Greek Intensive Care Unit Research Articles

Evaluation and Treatment of Dysphagia in Public and Private Intensive Care Units (ICUs) in Greece.

Introduction Dysphagia is a significant but underrecognized clinical issue in the intensive care unit (ICU), and it is associated with various complications. Despite its clinical importance, there is limited research and no Greek ICU-specific guidelines for managing dysphagic patients. Additionally, only a few ICUs in Greece have dysphagia specialists, specifically speech-language pathologists (SLPs) providing their expertise. Objective Τo identify the current practices for dysphagia management (screening, assessment, treatment) and gain insight into ICU directors' awareness/perceptions of the prevalence, complications, and risk of dysphagia. Materials and Methods We identified 138 Greek ICUs. Data were collected from ICU (including pediatric and neonatal) directors, working in public and private hospitals, via a 24-item, anonymous online questionnaire, within a 4-month period. Results Our survey was completed by 45 ICU directors. Most participants (84.4%) reported that dysphagia is a relevant clinical problem in their ICU, and 51.1% estimated a frequency rate < 20%. Non-instrumental approaches are mainly utilized to screen and diagnose dysphagia, whereas enteral nutrition and diet modifications are used to manage dysphagia. Additionally, 64.4% of ICU directors agreed that SLPs are essential for the management of dysphagic patients, and 66.7%, that awareness of dysphagia in their ICU could be increased. Conclusion The current study documented the methods and approaches used to manage dysphagic patients in Greek ICUs. The ICU directors seem to recognize the clinical significance of dysphagia and its complications. According to our findings, the employment of SLPs could result in a more comprehensive and intensive approach and improve the quality of care for these patients.

Impact of secondary sepsis on mortality in adult intensive care unit patients

RationaleSeptic patients admitted to the intensive care unit (ICU) suffer from immune dysregulation, potentially leading to a secondary sepsis episode. This study aims to (i) assess the secondary sepsis rate, (ii) compare the second with the first episodes in terms of demographics, clinical and laboratory characteristics, and outcomes, and iii) evaluate the outcome of secondary sepsis. MethodsA single-center, retrospective study (2014–2017) was conducted in a Greek ICU, including consecutive cases of adult patients admitted to the ICU for at least 48 h with a principal admission diagnosis of sepsis and stayed for at least 48 h. We searched for a secondary episode of sepsis following the primary-one. We performed survival analyses with Cox proportional hazard, Fine-Gray, and multistate models. ResultsIn this study, 121 patients that fulfilled the eligibility criteria were included. The secondary sepsis group included 28 (23.1 %) patients, with episode onset, median (interquartile range), 9.5 (7.7–16.2) days after ICU admission, who had less frequently had a medical admission diagnosis, a microbiologically confirmed first episode, and the C-reactive protein was lower. The overall ICU mortality of the cohort was 44.6 %. The group that developed secondary sepsis had higher mortality, but significance was lost in Cox regression [Hazard ratio (95 % CI) 0.59(0.31–1.16)]. However, after multistate modeling adjustment, the attributable mortality was estimated at 43.9 % (95 %CI ± 14.8 %). ConclusionSecondary sepsis was evident in a quarter of the study participants and may be associated with an increased risk of death.

Assessing Patients’ Needs in Greek Intensive Care Units. Validation of a Respiratory Patient Satisfaction Scale

