The impact of staffing on central venous catheter-associated bloodstream infections in preterm neonates – results of nation-wide cohort study in Germany

Rasmus Leistner,Frank Schwab,Sarah Thürnagel,Petra Gastmeier,Brar Piening,Christine Geffers

doi:10.1186/2047-2994-2-11

Abstract

BackgroundVery low birthweight (VLBW) newborns on neonatal intensive care units (NICU) are at increased risk for developing central venous catheter-associated bloodstream infections (CVC BSI). In addition to the established intrinsic risk factors of VLBW newborns, it is still not clear which process and structure parameters within NICUs influence the prevalence of CVC BSI.MethodsThe study population consisted of VLBW newborns from NICUs that participated in the German nosocomial infection surveillance system for preterm infants (NEO-KISS) from January 2008 to June 2009. Structure and process parameters of NICUs were obtained by a questionnaire-based enquiry. Patient based date and the occurrence of BSI derived from the NEO-KISS database. The association between the requested parameters and the occurrance of CVC BSI and laboratory-confirmed BSI was analyzed by generalized estimating equations.ResultsWe analyzed data on 5,586 VLBW infants from 108 NICUs and found 954 BSI cases in 847 infants. Of all BSI cases, 414 (43%) were CVC-associated. The pooled incidence density of CVC BSI was 8.3 per 1,000 CVC days. The pooled CVC utilization ratio was 24.3 CVC-days per 100 patient days. A low realized staffing rate lead to an increased risk of CVC BSI (OR 1.47; p=0.008) and also of laboratory-confirmed CVC BSI (OR 1.78; p=0.028).ConclusionsOur findings show that low levels of realized staffing are associated with increased rates of CVC BSI on NICUs. Further studies are necessary to determine a threshold that should not be undercut.

Highlights

Very low birthweight (VLBW) newborns on neonatal intensive care units (NICU) are at increased risk for developing central venous catheter-associated bloodstream infections (CVC blood stream infections (BSI))
Our results demonstrate that high staffing levels are associated with a lower incidence of central venous catheter-associated bloodstream infections (CVC BSI) and laboratory-confirmed BSI
We did not assess the nurse per patient ratio, but we showed that compliance with the in-house recommendations on staffing levels has the potential to prevent healthcareassociated BSI and is a relevant quality assurance tool

Summary

Introduction

Very low birthweight (VLBW) newborns on neonatal intensive care units (NICU) are at increased risk for developing central venous catheter-associated bloodstream infections (CVC BSI). In addition to the established intrinsic risk factors of VLBW newborns, it is still not clear which process and structure parameters within NICUs influence the prevalence of CVC BSI. Newborns with very low birthweight (VLBW) are at increased risk for developing healthcare-associated blood stream infections (BSI) [1,2,3]. The BSIs mostly occur on neonatal intensive care units (NICU) and are associated with the use of central venous catheters (CVC). To prevent these potentially lethal infections, consistent high quality of care is critical. Analyzing data from the German nation-wide nosocomial infection surveillance system for preterm infants on neonatology departments and ICUs (NEO-KISS), we are able to estimate the situation for a large part of Germany’s NICUs

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Discussion

Conclusion