Incidence of nosocomial infections with mrsa in correlation with the workload of medical nurses at the surgical intensive care unit of the General hospital Celje
Abstract
Background: Everywhere in the world, morbidity and mortality due to nosocomial infections are on increase. The effectiveness of nosocomial infection control has become an important indicator of the quality of hospital work as well as a considerable contribution towards cost reduction.
Methods: Our three-year prospective study was aimed to investigate the daily workload of medical nurses in correlation with the incidence of nosocomial infections caused by methicillin-resistant Staphylococcus aureus at the surgical intensive care unit of the General Hospital Celje, using a Therapeutic Intervention Scoring System. Although in our hospital the Surgical Intensive Care Unit meets the highest hygienic standards, the incidence of methicillin-resistant Staphylococcus aureus, despite its decreasing trend, is still high.
Results: Infections with methicillin-resistant Staphylococcus aureus occurred in the periods when the nurses were overloaded by more than 25% on average.
Conclusions: The excessive work overload of medical nurses is one of the key risk factors for spread of nosocomial infections.
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References
Lešničar G, Čretnik-Žohar T, Štorman A, Petrovec-Koščak A, Ratajc D, Šibanc B, et al. Organizacija izobraževanja na področju bolnišničnih okužb v celjski bolnišnici – Bolnišnične okužbe; 2003; Ljubljana, Slovenija. Ljubljana: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 2003.
Škerl M, Lužnik-Bufon T, Dolinšek M. Organisation of infection control in university medical centre. The IFIC workshop on hospital hygiene and infection control in intensive care units; 1998; Ljubljana, Slovenija. Ljubljana: University medical centre; 1998.
Lužnik-Bufon T. Nacionalne smernice za pripravo programa za preprečevanje in obvladovanje bolnišničnih okužb. Infektološki simpozij; 2001; Celje, Slovenija. Celje: Grafika Gracer; 2001.
Lužnik-Bufon T. Strokovne podlage za preprečevanje in obvladovanje bolnišničnih okužb. Bolnišnične okužbe; 2003; Ljubljana, Slovenija. Ljubljana: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 2003.
Škerl M, Lužnik-Bufon T, Klavs I, Dolinšek M. Organizacija dela na področju obvladovanja okužb. Bolnišnične okužbe; 2003; Ljubljana, Slovenija. Ljubljana: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 2003.
Pravilnik o pogojih za pripravo in izvajanje programa preprečevanja in obvladovanja bolnišničnih okužb. Ur l RS 74/99.
Državni zbor RS. Zakon o nalezljivih boleznih. Ur l RS 69/95.
Lešničar G. Obvladovanje in preprečevanje bolnišničnih okužb. Glasilo Splošne bolnišnice Celje. Monitor junij 2001. p. 84–5.
Šibanc B, Lešničar G, Tratar F. Rezultati nadzorovanega protimikrobnega zdravljenja v Splošni bolnišnici Celje 1995–2000. Med Razgl 2002; 41: 53–9.
Malstam J, Lind L. Therapeutic Intervention Scoring System (TISS) – a method for measuring workload and calculating costs in the ICU. Acta Anaesthesiol Scand 1992; 36: 758–63.
Cerović O. Točkovni sistemi v enoti za intenzivno terapijo. Šola intenzivne medicine; 2000; Ljubljana, Slovenija. Ljubljana: Slovensko združenje za intenzivno medicino; 2000.
Miranda DR, Rijk A, Schaufeli W. Simplified Therapeutic Intervention Scoring System: The TISS – 28 items – Results from multicenter study. Crit Care Med 1996; 24: 64–73.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000; 21: 510–5.
Muzlovič I, Trampuž A. Hospital infection and prevalence study in the ICUs in Slovenia. Hospital hygiene and infection control in intensive care units; 1998; Ljubljana, Slovenija. Ljubljana: University medical centre; 1998.
Klavs I, Bufon-Lužnik T, Škerl M, Grgič-Vitek M, Lejko-Zupanc T, Dolinšek 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: 149–57.
Klavs I, Škerl M, Lužnik-Bufon T, Grgič-Vitek M, Dolinšek M, Lejko-Zupanc T, et al. Zaključki nacionalne prečne raziskave o bolnišničnih okužbah iz leta 2001. Bolnišnične okužbe; 2003; Ljubljana, Slovenija. Ljubljana: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 2003.
Muzlovič I, Trampuž A, Jereb M, Kremžar B. Bolnišnične okužbe v slovenskih intenzivnih enotah. Bolnišnične okužbe; 1999; Maribor, Slovenija. Maribor: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 1999.
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Chanion MJ, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European prevalence of infection in intensive care (EPIC) study. JAMA 1995; 274: 639–44.
Harbarth S. Nosocomial transmission of antibiotic-resistant microorganisms. Curr Opin Infect Dis 2001; 14: 437–42.
Žohar-Čretnik T, Štorman A, Božanić V, Avguštin C, Lešničar G. Problem MRSA v regionalni bolnišnici. Antibiotiki – povezava mikrobiologa in klinika; 1998; Slovenj Gradec, Slovenija. Slovenj Gradec: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 1998.
Papuga V, Lešničar G, Žohar-Čretnik T, Štorman A, Božanič V, Vlaović M, et al. Okužbe z MRSA v enoti intenzivne medicine operativnih strok Splošne bolnišnice Celje. Infektološki simpozij; 2001; Celje, Slovenija. Celje: Grafika Gracer; 2001.