Respiratory patients constitute a specific and large category of patients hospitalized in Greek Intensive Care Units (ICUs). These patients have specific needs which differ significantly from other groups of patients treated in general ICUs. Assessing the needs and satisfaction levels of respiratory patients is a crucial issue, related to the quality of care provided in ICU. Many questionnaires have been developed to measure patient satisfaction or patient needs. However, no previous attempt has been made to develop an instrument focused on respiratory patient needs with the appropriate psychometric properties. The aim of this study was to describe the development and evaluation of the psychometric properties of the Respiratory Patient Satisfaction Scale, and its validity and reliability, by ICU respiratory patients’ satisfaction.Τhe questionnaire was pilot tested with 20 ICU respiratory patients to identify problems of wording or length of the instrument. Based on feedback, the wording was adjusted and certain items were combined. A new convenience sample of 164 ICU respiratory patients then performed a test-retest of the questionnaire. Internal consistency was assessed using Cronbach alpha coefficients and stability of items was evaluated through test and retest comparison and expressed through intraclass correlation coefficient (ICC). The internal consistency reliability coefficients exceed the minimum 0.50 for Cronbach’s coefficient alpha. An exploratory factor analysis revealed seventeen factors, explaining 74.5% of the variability. Respiratory Patient Satisfaction Scale found to be a comprehensive instrument with satisfactory psychometric properties. The results from this study would serve as references for continuous improvement in intensive care practice helping all patients hospitalized in Greek ICUs and not only the respiratory patients. Keywords: Respiratory patients, Intensive Care Unit, Patient Satisfaction Scale, Validation, Quality care. DOI: 10.7176/JEP/12-17-01 Publication date: June 30 th 2021

The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study

BackgroundIn the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a “nightmare scenario” with unknown clinical consequences. In the Greek ICU, in particular, gram negative ABRPs are now considered endemic. However, the possible longitudinal impact of ABRPs on long-term outcomes of ICU patients has not yet been determined.MethodsIn this two-year (January 2014-December 2015) single-centre observational longitudinal study, 351 non-neurocritical ICU patients ≥ 18 year-old were enrolled. Patients’ demographic, clinical and outcome data were prospectively collected. Quality-adjusted life years (QALY) were calculated at 6, 12, 18 and 24 months after ICU admission.ResultsFifty-eight patients developed infections due to ABRP (ABRP group), 57 due to non-ABRP (non-ABRP group), and 236 demonstrated no infection (no-infection group) while in ICU. Multiple regression analysis revealed that multiple organ dysfunction syndrome score (OR: 0.676, 95%CI 0.584–0.782; P < 0.001) and continuous renal replacement therapy (OR: 4.453, 95%CI 1.805–10.982; P = 0.001) were the only independent determinants for ABRP infections in ICU. Intra-ICU, 90-day and 2-year mortality was 27.9%, 52.4% and 61.5%, respectively. Compared to the non-ABRP and no-infection group, the ABRP group demonstrated increased intra-ICU, 90-day and 2-year mortality (P ≤ 0.022), worse 2-year survival rates in ICU patients overall and ICU survivor subset (Log-rank test, P ≤ 0.046), and poorer progress over time in 2-year QALY kinetics in ICU population overall, ICU survivor and 2-year survivor subgroups (P ≤ 0.013). ABRP group was further divided into multi-drug and extensively-drug resistant subgroups [MDR (n = 34) / XDR (n = 24), respectively]. Compared to MDR subgroup, the XDR subgroup demonstrated increased ICU, 90-day and 2-year mortality (P ≤ 0.031), but similar 90-day and 2-year QALYs (P ≥ 0.549). ABRP infections overall (HR = 1.778, 95% CI 1.166–2.711; P = 0.008), as well as XDR [HR = 1.889, 95% CI 1.075–3.320; P = 0.027) but not MDR pathogens, were independently associated with 2-year mortality, after adjusting for several covariates of critical illness.ConclusionsThe present study may suggest a significant association between ABRP (especially XDR) infections in ICU and increased mortality and inability rates for a prolonged period post-discharge that requires further attention in larger-scale studies.

Changing Characteristics and In Vitro Susceptibility to Ceftazidime/Avibactam of Bloodstream Extensively Drug-Resistant Klebsiella pneumoniae from a Greek Intensive Care Unit.

