Association of Nursing Overtime, Nurse Staffing, and Unit Occupancy with Health Care–Associated Infections in the NICU

Objective This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care–associated infections (HCAIs) in the neonatal intensive care unit (NICU). Study Design A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database “Logibec” and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio, and the unit occupancy rate over 3-day periods before HCAI were compared with days that did not precede infections. Adjusted odds ratios (aOR) that control for the latter factors and unit risk factors were also computed. Results A total of 122 (5%) infants developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (aOR, 1.70; 95% confidence interval [95% CI], 1.05–2.75, quartile [Q]4 vs. Q1). High unit occupancy rates were not associated with increased odds of infection (aOR, 0.85; 95% CI, 0.47–1.51, Q4 vs. Q1) nor were higher available/recommended nurse ratios (aOR, 1.16; 95% CI, 0.67–1.99, Q4 vs. Q1). Conclusion Nursing overtime is associated with higher odds of HCAI in the NICU.

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Health care-associated infections at an Egyptian tertiary care hospital: a 2-year prospective study

Menoufia Medical Journal ◽

10.4103/mmj.mmj_455_20 ◽

2021 ◽

Vol 34 (2) ◽

pp. 514

Author(s):

AymanA Sakr ◽

SanaaS Hamam ◽

WafaaA Zahran ◽

ReemM El Kholy ◽

ZeinabA Kasemy ◽

...

Keyword(s):

Health Care ◽

Prospective Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Health Care Associated Infections

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Endocrinology of labour

Fetal and Maternal Medicine Review ◽

10.1017/s0965539500000437 ◽

1991 ◽

Vol 3 (1) ◽

pp. 47-66 ◽

Cited By ~ 8

Author(s):

John RG Challis ◽

Simon C Riley ◽

Kaiping Yang

Keyword(s):

Health Care ◽

Intensive Care ◽

Management Strategy ◽

Neonatal Intensive Care ◽

Preterm Labour ◽

Tertiary Care ◽

Contributory Factor ◽

Mortality And Morbidity ◽

Intensive Care Nursery ◽

The Cost

Preterm labour, defined as delivery before 37 weeks of completed pregnancy, continues to present a major problem in clinical obstetrics and remains the major contributory factor to the perinatal mortality and morbidity statistics. While it is now possible, with recent advances in neonatal care, to take infants delivered very prematurely and provide them with the lifelines that will ensure their ultimate discharge from the neonatal intensive care nursery, the cost of this form of management – in terms both of health care funds and of emotion – is extraordinarily high. Hence there remains a strong rationale for attempting to understand the underlying biochemistry and physiology of labour in order to develop methods of recognizing the patient in true preterm labour, and of developing better strategies to prevent or to manage this condition. In the best of our neonatal intensive care settings, survival of the infant born at 28–30 weeks’ gestation, or greater than 1500 grams, may be greater than 90%. Thus, the clinical management strategy may be directed more towards sustaining intrauterine life for 4–6 weeks in those patients presenting in preterm labour before this time in order to gain time for intrauterine maturation of these fetuses before they are delivered to the tertiary care NICU setting.

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Emerging Chryseobacterium indologenes Infection in Indian Neonatal Intensive Care Units: A Case Report

Antibiotics ◽

10.3390/antibiotics7040109 ◽

2018 ◽

Vol 7 (4) ◽

pp. 109 ◽

Cited By ~ 4

Author(s):

Rishika Mehta ◽

Ashish Pathak

Keyword(s):

Health Care ◽

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Multidrug Resistant ◽

Neonatal Intensive Care Units ◽

Indwelling Catheters ◽

Chryseobacterium Indologenes ◽

Life Threatening ◽

Health Care Associated Infections

Antibiotic-resistant pathogens and nosocomial infections constitute common and serious problems for neonates admitted to neonatal intensive care units worldwide. Chryseobacterium indologenes is a non-lactose-fermenting, gram-negative, health care-associated pathogen (HCAP). It is ubiquitous and intrinsically resistant to several antibiotics. Despite its low virulence, C. indologenes has been widely reported to cause life-threatening infections. Patients on chronic immunosuppressant drugs, harboring invasive devices and indwelling catheters become the nidus for C. indologenes. Typically, C. indologenes causes major health care-associated infections such as pneumonia, empyema, pyelonephritis, cystitis, peritonitis, meningitis, and bacteremia in patients harboring central venous catheters. Management of C. indologenes infection in neonates is not adequately documented owing to underreporting, particularly in India. Because of its multidrug resistance and the scant availability of data from the literature, the effective empirical treatment of C. indologenes is challenging. We present an uncommon case of bacteremia caused by C. indologenes in a preterm newborn baby with moderate respiratory distress syndrome who was successfully treated. We also provide a review of infections in the neonatal age group. Henceforth, in neonates receiving treatments involving invasive equipment use and long-term antibiotic therapy, multidrug resistant C. indologenes should be considered an HCAP.

