ICU staffing and patient outcomes in English hospital Trusts: A longitudinal observational study examining ICU length of stay, re-admission and infection rates.

BackgroundExisting evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered...

In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.

Background/Objectives: Healthcare-associated infections (HAIs) remain a major source of morbidity, mortality, and healthcare burden, and were profoundly affected by the COVID-19 pandemic through changes in case mix, care organization, and antimicrobial use. This study aimed to compare the epidemiology, etiology, ward distribution, risk factors, and outcomes of HAIs during the pandemic and post-pandemic periods in southeastern Romania, with particular emphasis on Clostridioides difficile infection (CDI), multidrug-resistant (MDR) pathogens, and in-hospital mortality. Methods: This retrospective observational study included 3929 patients with confirmed HAIs reported by 10 hospitals in one Romanian county between March 2020 and December 2024, divided into a pandemic period (March 2020-March 2022) and a post-pandemic period (April 2022-December 2024). Sociodemographic, clinical, ward-related, therapeutic, and microbiological variables, together with discharge status and cause of death, were analyzed using Fisher's exact test, Z-tests with Bonferroni correction, the Mann-Whitney U test, and multivariable models, applying national and ECDC-aligned surveillance definitions for HAIs. Results: Patients were predominantly older adults (median age 67 years), with a slight male and urban predominance. Hospital stays were longer during the pandemic. Immunosuppression, previous surgery, antisecretory therapy, and chemotherapy were more frequent post-pandemic. HAIs were mainly reported from medical wards, with a relative shift towards intensive care units during the pandemic; pediatric wards carried a smaller burden. CDI was the leading HAI (about half of all cases) with higher post-pandemic prevalence, whereas SARS-CoV-2 infections predominated in medical and surgical wards; Acinetobacter baumannii and Klebsiella pneumoniae clustered in intensive care units during the pandemic, and were more often associated with mortality. Overall, 59.7% of patients improved and 17.5% died, with higher mortality during the pandemic, while post-pandemic deaths were more frequently unrelated to HAIs. Conclusions: This study demonstrates a substantial and ongoing burden of healthcare-associated infections in southeastern Romania, with elderly patients with prolonged hospital stays and complex medical conditions being most affected and experiencing considerable mortality, particularly in medical and intensive care units. After the pandemic, Clostridioides difficile infections became more prevalent in the context of repeated antibiotic use and immunosuppression. Mortality among patients with HAIs was higher during the pandemic, whereas in the post-pandemic period deaths were more often unrelated to HAIs, underscoring the need to strengthen antimicrobial stewardship programs and infection prevention strategies.

Introduction to the WHO Year of the Nurse and Midwife: The impact of critical care nurses and meet the new editors.

ABSTRACTBACKGROUND:A major problem of the coronavirus pandemic is the increase of patients requiring intensive care unit (ICU) support in an extremely limited period of time. As a result, most countries have prioritized coronavirus disease 2019 (COVID-19) care in ICUs and take new arrangements to increase hospital capacity in emergency department and ICUs. This study aimed to evaluate the changes in the number, clinical and demographic characteristics of patients hospitalized in non-COVID ICUs during the COVID-19 pandemic period compared to the previous year (pre-pandemic period), and to reveal the effects of the pandemic.METHODS:Hospitalized patients in non-COVID ICUs of our hospital between 11 March 2019 and 11 March 2021 were included in the study. The patients were divided into two groups according to date of the start of the COVID period. Patient data were scanned and recorded retrospectively from hospital information system and ICU assessment forms. Information regarding demographics (age and gender), comorbidities, COVID 19 polymerase chain reaction result, place of ICU admission, the diagnoses of patients admitted to ICU, length of ICU stay, Glasgow coma scale and mortality rates, and the Acute Physiology and Chronic Health Evaluation II score were collected.RESULTS:A total of 2292 patients were analyzed, including 1011 patients (413 women and 598 men) in the pre-pandemic period (Group 1) and 1281 patients (572 women and 709 men) in the pandemic period (Group 2). When the diagnoses of patients admitted to ICU were compared between the groups, there was a statistically significant difference between post-operation, return of spontaneous circulation, intoxication, multitrauma, and other reasons. In the pandemic period, the patients had a statistically significant longer length of ICU stay.CONCLUSION:Changes were observed in the clinical and demographic characteristics of patients hospitalized in non-COVID-19 ICUs. We observed that the length of ICU stay of the patients increased during the pandemic period. Due to this situation, we think that intensive care and other inpatient services should be managed more effectively during the pandemic.

ObjectivesTo examine associations between mortality and registered nurse (RN) staffing in English hospital trusts taking account of medical and healthcare support worker (HCSW) staffing.SettingSecondary care provided in acute hospital National...