During 2014-2016, a total of 248 carbapenem-resistant Klebsiella pneumoniae (CARB-R Kp) were recovered in a Greek intensive care unit (ICU), the colistin resistance (COL-R) rates among CARB-R Kp from bloodstream infections (BSIs) were determined, and molecular characterization and the in vitro susceptibility of CARB-R+COL-R Kp to ceftazidime/avibactam were performed. The majority of CARB-R Kp from BSIs (n = 53) were OXA-48 (43.4%) and KPC (33.9%) producers, but no statistically significant differences were observed for the clinical characteristics of ICU patients affected by OXA-48 and other carbapenemase-producing K. pneumoniae. CARB-R+COL-R Kp (n = 28) represented 52.8% of 53 CARB-R Kp recovered from BSIs. The increase in the COL-R rates from 2014 to 2015 was mainly associated with the diffusion of extensively drug-resistant (XDR) OXA-48-co-producing CTX-M-15-like K. pneumoniae, assigned to multilocus-sequence typing ST101, possessing alterations in the mgrB loci. Ceftazidime/avibactam was active against all OXA-48 and KPC producers. Thus, the spread of XDR Kp possessing different types of carbapenemases further complicates the infection control strategies for the management of XDR Kp, whereas ceftazidime/avibactam may be a reasonable alternative to colistin for the treatment of XDR Kp in settings with low prevalence of metallo-β lactamase-producing K. pneumoniae.

Characteristics, risk factors and outcomes of Clostridium difficile infections in Greek Intensive Care Units

BackgroundClostridium difficile is one of the major causes of diarrhoea among critically ill patients and its prevalence increases exponentially in relation to the use of antibiotics and medical devices. We sought to investigate the incidence of C. difficile infection in Greek units, and identify potential risk factors related to C. difficile infection. MethodsA prospective multicenter cohort analysis of critically ill patients (3 ICUs from 1/1/2014 to 31/12/2014). ResultsAmong 970(100%) patients, 95(9.79%) with diarrhoea, were included. Their demographic, comorbidity and clinical characteristics were recorded on admission to the unit. The known predisposing factors for the infection were recorded and the diagnostic tests to confirm C. difficile were conducted, based on the current guidelines. The incidence of C. difficile infection was 1.3% (n = 13). All-cause mortality in patients with diarrhoea, C. difficile infection and attributable mortality in patients with C. difficile infection was 28%, 38.5% and 30.8% respectively. Sequential Organ Failure Assessment (SOFA) scores on admission were significantly lower and prior C. difficile infection was more common in patients with current C. difficile infection. Regarding other potential risk factors, no difference was found between groups. No factor was independently associated with C. difficile infection. ConclusionsC. difficile infection is low in Greek intensive care units, but remains a serious problem among the critically-ill. Mortality was similar to reports from other countries. No factor was independently associated with C. difficile infection.

Current physiotherapy practice in Greek intensive care units: a national study

Background: The purpose of the study was to investigate the responsibilities and frequency of clinical procedures that physiotherapists perform within the intensive care unit (ICU) in Greece, along with the level of education and training of these physiotherapists.Methods: Physiotherapists who work in general ICUs of hospitals were invited to complete a developed questionnaire. The questionnaire consisted of 83 items, of closed and opened–ended format. Items for service provision and physiotherapists’ employment were included, along with participants’ involvement in respiratory care, early mobilisation and the use of the ICU equipment.Results: One hundred forty physiotherapists completed the questionnaire. Seventy-three respondents (52%) reported working in ICU in Athens and 67 (48%) in other cities of Greece. Almost all the physiotherapists’ performed early mobilisation and respiratory techniques; although the frequency of procedures and use of equipment were variable. Sixty-one (44%) and 70 (50%) respondents participated in the weaning procedure and mobilised the patient whilst using the ventilator, respectively.Conclusion: The physiotherapists are from ICUs all over Greece. The results reflect the differences among the procedures that physiotherapists perform, regarding early mobility and respiratory physiotherapy. The results indicate the need for a national up-to-date job description of the physiotherapy services in ICUs in Greece.

