Bed occupancy and nosocomial infections in the intensive care unit: A retrospective observational study in a tertiary hospital
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Abstract
Background. Healthcare-associated infections (HAI) are a major problem globally, contributing to prolonged hospital admissions and poor outcomes.
Objective. To examine HAI incidence and risk factors in an intensive care unit (ICU) during high v. low occupancy periods.
Methods. This retrospective, descriptive analysis investigated HAI incidence among adult patients admitted to the ICU at Chris Hani Baragwanath (CHBH) during a high (H2019) and low (L2020) occupancy. Data were extracted from the clinical records of 440 eligible patients.
Results. We found an increased risk of HAI during H2019 compared with L2020 (relative risk (RR) 1.42, 95% confidence interval (CI) 1.03 - 1.94). The overall frequency density of HAI was 25/1 000 ICU days. There was no difference in the distribution of the site of infection (blood v. other) (p=0.27) or bacterial category (Gram stain) (p=0.62). Five organisms accounted for 89% of pathogens: Klebsiella (26%), Staphylococcus (21%), Acinetobacter (16%), Candida (16%) and Enterobacter (10%). The incidence of multidrug-resistant/extensively drug-resistant (MDR/XDR) organisms was 4.2-fold higher (95% CI 1.3 - 13.4) during H2019 compared with L2020. Logistic regression analysis revealed two independent predictors of nosocomial infection: ICU length of stay (odds ratio (OR) 1.12, 95% CI 1.02 - 1.22) and intercostal drain duration in days (OR 1.27, 95% CI 1.09 - 1.47).
Conclusion. High occupancy in the ICU was associated with an increased risk of HAI and a greater incidence of MDR and XDR pathogens. Increasing ICU length of stay and invasive device duration were independent predictors of HAI.
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References
Appelgren P, Hellström I, Weitzberg E, Söderlund V, Bindslev L, Ransjö U. Risk factors for nosocomial intensive care infection: A long-term prospective analysis. Acta Anaesthesiol Scand 2001;45(6):710-719. https://doi.org/10.1034/j.1399-6576.2001.045006710.x
Melsen W, Rovers M, Groenwold R, et al. Attributable mortality of ventilator-associated pneumonia: A meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013;13(8):665-671. https://doi.org/10.1016/S1473-3099(13)70081-1
Aragon D, Sole M. Implementing best practice strategies to prevent infection in the ICU. Crit Care Nurs Clin North Am 2006;18(4):441-452. https://doi.org/10.1016/j.ccell.2006.08.003
Magill S, Edwards J, Bamberg W, et al. Multistate point- prevalence survey of health care- associated infections. N Eng J Med 2014;370:1198-1208. https://doi.org/10.1056/NEJMoa1306801
Klevens R, Edwards J, Richards C, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Pub Health Rep 2007;122(2):160-166. https://doi. org/10.1177/003335490712200205
Zimlichman E, Henderson D, Tamir O, et al. Health care–associated infections: A meta-analysis of costs and financial impact on the US health care system. J Am Med Assoc Internal Med 2013;173(22):2039-2046. https://doi.org/10.1001/jamainternmed.2013.9763
Centers for Disease Control and Prevention. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention, 2010. https://stacks.cdc.gov/view/ cdc/11550 (accessed 26 March 2024).
European Centre for Disease Prevention and Control. annual epidemiological report on communicable diseases in Europe 2008. Stockholm: ECDC, 2008. https://www.ecdc.europa. eu/en/publications-data/annual-epidemiological-report-communicable-diseases-europe-2008- 2006-data (accessed 26 March 2024).
Allegranzi B, Bagheri S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis. Lancet 2011;377(9761):228-241. https://doi.org/10.1016/S0140-6736(10)61458-4
Dell A, Navsaria P, Gray S, Kloppers J. Nosocomial infections: A further assault on patients in a high-volume urban trauma centre in South Africa. S Afr Med J 2020;110(2):123-125. https://doi. org/10.7196/SAMJ.2020.v110i2.14243
Fotso C, Abaver D, Muballe D, Vasaikar S, Apalata T. Postoperative infections: Aetiology, incidence and risk factors among neurosurgical patients in Mthatha, South Africa. S Afr Med J 2020;110(5):403-408. https://doi.org/10.7196/SAMJ.2020.v110i5.13779
Griffiths P, Renz A, Hughes J, Rafferty A. Impact of organisation and management factors on infection control in hospitals: A scoping review. J Hosp Infect 2009;73(1):1-14. https://doi. org/10.1016/j.jhin.2009.05.003
Cunningham J, Kernohan W, Rush T. Bed occupancy, turnover intervals and MRSA rates in English hospitals. Br J Nurs 2006;15(12):656-660. https://doi.org/10.12968/bjon.2006.15.12.21398 14. Fridkin S, Pear S, Williamson T, Galgiani J, Jarvis W. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17(3):150-158.