Widmer AF. Vom Ende des Händewaschens: Mit der hygienischen Händedesinfektion ins nächste Jahrtausend. Schweiz Rundsch Med Prax 1999; 88: 761–3.
Jernigan JA, Titus MG, Groschel DH, Getchell White S, Farr BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996; 143: 496–504.
Fluckiger U, Widmer AF. Epidemiology of methicillin-resistant Staphylococcus aureus. Chemotherapy 1999; 45: 121–34.
Kibbler CC, Quick A, O’Neill AM. The effect of increased bed numbers on MRSA transmission in acute medical wards. J Hosp Infect 1998; 39: 213–9.
Andersen BM, Lindemann R, Bergh K, Nesheim BI, Syversen G, Solheim N, et al. Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect 2002; 50: 18–24.
Haley RW, Cushion NB, Tenover FC. Eradication of endemic methicillinresistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995; 171: 614–24.
Jackson M, Chiarello LA, Gaynes RP, Gerberding LJ. Nurse staffing and health care-associated infections: proceedings from a working group meeting. Am J Infect Control 2002; 30: 199–206.
Grilc T, Miklavčič V, Slemenjak J, Muzlovič I, Jereb M, Trampuž A. Analiza upoštevanja higiene rok na intenzivnem oddelku. Obzor Zdr N 2002; 36: 153–9.
Taunton RL, Kleinbeck SVM, Stafford R, Woods CQ, Bott MJ. Patient outcomes. Are they linked to registered nurse absenteeism, separation or work load? J Nurs Adm 1994; 24: 48–54.
Fridkin SK, Pear SM, Williamson TH, Galgiani JN, Jarvis WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996; 17: 150–8.
Farr BM. Understaffing: A risk factor for infection in the era of downsizing? Infect Control Hosp Epidemiol 1996; 17: 147–9.
Vicca AF. Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J Hosp Infect 1999; 43: 109–13.
Lešničar G, Reberšek-Gorišek J. Vloga infektologa v regijski bolnišnici. Infektološki simpozij; 2001; Celje, Slovenija. Celje: Grafika Gracer; 2001.
Rezar L, Trampuž A. Proti meticilinu odporen Staphylococcus aureus kot nevarna bolnišnična klica. Zdrav Vestn 2002; 71: 543–7.
Trampuž A, Muzlovič I, Jereb M, Vidmar L and the Infection Control Team. Effective control measures for preventing transmission of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. 39th Annual Meeting of the Infectious Diseases Society of America; 2001; San Francisco; USA. San Francisco: Infectious Diseases Society; 2001.
Graffunder EM, Venezia RA. Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother 2002; 49: 999–1005.
Lejko-Zupanc T, Kolman J, Kirbiš J, Brecelj A. Okužba z MRSA z zmanjšano občutljivostjo za glikopeptide – prikaz primera. Bolnišnične okužbe; 2003; Ljubljana, Slovenija. Ljubljana: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 2003.
Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003; 36: 281–5.
Boyce JM. Understanding and controlling methicillin-resistant Staphylococcus aureus infections. Infect Control Hosp Epidemiol 2002; 23: 485–6.
Müller-Premru M, Križan-Hergouth V, Seme K, Gubina M. MRSA – rezultati spremljanja občutljivosti bakterije Staphylococcus aureus v Kliničnem centru v Ljubljani. Mikrobi in antibiotiki; 2001; Ljubljana, Slovenija. Ljubljana: Zavod za farmacijo in za preizkušanje zdravil; 2001.
Kolman J, Gubina M, Müller-Premru M, Sočan M, Cvetkovski L, Koren S. Slovenski rezultati občutljivosti bakterij Staphylococcus aureus in Streptococcus pneumoniae iz hemokultur in likvorjev, zbrani v okviru projekta EARSS. Mikrobi in antibiotiki; 2001; Ljubljana, Slovenija. Ljubljana: Zavod za farmacijo in za preizkušanje zdravil; 2001.
Dolinšek M, Krist A, Zupančič P, Prevec M, Gaspari L, Čepon V, et al. Izkušnje strokovnega nadzora na področju bolnišnične higiene v Kliničnem centru Ljubljana na enotah intenzivne terapije v letih 2001 in 2002. Bolnišnične okužbe; 2003; Ljubljana, Slovenija. Ljubljana: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 2003.
Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Infect Control Hosp Epidemiol 2002; 23: S3–S40.
Miklavčič V, Slemenjak J, Muzlovič I, Jereb M, Trampuž A. Uspešna zajezitev epidemije MRSA na intenzivnem oddelku. Obzor Zdr N 2002; 36: 7–13.
Kolman J, Gubina M, Müller-Premru M, Sočan M, Cvetkovski L, Koren S. Sodelovanje Slovenije v evropskem projektu EARSS – prikaz rezultatov deleža MRSA-izolatov iz hemokultur. ISIS december 2003. p. 30–3.
Vasquez JE, Walker ES, Franzus BW, Overbay BK, Reagan DR, Sarubbi FA. The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a veterans’ affairs hospital. Infect Control Hosp Epidemiol 2000; 21: 459–64.
Gubina M. Bolnišnična higiena v Sloveniji. Bolnišnične okužbe; 2003; Ljubljana, Slovenija. Ljubljana: Sekcija za klinično mikrobiologijo in hospitalne infekcije; 2003.
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