceptibility testing using the VITEK 2 system, MALDI-TOF-MS and 16S rRNA-based sequencing methods were performed for confirmation and species-level identification. Pulsed-field gel electrophoresis (PFGE) was performed in order to investigate the clonal relatedness of the isolates. All the patients were immunocompromised and underwent urinary catheterization. None of the patients had urinary neoplasm, surgery, or calculi. VITEK 2 and MALDI-TOF-MS systems revealed that the isolates belonged to the Myroides genus; however, the aforementioned systems neglected to identify the isolates at the species level. The isolates were all successfully identified as M. odoratimimus through 16S rRNA-based sequencing. The isolates were resistant to every antibiotic tested. All isolates had an indistinguishable PFGE pattern, thus indicating cross-transmission between cases. Although M. odoratimimus is rarely isolated from human specimens, clinicians should be aware of its ability to cause UTIs and infectious outbreaks.

Impact of medical professionals on Carbapenem-resistant Pseudomonas aeruginosa: moderating effect of workload based on the panel data in China

Background

Antimicrobial resistance (AMR), especially carbapenem-resistant Pseudomonas aeruginosa (CRPA), causes a serious increase in morbidity, mortality and costs. Medical professionals play an important role in curbing AMR. Previous studies overlooked the impact of workload on the relationship between medical professionals and AMR. This study aimed to explore the relationship between medical professionals and the CRPA rate as well as the moderating effect of medical professionals’ workload on this relationship.

Methods

A provincial-level panel dataset from 2014 to 2017 was constructed. Medical professionals were measured by the numbers of physicians, registered nurses, pharmacists, and clinical microbiologists per 1000 population. Workload was measured by the number of daily physician visits. Fixed effect model and hierarchical regression analysis were performed to explore the moderating effect of workload on medical professionals and the CRPA rate.

Results

The numbers of physicians, registered nurses, pharmacists and clinical technicians were significantly negative associated with the CRPA rate (coef. = − 0.889, − 0.775, − 1.176, and − 0.822; P = 0.003, 0.003, 0.011, and 0.007, respectively). Workload had a significant and positive moderating effect on physicians, registered nurses, pharmacists, clinical technicians and the CRPA rate (coef. = 1.270, 1.400, 2.210, and 1.634; P = 0.004, 0.001, 0.035, and 0.003, respectively).

Conclusions

Increasing the number of medical professionals may help curb the CRPA rate. Measures aimed at reducing medical professionals’ workload should be implemented to further improve CRPA performance.

A healthcare-associated outbreak of urinary tract infections due to Myroides odoratimimus

Myroides spp. are low-grade opportunistic pathogens. There were only a few outbreaks due to Myroides spp. described in the literature to date. We report a healthcare-associated outbreak of urinary tract infections caused by Myroides odoratimimus in a Turkish hospital. From March to May 2019, six strains of M. odoratimimus were isolated from the urine samples of patients hospitalized in the intensive care units (ICUs). After identification and antibiotic susceptibility testing with VITEK 2 system, MALDI-TOF-MS and 16S rRNA based sequencing methods were performed for confirmation and species level identification. Pulsed-field gel electrophoresis (PFGE) was used to investigate clonal relatedness of the isolates. All the patients were immunocompromised and underwent urinary catheterization. None of them had urinary neoplasm, surgery or calculi. VITEK 2 and MALDI-TOF-MS systems revealed that the isolates belong to the Myroides genus but lacked to identify the isolates at the species level. 16S rRNA based sequencing successfully identified all the isolates as M. odoratimimus. The isolates were resistant to all antibiotics tested. All isolates had indistinguishable PFGE pattern indicating cross-transmission between cases. Although M. odoratimimus is rarely isolated from human specimens, clinicians should be aware of its ability to cause UTIs and outbreaks.

Nursing Workload, Knowledge about Pain, and Their Relation to Pain Records

PURPOSE

To study the relationship between frequency of pain assessment and nursing workload, and also to analyze the frequency of pain assessment and its relation to knowledge and attitudes toward pain on nursing professionals in intensive care unit.

METHODS

An ambispective study was conducted in a Spanish tertiary-level intensive care unit between October 2017 and April 2018. For measurement of workload, the Nursing Activities Score scale was used, and for measurement of pain knowledge, the Knowledge and Attitudes Survey Regarding Pain was used.

RESULTS

There were 1,207 measurements among 41 nurses and 1,838 among 317 patients. The average nursing workload was high (70.97 points). We found statistically significant positive association between nursing workload and the frequency of assessment (p < .001), as well as frequency of assessment and patients with communicative capacity (p = .008).

CONCLUSIONS

Nursing workload affects the registration and assessment of patients' pain, resulting in a greater number of records as the workload performed by nurses increases. It is necessary to study in greater depth how the severity of pain, gender of the patients, and workload of nurses influence pain registration and assessment.

