PDF(Pubmed)
Abstract：
UNASSIGNED: To evaluate the association between shift-level organizational data (unit occupancy, nursing overtime ratios [OTRs], and nursing provision ratios [NPRs]) with nosocomial infection (NI) among infants born very preterm in the neonatal intensive care unit (NICU).
UNASSIGNED: This was a multicenter, retrospective cohort study, including 1921 infants 230/7-326/7 weeks of gestation admitted to 3 tertiary-level NICUs in Quebec between 2014 and 2018. Patient characteristics and outcomes (NIs) were obtained from the Canadian Neonatal Network database and linked to administrative data. For each shift, unit occupancy (occupied/total beds), OTR (nursing overtime hours/total nursing hours), and NPR (number of actual/number of recommended nurses) were calculated. Mixed-effect logistic regression models were used to calculate aOR for the association of organizational factors (mean over 3 days) with the risk of NI on the following day for each infant.
UNASSIGNED: Rate of NI was 11.5% (220/1921). Overall, median occupancy was 88.7% [IQR 81.0-94.6], OTR 4.4% [IQR 1.5-7.6], and NPR 101.1% [IQR 85.5-125.1]. A greater 3-day mean OTR was associated with greater odds of NI (aOR 1.08, 95% CI 1.02-1.15), a greater 3-day mean NPR was associated lower odds of NI (aOR 0.96, 95% CI 0.95-0.98), and occupancy was not associated with NI (aOR, 0.99, 95% CI 0.96-1.02). These findings were consistent across multiple sensitivity analyses.
UNASSIGNED: Nursing overtime and nursing provision are associated with the adjusted odds of NI among infants born very preterm in the NICU. Further interventional research is needed to infer causality.
UNASSIGNED: This was a multicenter, retrospective cohort study, including 1921 infants 230/7-326/7 weeks of gestation admitted to 3 tertiary-level NICUs in Quebec between 2014 and 2018. Patient characteristics and outcomes (NIs) were obtained from the Canadian Neonatal Network database and linked to administrative data. For each shift, unit occupancy (occupied/total beds), OTR (nursing overtime hours/total nursing hours), and NPR (number of actual/number of recommended nurses) were calculated. Mixed-effect logistic regression models were used to calculate aOR for the association of organizational factors (mean over 3 days) with the risk of NI on the following day for each infant.
UNASSIGNED: Rate of NI was 11.5% (220/1921). Overall, median occupancy was 88.7% [IQR 81.0-94.6], OTR 4.4% [IQR 1.5-7.6], and NPR 101.1% [IQR 85.5-125.1]. A greater 3-day mean OTR was associated with greater odds of NI (aOR 1.08, 95% CI 1.02-1.15), a greater 3-day mean NPR was associated lower odds of NI (aOR 0.96, 95% CI 0.95-0.98), and occupancy was not associated with NI (aOR, 0.99, 95% CI 0.96-1.02). These findings were consistent across multiple sensitivity analyses.
UNASSIGNED: Nursing overtime and nursing provision are associated with the adjusted odds of NI among infants born very preterm in the NICU. Further interventional research is needed to infer causality.
摘要：
■要评估班次级组织数据(单位占用率，护理加班比率[OTR]，和护理提供比[NPRs]）在新生儿重症监护病房（NICU）中早产的婴儿中发生医院感染（NI）。
■这是一个多中心，回顾性队列研究，包括2014年至2018年间魁北克3个三级NICU收治的1921名怀孕230/7-326/7周的婴儿。患者特征和结果（NIs）是从加拿大新生儿网络数据库获得的，并与管理数据相关联。对于每个班次，单位占用率(占用/总床位)，OTR（护理加班时间/总护理时间），并计算NPR(实际/推荐护士人数).使用混合效应逻辑回归模型来计算每个婴儿的组织因素（3天内的平均值）与第二天NI风险的关联的aOR。
■NI率为11.5%（220/1921）。总的来说,入住率中位数为88.7%[IQR81.0-94.6]，OTR4.4%[IQR1.5-7.6]，和NPR101.1%[IQR85.5-125.1]。更大的3天平均OTR与更大的NI几率相关(aOR1.08，95%CI1.02-1.15)，更大的3天平均NPR与更低的NI几率相关(aOR0.96，95%CI0.95-0.98)，和入住率与NI(AOR，0.99，95%CI0.96-1.02）。这些发现在多个敏感性分析中是一致的。
■在NICU中非常早产的婴儿中，护理超时和护理提供与NI的校正几率相关。需要进一步的干预研究来推断因果关系。
■这是一个多中心，回顾性队列研究，包括2014年至2018年间魁北克3个三级NICU收治的1921名怀孕230/7-326/7周的婴儿。患者特征和结果（NIs）是从加拿大新生儿网络数据库获得的，并与管理数据相关联。对于每个班次，单位占用率(占用/总床位)，OTR（护理加班时间/总护理时间），并计算NPR(实际/推荐护士人数).使用混合效应逻辑回归模型来计算每个婴儿的组织因素（3天内的平均值）与第二天NI风险的关联的aOR。
■NI率为11.5%（220/1921）。总的来说,入住率中位数为88.7%[IQR81.0-94.6]，OTR4.4%[IQR1.5-7.6]，和NPR101.1%[IQR85.5-125.1]。更大的3天平均OTR与更大的NI几率相关(aOR1.08，95%CI1.02-1.15)，更大的3天平均NPR与更低的NI几率相关(aOR0.96，95%CI0.95-0.98)，和入住率与NI(AOR，0.99，95%CI0.96-1.02）。这些发现在多个敏感性分析中是一致的。
■在NICU中非常早产的婴儿中，护理超时和护理提供与NI的校正几率相关。需要进一步的干预研究来推断因果关系。