The effect of the Greek financial crisis on the operation of public intensive care units

SUMMARYThe National Healthcare System in Greece has taken a serious blow by the financial crisis the country has been experiencing for the past 9 years. The operation of the Intensive Care Units (ICUs) in public hospitals could not remain unaffected, since the largest part of their funding comes from the state’s budget.Objective: To investigate the effect of the financial crisis on the operation of public ICUs in Greek hospitals.Method: Narrative literature review including Greek and English language articles in medical databases such as PUBMED, CINAHL, and in websites of Greek newspapers and other media.Results: During the crisis years, a clear shift of healthcare users from the private sector to public hospitals, together with a significant reduction of functional beds in the ICUs of public hospitals have created significant ICU bed shortages and rendered Greek ICUs clearly incapable of meeting nationwide needs. The doctors and nurses employed in public ICUs are not sufficient, and, subsequently, a decline in the quality of the healthcare provided to the critically ill has been noted.Conclusions: The situation in Greek public ICUs is critical. Without sufficient state funding, staff and ICU-bed shortages increase the likelihood that the care provided within Greek ICUs will deviate from international standards.

Toll-like receptor 2, 4 and 9 polymorphisms and their association with ICU-acquired infections in Central Greece

PurposeTo test the potential of four common Toll-like receptor (TLR) polymorphisms to predispose to specific intensive care unit (ICU)-acquired infections and affect outcomes in a Greek ICU. Materials and methodsThe incidence of TLR2-Arg753Gln, TLR4-Asp299Gly, TLR4-Thr399Ile and TLR9-T1237C polymorphisms, and their association with ICU-acquired infections and patients' clinical outcomes were prospectively evaluated The examined genetic polymorphisms were assessed by real-time Polymerase-Chain-Reaction (PCR). ResultsDuring a 15-month period, 224 patients were enrolled and genotyped. The prevalence of genetic polymorphisms for TLR4-Asp299Gly, TLR4-Thr399Ile, mixed TLR4-Asp299Gly/Thr399Ile, TLR9-T1237C and TLR2-Arg753Gln was 14.4%, 14.7%, 11.2%, 24.5% and 2.2%, respectively.TLR4 polymorphisms were associated with increased susceptibility towards specific ICU-acquired infections, i.e. Gram-negative central-nervous-system infections (CNSI), ventilator-associated pneumonia (VAP) and urinary-tract infections (UTI), principally due to multi-drug resistant (MDR) Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumonia, respectively (all P < 0.05). TLR9-T1237C polymorphism was associated with lower incidence and fewer relapses of CNSIs and UTIs when compared to mixed TLR4-Asp299Gly/Thr399Ile polymorphism group (P ≤ 0.039).ICU-stay was significantly prolonged in TLR4 polymorphisms (P ≤ 0.0416). ConclusionsCommon TLR-signaling polymorphisms might be implicated in the clinical phenotype of ICU-acquired infections in Central Greece. The possible impact of TLR4 polymorphisms on enhanced susceptibility towards Gram-negative MDR-infections in defined critical-disease states warrants further investigation.Trial Registration Clinical Trials.gov identifier: NCT00932243

Risk factors and predictors of mortality of candidaemia among critically ill patients: role of antifungal prophylaxis in its development and in selection of non-albicans species.