BackgroundThe level of registered nurse (RN) staffing is a fundamental factor influencing patient safety. Craniotomy patients need intensive care after surgery, the majority of which is provided by RNs.MethodsThis study was conducted to investigate the relationship of the RN staffing level of general wards and intensive care units (ICUs) with in-hospital mortality after craniotomy using Korean National Health Insurance claim data. The RN staffing level was categorized based on the bed-to-RN ratio.ResultsThe in-hospital mortality rate of craniotomy patients was elevated at hospitals with a high bed-to-RN ratio in general wards, ICUs, and hospitals overall. It was determined that in-hospital mortality of craniotomy patients could be decreased by more than 50% by reducing the bed-to-RN ratio from 4.5 or more to less than 3.5 in general wards, from 1.25 or more to less than 0.88 in ICUs, and from 2.5 or more to less than 1.67 in hospitals overall.ConclusionsSince the RN staffing level is related to the in-hospital mortality rate of craniotomy patients, a sufficient staffing level of RNs should be ensured to reduce the mortality of craniotomy patients.

PurposeThis study aims to investigate the spectrum of viruses leading to severe viral pneumonia (SVP) and the associated risk factors for mortality among pediatric patients in the pediatric intensive care unit (PICU).MethodsTaking the outbreak and end of the COVID-19 pandemic as a aboundary, The pre-pandemic period of COVID-19 spans from 01/2017 to 12/2019, the pandemic period from 01/2020 to 12/2021, and the post-pandemic period from 01/2022 to 12/2023. Patients were subsequently stratified into survivor and non-survivor groups based on clinical outcomes.ResultsA total of 1007 patients (median age 1.42 years, range 0.58–4.00; male: female ratio 1.7:1) diagnosed with SVP. Cases were stratified into pre-pandemic (n = 419, 41.6%), pandemic (n = 272, 27.0%), and post-pandemic (n = 316, 31.4%) periods. Viral predominance varied across phases: Pre-pandemic: Influenza A (IVA, 37.0% [155/419]), respiratory syncytial virus (RSV, 29.8%), adenovirus (19.8%), and influenza B (15.5%). Pandemic phase: Human rhinovirus (HRV, 40.1% [109/272]), RSV (33.1%), parainfluenza viruses (11.4%), and bocavirus (HBoV, 10.7%). Post-pandemic: HRV (24.4% [77/316]), RSV (22.8%), HBoV (14.2%), and IVA (13.6%). Comparative analysis revealed significant intergroup differences in the proportion of patients aged < 3 years, primary immunodeficiency disorders (PIDs), and sepsis between pure viral infection deaths and coinfection-associated fatalities among SVP cases. Logistic regression identified eight independent mortality predictors: acute leukemia, other malignant tumors, PIDs, moderate-to-severe underweight, rhabdomyolysis, acute respiratory distress syndrome (ARDS), infection-related encephalopathy, and multiorgan dysfunction syndrome (MODS). The prediction model demonstrated robust discriminative capacity for SVP mortality: sensitivity 73.8%, specificity 90.2%, and AUC 0.888 (95%CI 0.838–0.938) via ROC curve analysis.ConclusionsThe COVID-19 pandemic has altered the landscape of respiratory viruses causing SVP in children. The presence of underlying health conditions, particularly acute leukemia, other malignancies, and immunodeficiency, significantly increases the risk of death in children with viral pneumonia. The risk prediction model offers a reliable tool for clinical practice to predict mortality in these patients.

ObjectiveTo determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality.DesignThis is a retrospective longitudinal observational study using routinely collected data. We used...

