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25-03-2013 | Emergency medicine | Article

Understaffing for intensive care infants has infection consequences


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medwireNews: Nurse understaffing relative to national guidelines is associated with higher rates of infection among very-low-birthweight (VLBW) infants in US neonatal intensive care units (NICUs), a study shows.

Sixty-seven NICUs from the Vermont Oxford Network, a voluntary network of hospital NICUs disproportionately recognized for nursing excellence, were included in the study.

Lead researcher Jeanette Rogowski (University of Medicine and Dentistry of New Jersey, Piscataway, USA) and colleagues looked at data for all inborn VLBW infants, with a NICU stay of at least 3 days, discharged in 2008 (n=5771) and 2009 (n=5630).

Nurse understaffing was measured relative to minimum guidelines using two different methods: a web-based survey in 2008; and data for four complete shifts in 2009/2010. The authors acknowledge that "survey-based measures are expected to be biased toward larger understaffing compared with complete shift data," but add that "the results based on the 2009 data were emphasized." They also point out that the use of minimum guidelines should lead to conservative estimates of understaffing.

Hospitals were found to have understaffed 32% of all NICU infants in 2009, and this rose to 92% of high-acuity infants, who are particularly at risk and need higher levels of care. To meet minimum staffing requirements, the nurse numbers per infant would need to rise by 0.11 overall, and by 0.39 for high-acuity infants.

In 2008 and 2009, 16.5% and 13.9% of the VLBW infants, respectively, contracted a hospital-acquired infection. Robowski et al found that nurse understaffing was associated with significantly greater infection risk in VLBW infants, with an increase in understaffing of 1 standard deviation leading to a 39% higher odds for infection.

Writing in JAMA Pediatrics, the researchers point out that the hospitals they sampled had higher overall registered nurse staffing than is usual for US hospitals with a NICU (10.4 vs 9.4 hours/patient day) and suggest that: "Even in some of the nation's best NICUs, nurse staffing does not match guidelines."

They conclude: "Hospital administrators and NICU managers must assess their staffing decisions to devote needed nursing care to critically ill infants."

By Afsaneh Gray, medwireNews Reporter

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