The aim of the present study is to identify risk factors for development and predictors of mortality of candidaemia among critically ill patients. A 1:7 case-control study was conducted during a 4-year period (2012-2015) in a Greek Intensive Care Unit (ICU). Candidaemia was confirmed by positive blood cultures. All yeasts were identified using API 20C AUX System or Vitek 2 Advanced Expert System. Epidemiologic data were collected from the ICU computerized database and patients' chart reviews. Fifty-three patients developed candidaemia with non-albicans species being the predominant ones (33 patients, 62.3%). Multivariate analysis found that prior emergency surgery, malignancy, hospitalization during summer months, prior septic shock by KPC-producing Klebsiella pneumoniae and number of antibiotics administered were independently associated with candidaemia, while, prior administration of azole was a protective factor. Non-albicans candidaemia was associated with number of antibiotics administered and prior administration of echinocandin. Mortality of 14 days was 28.3% (15 patients) and was associated with SOFA score upon infection onset and septic shock, while, appropriate empirical antifungal treatment was associated with better survival. Prophylactic azole administration prevents development of candidaemia, while, echinocandin administration predisposes to non-albicans candidaemia. Empirical administration of an appropriate antifungal agent is associated with better survival.

The impact of healthcare professionals’ personality and religious beliefs on the decisions to forego life sustaining treatments: an observational, multicentre, cross-sectional study in Greek intensive care units

ObjectivesTo assess the opinion of intensive care unit (ICU) personnel and the impact of their personality and religious beliefs on decisions to forego life-sustaining treatments (DFLSTs).SettingCross-sectional, observational, national study in...

Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational, multicenter, cross-sectional study

ObjectivesTo investigate if burnout in the Intensive Care Unit (ICU) is influenced by aspects of personality, religiosity and job satisfaction. Research methodologyCross-sectional study, designed to assess burnout in the ICU and to investigate possible determinants. Three different questionnaires were used: the Malach Burnout Inventory, the Eysenck Personality Questionnaire and the Spiritual/Religious Attitudes Questionnaire. Predicting factors for high burnout were identified by multivariate logistic regression analysis. Setting/ParticipantsThis national study was addressed to physicians and nurses working full-time in 18 Greek ICU departments from June to December 2015. ResultsThe participation rate was 67.9% (n=149) and 65% (n=320) for ICU physicians and nurses, respectively). High job satisfaction was recorded in both doctors (80.8%) and nurses (63.4%). Burnout was observed in 32.8% of the study participants, higher in nurses compared to doctors (p<0.001). Multivariate analysis revealed that neuroticism was a positive and extraversion a negative predictor of exhaustion (OR 5.1, 95%CI 2.7–9.7, p<0.001 and OR 0.49, 95%CI 0.28–0.87, p=0.014, respectively). Moreover, three other factors were identified: Job satisfaction (OR 0.26, 95%CI 0.14–0.48, p<0.001), satisfaction with current End-of-Life care (OR 0.41, 95%CI 0.23–0.76, p=0.005) and isolation feelings after decisions to forego life sustaining treatments (OR 3.48, 95%CI 1.25–9.65, p=0.017). ConclusionsPersonality traits, job satisfaction and the way End-of-Life care is practiced influence burnout in the ICU.

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First Peripherally Inserted Central Catheter Under Ultrasound Guidance in a Greek Intensive Care Unit: A New Role for Greek Perianesthesia Nurses.

We present a case of a 67-year-old Caucasian female who was admitted to the pulmonary clinic of a general hospital in Athens with fever and respiratory symptoms. A lung biopsy was ordered because a clinical diagnosis of interstitial lung disease was suspected. The patient was then hospitalized in the intensive care unit. Because of the fact that peripheral catheterization was impossible and the prospect of further long-term hospitalization, the patient was referred to a vascular access nursing team composed of perianesthesia nurses to advance a peripherally inserted central catheter and support the line during treatment. The peripherally inserted central catheter line was advanced with no complications, and the position of the catheter was checked using the electrocardiography method.

Attitudes towards euthanasia among Greek intensive care unit physicians and nurses

ObjectivesTo investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia. BackgroundICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile. MethodsThis was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses. ResultsOf respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician – assisted suicide. Only one third of participants defined euthanasia correctly. While 59% of doctors and 64% of nurses support the legalization of active euthanasia, just 28% and 26% of them, respectively, agree with it ethically. ConclusionsConfusion prevails among Greek ICU physicians and nurses regarding the definition of euthanasia. The majority of staff disagrees with active euthanasia, but upholds its legalization.