BackgroundPandemic influenza A(H1N1) 2009 virus was first detected in Japan in May 2009 and continued to circulate in the 2010–2011 season. This study aims to characterize human influenza viruses circulating in Japan in the pandemic and post-pandemic periods and to determine the prevalence of antiviral-resistant viruses.MethodsRespiratory specimens were collected from patients with influenza-like illness on their first visit at outpatient clinics during the 2009–2010 and 2010–2011 influenza seasons. Cycling probe real-time PCR assays were performed to screen for antiviral-resistant strains. Sequencing and phylogenetic analysis of the HA and NA genes were done to characterize circulating strains.Results and ConclusionIn the pandemic period (2009–2010), the pandemic influenza A(H1N1) 2009 virus was the only circulating strain isolated. None of the 601 A(H1N1)pdm09 virus isolates had the H275Y substitution in NA (oseltamivir resistance) while 599/601 isolates (99.7%) had the S31N substitution in M2 (amantadine resistance). In the post-pandemic period (2010–2011), cocirculation of different types and subtypes of influenza viruses was observed. Of the 1,278 samples analyzed, 414 (42.6%) were A(H1N1)pdm09, 525 (54.0%) were A(H3N2) and 33 (3.4%) were type-B viruses. Among A(H1N1)pdm09 isolates, 2 (0.5%) were oseltamivir-resistant and all were amantadine-resistant. Among A(H3N2) viruses, 520 (99.0%) were amantadine-resistant. Sequence and phylogenetic analyses of A(H1N1)pdm09 viruses from the post-pandemic period showed further evolution from the pandemic period viruses. For viruses that circulated in 2010–2011, strain predominance varied among prefectures. In Hokkaido, Niigata, Gunma and Nagasaki, A(H3N2) viruses (A/Perth/16/2009-like) were predominant whereas, in Kyoto, Hyogo and Osaka, A(H1N1)pdm09 viruses (A/New_York/10/2009-like) were predominant. Influenza B Victoria(HA)-Yamagata(NA) reassortant viruses (B/Brisbane/60/2008-like) were predominant while a small proportion was in Yamagata lineage. Genetic variants with mutations at antigenic sites were identified in A(H1N1)pdm09, A(H3N2) and type-B viruses in the 2010–2011 season but did not show a change in antigenicity when compared with respective vaccine strains.

The most common indoor allergens are house dust mites, molds, cockroaches, and pet allergens. Increasing exposure to these allergens increases the possibility of sensitization. This study examines changes in allergen sensitivity during the pre-pandemic, pandemic, and post-pandemic periods. We retrospectively analyzed 19,525 skin prick test results from patients visiting the allergy clinic between January 2017 and August 2024. Patients were categorized into pre-pandemic (January 2017-March 2020), pandemic (March 2020-December 2022), and post-pandemic (January 2023-August 2024) periods. Allergen sensitization rates were compared across these timeframes. A linear increase was observed in cats-Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Artemisia vulgaris allergen sensitization during and after the pandemic period compared to the pre-pandemic period (all p<0.001). Cockroach and grass-pollen sensitivities increased during the pandemic and remained elevated post-pandemic (all p<0.001). Dog allergen sensitivity peaked during the pandemic but declined post-pandemic (p<0.001). Sensitivity to the tree-pollen mixture, weed-pollen mixture, and Chenopodium album increased during the pandemic, slightly decreased post-pandemic, but remained significantly higher than pre-pandemic levels (p<0.001). In the test results studied since the pandemic period, Aspergillus fumigatus (p=0.007) and Cladosporium herbarum (p=0.005) allergen sensitivity was seen less in the post-pandemic period. The current study reveals that the COVID-19 pandemic has significant effects on allergen sensitivity profiles along with changes in living habits. In particular, the increase in sensitivity to indoor allergens may be associated with the increased time spent at home during the pandemic, emphasizing the importance of environmental factors in the development of allergic diseases.

Comparison of severely ill patients with influenza A(H1N1)pdm09 infection during the pandemic and post-pandemic periods in Singapore

The impact of the COVID-19 pandemic on chronic lymphocytic thyroiditis: A single-center retrospective analysis.

