title: Association of Nursing Overtime, Nurse Staffing, and Unit Occupancy with Health Care-Associated Infections in the NICU.
abstract: ObjectiveThis 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 DesignA 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.ResultsA 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).ConclusionNursing overtime is associated with higher odds of HCAI in the NICU.
authors.affiliation: Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Beltempo
authors.affiliation: Department of Health Administration, Université de Montreal, Montreal, Quebec, Canada.
authors.forename: Régis
authors.initials: R
authors.lastname: Blais
authors.affiliation: Department of Economics, Université Laval, Quebec, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: Lacroix
authors.affiliation: Department of Pediatrics, CHU de Québec, Université Laval, Quebec, Canada.
authors.forename: Michèle
authors.initials: M
authors.lastname: Cabot
authors.affiliation: Department of Pediatrics, CHU de Québec, Université Laval, Quebec, Canada.
authors.forename: Bruno
authors.initials: B
authors.lastname: Piedboeuf
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D009740:Nursing Staff / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D012307:Risk Factors; D000078329:Workforce