Emergence of a pandrug-resistant VIM-1-producing Providencia stuartii clonal strain causing an outbreak in a Greek intensive care unit

Here we describe an outbreak caused by a pandrug-resistant Providencia stuartii strain involving 15 critically ill patients in a Greek intensive care unit (ICU) during September–November 2011. All isolates harboured the blaVIM-1 gene and a class 1 integron structure of 1913 bp as well as blaSHV-5 and blaTEM-1. Pulsed-field gel electrophoresis (PFGE) demonstrated that isolates from all 15 patients belonged to a single P. stuartii clonal type. As all of the infected patients were hospitalised during overlapping time periods, horizontal intra-ICU transmission was considered as the main route for the dissemination of the outbreak strain. The outbreak ended following reinforcement of infection control measures, including implementation of additional barrier precautions for infected patients.

Carbapenem-resistant Klebsiella pneumoniae infections in a Greek intensive care unit: Molecular characterisation and treatment challenges.

Acquisition of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) strains poses a major threat to critically ill patients. The objectives of this study were to describe the epidemiology of CP-Kp isolates as well as the clinical outcome associated with the corresponding infections and to identify risk factors for mortality of intensive care unit (ICU) patients in a Greek hospital. A prospective, observational study was conducted in a nine-bed general ICU over a 2-year period (April 2010-March 2012). Imipenem-resistant K. pneumoniae isolates recovered from clinical samples of ICU patients were prospectively collected and studied for the presence of carbapenemases. Isolates were submitted to molecular typing using pulsed-field gel electrophoresis (PFGE). In total, 61 CP-Kp isolates (48 KPC-producers and 13 VIM-producers) were recovered from 58 ICU patients. The majority of KPC-producers were classified into a single PFGE type, indicating potent clonal dissemination. Among the 32 infected patients, bacteraemia was diagnosed in 16. Tigecycline+colistin was the most common combination antimicrobial regimen. Infection-attributable mortality was 43.8%. Regarding mortality risk factors, non-survivors were older (P=0.080), all of them presented with septic shock (P=0.010) and they had higher Sepsis-related Organ Failure Assessment (SOFA) scores at infection onset (P=0.004) compared with survivors. Appropriate definitive treatment and combination regimens were not associated with patient survival. In conclusion, CP-Kp infections are associated with limited treatment options and high in-hospital mortality. Effective measures for preventing dissemination of respective isolates in the hospital setting are required.

Family visitation in greek intensive care units: nurses' perspective.

Policies of flexible and open visiting in intensive care units benefit both patients and patients' families. In Greek intensive care units, gaps exist between evidence and practice for family visitation, resulting in restricted visiting policies. To explore the beliefs of nurses in Greek intensive care units about the effects of visiting on patients, patients' families, and unit staff and nurses' attitudes toward visiting policies. A descriptive correlational survey was conducted in 6 public hospitals in Athens, Greece, with a sample of 143 critical care nurses. Data were collected via an anonymous questionnaire consisting of 3 validated scales to assess the nurses' beliefs about and attitudes toward visitation. Generally, nurses were resistant to family visiting and open visiting, and most (94.4%) did not want an open policy in their unit. Nurses think that open visiting policies are supportive for patients and patients families, but the overall effects of visiting depend on both the nurse and the patient (91.6%). Nurses reported that open visiting created increased physical and psychological burdens for them (87.5%) and hampered nursing care (75.5%). Years of work experience, staffing level, and number of night shifts worked by nurses per 15 days were factors predictive of nurses' attitudes toward and beliefs about family visitation. Nurses' beliefs about and attitudes toward visitation are important factors in the implementation of more flexible visiting policies in Greek intensive care units. Well-staffed units with experienced nurses and fewer shifts per week may affect nurses' negative attitude toward open visitation.