Listening to the evening newscasts is usually an opportune time each day to hear about what’s going on in the world and to keep up on important world, national, and local events. Webster’s1 defines newsworthy as “sufficiently interesting to the general public to warrant reporting” and news as “a report of recent events” and as “matter that is newsworthy.” Every now and then, I hear a news report that rings in my ears as the oxymoron of “old news.” Such was the case a few months ago, when Tom Brokaw introduced the nightly “News for Your Health” segment with the steely eyed and slowly paced revelation that research just published in the Journal of the American Medical Association found that burdening registered nurses (RNs) with increasingly heavier patient workloads can be dangerous to a patient’s health. The newscaster referred to a research study reported by Aiken et al in a late October 2002 issue of the Journal of the American Medical Association,2 in which data from a cross-sectional analysis of 232342 general, orthopedic, and vascular surgery patients, aged 20 to 85 years, discharged from 168 nonfederal hospitals in Pennsylvania over an 18-month period, were examined to determine the association between patient:nurse ratio and patient mortality within 30 days of admission, as well as patient:nurse ratio and patient mortality following complications (“failure to rescue”). The findings indicated that after adjusting for patient and hospital features (such as size and teaching status), each patient added to an RN’s average workload was associated with a 7% greater likelihood of patient death subsequent to complications and a 7% greater likelihood of patient death within 30 days of admission to the hospital. As a result, increasing an RN’s patient assignment by 2 patients (eg, from 4 patients to 6 patients) was associated with a 14 % increase in mortality and increasing it by 4 (ie, from 4 to 8 patients) was associated with a 31% increase in patient mortality. As preliminary as these findings may be, they clearly support the contention that inadequate RN staffing has a direct and positive correlation with higher patient mortality. Finding statistical evidence that patients can die in proportion to the weight of a nurse’s patient assignment is surely notable and newsworthy, but is it news?Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications. Findings among surgical patients were consistent in the incidence of urinary tract infections and mortality attributable to complications. Finding statistical evidence that hospitalized patients experience fewer serious complications and die less often from their complications is—once again—both striking and newsworthy to the public, but does it constitute news?Perhaps these findings constitute news in a hospital’s medical and surgical units, but is there any evidence of comparable findings within critical care areas? Unfortunately, there is. Dimick et al4 at The Johns Hopkins School of Medicine recently examined hospital discharge data on 569 adults admitted to the intensive care unit (ICU) following high-risk surgery (hepatic resection) over a 4-year period. Findings revealed that ICU nurse:patient ratios of 1:3 or higher on night shift are associated with increased risks of pulmonary failure and reintubation on high-risk surgery (hepatectomy) patients compared with nurse:patient ratios of 1:1 or 1:2 at night. Similarly, studies reported by both the department of nursing5 at Hopkins as well as by the departments of medicine, hygiene, and public health6 found that having fewer ICU nurses per patient is associated with a significantly increased risk of respiratory complications in patients undergoing abdominal aortic surgery.No doubt it would be an understatement to characterize these findings as newsworthy for the general public. But if news truly refers to “a report of recent events,” I can’t name one nurse, with a pulse—particularly any critical care nurse—who has not known these things pretty much since the ink dried on their first RN license. The due recognition awarded to magnet hospitals offers evidence that at least a few healthcare facilities get it—that is, they not only acknowledge but voluntarily and intentionally design patient care delivery systems that recognize the pivotal contributions that RNs make to patient outcomes. In so many other instances, however, healthcare facilities must be dragged kicking and screaming into legislatively mandated minimum staffing ratios. Evidence that findings such as these were wholeheartedly and nationally translated into improved RN staffing of healthcare facilities—now that would be news!

This paper aimed to evaluate the effects of the COVID-19 pandemic on healthcare-associated infections (HAIs), antibiotic resistance and consumption rates in intensive care units (ICUs) of a tertiary care university hospital. Between 1 January 2018 and 31 December 2021, adult patients diagnosed with HAIs in ICUs were investigated retrospectively. Patients were divided into pre-pandemic (2018-2019) and pandemic periods (2020-2021). Antibiotic consumption index was calculated via using the formula of (total dose (grams)/defined daily dose (DDD) x total patient days) x1000. A p value below 0.05 was accepted as statistically significant. The incidence of HAIs (per 1000 patient days) in the ICU of COVID-19 patients was 16.59, while it was 13.42 in the other ICUs during the pandemic period (p=0.107). The bloodstream infection (BSI) incidence was 3.32 in the pre-pandemic period and 5.41 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p<0.001). In the pandemic period, the BSI incidence rate was significantly higher in the ICU of COVID-19 patients than in the other ICUs (14.26 vs 5.41, p<0.001). Central venous catheter bloodstream infections incidence rate was 4.72 in the pre-pandemic and 7.52 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p=0.0019). During the pandemic period, the bacteraemia episode rates of Acinetobacter baumannii (5.375 vs 0.984, p<0.001), Enterococcus spp. (1.635 vs 0.268, p<0.001) and Stenotrophomonas maltophilia (3.038 vs 1.297, p=0.0086) in the ICU of COVID-19 patients were significantly found higher than others. The extended-spectrum beta-lactamase (ESBL) positivity rates for Klebsiella pneumoniae and Escherichia coli were 61% and 42% in the pre-pandemic period; 73% and 69% in the pandemic period in ICUs other than the ICU of COVID-19 patients (p>0.05). In the pandemic period, the ESBL positivity rates for K. pneumoniae and E. coli were 83% and 100% in the ICU of COVID-19 patients, respectively. Meropenem (p<0.001), teicoplanin (p<0.001) and ceftriaxone (p<0.001) consumptions were increased while ciprofloxacin (p=0.003) consumption was decreased in all ICUs after the pre-pandemic period. BSI and CVCBSI incidence rates were significantly increased in all ICUs after the COVID-19 pandemic in our hospital. Bacteraemia episode rates of A. baumannii, Enterococcus spp. and S. maltophilia in ICU of COVID-19 patients were significantly found higher than others. In addition, meropenem, teicoplanin and ceftriaxone consumptions were increased in all ICUs after the COVID-19 pandemic.