https://doi.org/10.1017/S0195941700006445
Clements A, Halton K, Graves N, et al. Overcrowding and understaffing in modern health-care systems: Key determinants in methicillin-resistant Staphylococcus aureus transmission. Lancet Infect Dis 2008;8(7):427-434. https://doi.org/10.1016/S1473-3099(08)70151-8
Vicca A. Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J Hosp Infect 1999;43(2):109-113. https://doi. org/10.1053/jhin.1999.0246
Ahyow L, Lambert P, Jenkins D, Neal K, Tobin M. Bed Occupancy rates and hospital-acquired clostridium difficile infection: A cohort study. Infect Control Hosp Epidemiol 2013;34(10):1062- 1069. https://doi.org/10.1086/673156
Borg M. Bed occupancy and overcrowding as determinant factors in the incidence of MRSA infections within general ward settings. J Hosp Infect 2003;54(4):316-318. https://doi.org/10.1016/ S0195-6701(03)00153-1
Nijssen S, Bonten M, Franklin C, Verhoef J, Hoepelman A, Weinstein R. Relative risk of physicians and nurses to transmit pathogens in a medical intensive care unit. Arch Internal Med 2003;163(22):2785-2786. https://doi.org/10.1001/archinte.163.22.2785
Dubory A, Giorgi H, Walter A, et al. Surgical-site infection in spinal injury: Incidence and risk factors in a prospective cohort of 518 patients. Eur Spine J 2015;24(3):543-554. https://doi. org/10.1007/s00586-014-3523-4
Beavers S, Blossom D, Wiemken T, et al. Comparison of risk factors for recovery of Acinetobacter baumannii during outbreaks at two Kentucky hospitals, 2006. Pub Health Rep 2009;124(6):868- 874. https://doi.org/10.1177/003335490912400615
Rodríguez-Acelas A, de Abreu Almeida M, Engelman B, Cañon-Montañez W. Risk factors for healthcare-associated infection in hospitalised adults: Systematic review and meta-analysis. Am J Infect Control 2017;45(12):e149-156. https://doi.org/10.1016/j.ajic.2017.08.016
Ayed H, Yaich S, Trigui M, et al. Prevalence and risk factors of healthcare-associated infections in a limited resources country: A cross-sectional study. Am J Infect Control 2019;47(8):945-950. https://doi.org/10.1016/j.ajic.2019.01.008
Garner J, Jarvis W, Emori T, Horan T, Hughes J. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16(3):128-140. https://doi.org/10.1016/0196-6553(88)90053-3
Starakis I, Marangos M, Gikas A, Pediaditis I, Bassaris H. Repeated point prevalence survey of nosocomial infections in a Greek University Hospital. J Chemotherapy 2002;14(3):272-278. https://doi.org/10.1179/joc.2002.14.3.272
Eriksen H, Iversen B, Aavitsland P. Prevalence of nosocomial infections in hospitals in Norway, 2002 and 2003. J Hosp Infect 2005;60(1):40-45. https://doi.org/10.1016/j.jhin.2004.09.038
Klavs I, Bufon Luznik T, Skerl M, et al. Prevalence of and risk factors for hospital-acquired infections in Slovenia-results of the first national survey, 2001. J Hosp Infect 2003;54(2):149-157. https://doi.org/10.1016/s0195-6701(03)00112-9
Vaqué J, Rosselló J, Arribas J. Prevalence of nosocomial infections in Spain: EPINE study 1990- 1997. EPINE Working Group. J Hosp Infect 1999;43 Suppl:S105-111. https://doi.org/10.1016/ s0195-6701(99)90073-7
Tabah A, Koulenti D, Laupland K, et al. Characteristics and determinants of outcome of hospital- acquired bloodstream infections in intensive care units: The EUROBACT International Cohort Study. Intensive Care Med 2012;38(12):1930-1945. https://doi.org/10.1007/s00134-012-2695-9