Surveillance of Device-Associated Infection Rates and Mortality in 3 Greek Intensive Care Units

Several studies suggest that device-associated, health care-associated infections (DA-HAIs) affect the quality of care in intensive care units, increasing patients' morbidity and mortality and the costs of patient care. To assess the DA-HAIs rates, microbiological profile, antimicrobial resistance, and crude excess mortality in 3 intensive care units in Athens, Greece. A prospective cohort, active DA-HAI surveillance study was conducted in 3 Greek intensive care units from July 2009 to June 2010. The rates of mechanical ventilator-associated pneumonia (VAP), central catheter-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) were calculated along with microbiological profile, antimicrobial resistance, and crude excess mortality. During 6004 days in intensive care, 152 of 294 patients acquired 205 DA-HAIs, an overall rate of 51.7% of patients or 34.1 DA-HAIs per 1000 days (95% CI, 29.3-38.6). The VAP rate was 20 (95% CI, 16.3-23.7) per 1000 ventilator-days, the CLABSI rate was 11.8 (95% CI: 9.2-14.8) per 1000 catheter-days, and the CAUTI rate was 4.2 (95% CI, 2.5-5.9) per 1000 catheter-days. The most frequently isolated pathogen was Acinetobacter baumannii among patients with CLABSI (37.8%) and Candida species among patients with CAUTI (66.7%). Excess mortality was 20.3% for VAP and CLABSI and 32.2% for carbapenem-resistant A baumannii CLABSI. High rates of DA-HAIs, device utilization, and antimicrobial resistance emphasize the need for antimicrobial stewardship, the establishment of an active surveillance program of DA-HAIs, and the implementation of evidence-based preventive strategies.

Exploration of the Association Between Professional Interactions and Emotional Distress of Intensive Care Unit Nursing Personnel

: Several studies provide evidence for the association between the quality of collaboration among intensive care unit (ICU) professionals and patients' outcomes, as well as nurses' moral distress and professional satisfaction. However, potential associations between collaboration and nurses' mental health indices have not been explored. The aim of this descriptive correlational study was to investigate the degree of satisfaction from interaction among ICU nursing personnel, as well as between ICU nursing personnel and physicians, and potential associations with ICU nursing personnel's anxiety symptoms. The sample consisted of ICU nursing personnel from 11 adult general hospitals in Greece (n = 229). Hamilton's Anxiety scale was applied for the quantitative assessment of anxiety symptoms and Stamps' Index of Work Satisfaction for the appraisal of nursing personnel's satisfaction from professional interactions. Demographic, vocational, and educational data were also recorded. Descriptive statistics were explored, and group comparisons, correlation, and regression analysis were used. The average satisfaction score from interaction among nursing personnel was moderate to high (5.3 [SD, 1.0]) and from nurse-to-physician interaction was moderate (4.0 [SD, 1.4]) (scale range, 1-7). The score of satisfaction from nurse-to-physician interaction was negatively mildly correlated with participants' (a) total anxiety score (τ = -0.160, P = .001), (b) tension (τ = -0.125, P = .015), and (c) depressive symptoms (τ = -0.148, P = .005). Weak negative correlations were detected between satisfaction from interaction among nursing personnel and participants' (a) total anxiety state (τ = -0.139, P = .003), (b) tension (τ = -0.137, P = .008), and (c) sleep disturbances (τ = -0.150, P = .003). Overall, female respondents had higher levels of anxiety symptoms than male respondents (Mann-Whitney U, P = .007). Satisfaction from professional interaction was not a strong predictor of anxiety symptoms among ICU nursing personnel (R² = 0.046, ?0.15). Nursing personnel in Greek ICUs seem to be satisfied with the quality of relationships among them, as well as with physicians. Despite that anxiety symptoms associate with the degree of satisfaction from professional interaction, the latter may not be a significant indicator of ICU nurses' well-being. Further qualitative research is needed to identify mediating factors.