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Effect of Antiseptic Handwashing vs Alcohol Sanitizer on Health Care–Associated Infections in Neonatal Intensive Care Units

Archives of Pediatrics and Adolescent Medicine ◽

10.1001/archpedi.159.4.377 ◽

2005 ◽

Vol 159 (4) ◽

pp. 377 ◽

Cited By ~ 62

Author(s):

Elaine L. Larson ◽

Jeannie Cimiotti ◽

Janet Haas ◽

Michael Parides ◽

Mirjana Nesin ◽

...

Keyword(s):

Health Care ◽

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Health Care Associated Infections

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Empty Beds in Nursing Homes Filled by Younger Individuals Following ACA Medicaid Eligibility Expansion

Innovation in Aging ◽

10.1093/geroni/igaa057.585 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 181-181

Author(s):

Ashley Ritter ◽

Norma Coe ◽

Salama Freed

Keyword(s):

Nursing Homes ◽

Patient Outcomes ◽

Low Income ◽

Fixed Effects ◽

Severity Index ◽

Occupancy Rate ◽

Percentage Point Increase ◽

Medicaid Eligibility ◽

Facility Level ◽

Occupancy Rates

Abstract National decline in nursing home occupancy rates coupled with expansion of Medicaid insurance eligibility under the Affordable Care Act (ACA) potentially create an opportunity for younger, low-income individuals to enter nursing homes following a hospitalization. Changes in the population of individuals using nursing homes could result in downstream consequences on facility payor mix, case severity index, and ultimately patient outcomes. This study measures the effect of ACA Medicaid eligibility expansion on the patient population using nursing homes, accounting for the nursing homes’ occupancy rate. Data were obtained from the publicly available national dataset, LTCfocus (2009-2016). Difference in differences estimation with time and state fixed effects was utilized to examine the effect of ACA Medicaid eligibility expansion on two outcomes, 1) average age in years of residents as of April 1 and 2) the proportion of individuals covered by Medicaid insurance at the facility level. Results show facilities with pre-ACA occupancy rates between 40% and 50% demonstrated the largest decrease in average age by year three, 1.32 years [95% CI: -2.257, -0.385]. Facilities with a pre-ACA occupancy rate of 60-70% demonstrated the largest increase in the proportion of individuals covered by Medicaid in year one, a 5.5 percentage point increase [95% CI: 0.009, 0.102]. In summary, Medicaid expansion under the ACA resulted in an increase in younger individuals and individuals covered by Medicaid using nursing homes, varying across pre-ACA occupancy rates. It remains to be studied if increased utilization of this high cost setting provides superior patient outcomes for these populations.

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Sa1093 – Health Care Costs of Endoscopy and Patient Outcomes in Unplanned Repeat Endoscopically Placed Nasoenteric Tubes At a Tertiary Care Center

Gastroenterology ◽

10.1016/s0016-5085(19)37476-1 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-268

Author(s):

Florence-Damilola Odufalu ◽

Mitchell Edwards ◽

Bhairvi Jani ◽

Chrisitne Hachem

Keyword(s):

Health Care ◽

Patient Outcomes ◽

Health Care Costs ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Care Costs

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Neonatal Back Transport: Perspectives from Parents of Medicaid-Insured Infants and Providers

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.26.5.301 ◽

2007 ◽

Vol 26 (5) ◽

pp. 301-311 ◽

Cited By ~ 11

Author(s):

Krystal Hanrahan ◽

Mohammad-Ali Attar ◽

Alice Frohna ◽

Molly Gates ◽

Sylvia Lang ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Information Exchange ◽

Neonatal Intensive Care ◽

Community Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Providers ◽

Cross Sectional ◽

Early Communication

Purpose: To examine parents’ and health care providers’ perceptions of back transport from a tertiary care neonatal intensive care unit to a community hospital.Design: Qualitative, hypothesis-generating, cross-sectional study utilizing focus group methodology.Sample: Participants included 12 parents of back-transported infants insured by Medicaid, 6 regional NICU health care providers, and 17 community hospital special care nursery health care providers.Main Outcome Measures: Participant perceptions of factors that support or impede successful back transport.Results: Data from the focus groups were analyzed to identify five main themes: early communication about back transport, preparing parents for back transport, communication between hospitals at the time of back transport, follow-up and information exchange after back transport, and improving the back-transport experience for parents.

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Examining the Relationship between Cost and Quality of Care in the Neonatal Intensive Care Unit and Beyond

Children ◽

10.3390/children7110238 ◽

2020 ◽

Vol 7 (11) ◽

pp. 238

Author(s):

Lauren Culbertson ◽

Dmitry Dukhovny ◽

Wannasiri Lapcharoensap

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Quality Of Care ◽

Neonatal Intensive Care Unit ◽

Patient Outcomes ◽

Neonatal Intensive Care ◽

Future Research ◽

The Relationship

There is tremendous variation in costs of delivering health care, whether by country, hospital, or patient. However, the questions remain: what costs are reasonable? How does spending affect patient outcomes? We look to explore the relationship between cost and quality of care in adult, pediatric and neonatal literature. Health care stewardship initiatives attempt to address the issue of lowering costs while maintaining the same quality of care; but how do we define and deliver high value care to our patients? Ultimately, these questions remain challenging to tackle due to the heterogeneous definitions of cost and quality. Further standardization of these terms, as well as studying the variations of both costs and quality, may benefit future research on value in health care.

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