Mobile application for the evaluation and planning of nursing workload in the intensive care unit

OBJECTIVE

In this study, we present an application type software which employs the Nursing Activities Score (NAS), a management tool for measuring nursing workload prospectively.

METHOD

The system was developed in two modules: WEB (controlled from an Internet browser) for data administration using Java Script; and APP (operated from a smartphone or tablet device) for data acquisition using Hypertext Preprocessor (PHP). White and black box tests were performed in the software.

RESULTS

A software was developed with an interface that allows the calculation of the scale score by the same professional who provided assistance, generating reports to help nursing management. The functional test was successfully performed using the Android operational system.

CONCLUSION

The efficiency of the software was demonstrated by the functional test and the main innovations brought herein are the prospective use and the generation of management reports, which can contribute positively by improving nursing quality and safety in the intensive care unit.

Increased nurse workload is associated with bloodstream infections in very low birth weight infants

Neonatal sepsis is a major cause of morbidity and mortality in very low birth weight infants (VLBWI). Nurse workload considerably affects infection rates in intensive care units. However, data concerning the impact of staff workload on bloodstream infections (BSI) in VLBWI are scarce. The aim of the study was to examine the association between nurse workload and BSI in VLBWI. VLBWI admitted to our neonatal intensive care unit during 2016–2017 were retrospectively analysed. Association between nurse workload, determined by a standardized nursing score, and the BSI occurrence was investigated. A higher nurse workload was significantly associated with higher occurrence of BSI (p = 0.0139) in VLBWI. An assumed workload of 120% or higher, representing the need for additional nurses in our NICU setting, is associated with an elevated risk for BSI in this vulnerable population OR 2.32 (95% CI: 1.42–3.8, p = 0.0005). In conclusion, nurse understaffing is associated with a higher risk for BSI in VLBWI.

Prevenção e controle de infecções relacionadas a assistência à saúde: fatores extrínsecos ao paciente

O objetivo deste estudo foi levantar os fatores extrínsecos ao paciente ligados à Infecções relacionadas a assistência à saúde e apontar medidas utilizadas por enfermeiros no Controle de Infecção relacionadas a estes fatores. Trata-se de uma pesquisa bibliográfica, descritiva e com abordagem qualitativa. Utilizou-se 15 artigos disponíveis nas bases Scielo, Lilacs, BVS e Bireme. O recorte temporal foi de 2009 a 2015. Os resultados apontaram que os principais fatores que possibilitam as infecções são a falta da higienização das mãos, o uso indiscriminado de antibióticos, a ausência de manuais de rotinas e procedimentos técnicos e a não adesão às medidas de precaução pela equipe. Quanto às medidas utilizadas pela CCIH e a equipe de enfermagem, para o controle das infecções, destacaram-se a padronização de técnicas para a realização de procedimentos, atualização de Manuais e a Educação Permanente aos profissionais de saúde. Torna-se assim, relevante a valorização do trabalho da equipe de saúde no contexto da prevenção de infecções hospitalares ligadas a fatores tanto extrínsecos como intrínsecos visando a adequação da segurança do paciente e qualidade assistencial prestada nos serviços de saúde.

A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria

BACKGROUND

The prognostic value of blood culture testing in the diagnosis of bacteremia is limited by contamination.

OBJECTIVES

In this multicenter study, the aim was to evaluate the contamination rates of blood cultures as well as the parameters that affect the culture results.

MATERIALS AND METHODS

Sample collection practices and culture data obtained from 16 university/research hospitals were retrospectively evaluated. A total of 214,340 blood samples from 43,254 patients admitted to the centers in 2013 were included in this study. The blood culture results were evaluated based on the three phases of laboratory testing: the pre-analytic, the analytic, and the post-analytic phase.

RESULTS

Blood samples were obtained from the patients through either the peripheral venous route (64%) or an intravascular catheter (36%). Povidone-iodine (60%) or alcohol (40%) was applied to disinfect the skin. Of the 16 centers, 62.5% have no dedicated phlebotomy team, 68.7% employed a blood culture system, 86.7% conducted additional studies with pediatric bottles, and 43.7% with anaerobic bottles. One center maintained a blood culture quality control study. The average growth rate in the bottles of blood cultures during the defined period (1259 - 26,400/year) was 32.3%. Of the growing microorganisms, 67% were causative agents, while 33% were contaminants. The contamination rates of the centers ranged from 1% to 17%. The average growth time for the causative bacteria was 21.4 hours, while it was 36.3 hours for the contaminant bacteria. The most commonly isolated pathogens were Escherichia coli (22.45%) and coagulase-negative staphylococci (CoNS) (20.11%). Further, the most frequently identified contaminant bacteria were CoNS (44.04%).

CONCLUSIONS

The high contamination rates were remarkable in this study. We suggest that the hospitals' staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment.