Address critical care area weaknesses to help reduce healthcare-associated infections

Healthcare-associated infections (HAIs) are less likely to occur in favorable critical care work environments, according to a study in the November issue of American Journal of Critical Care.

The study found nurses working in favorable critical care environments were about 40%  less likely to report that HAIs, including urinary tract infections, ventilator-associated pneumonias, and central line associated blood stream infections, occurred frequently (more than once a month) compared to nurses working in poor critical care work environments.

Kelly“HAIs lead to the loss of tens of thousands of lives and cost the US healthcare system billions of dollars each year,” said lead author Deena Kelly, RN, PhD, from the Center for Health Outcomes and Policy Research at University of Pennsylvania School of Nursing, Philadelphia. “In addition, HAIs can have devastating emotional, financial and medical consequences for patients.”

This study employed a retrospective, cross-sectional design to examine the association between the critical care work environment and nurse-reported frequency of HAIs in 4 states during 2005 to 2008 using linked nurse and hospital survey data. The sample included adult, nonfederal, acute care hospitals in New Jersey, Pennsylvania, California, and Florida that responded to the American Hospital Association Annual Survey in 2007 and also had at least 5 critical care nurse respondents from the University of Pennsylvania Multi-State Nursing Care and Patient Safety Study. The final sample totaled 3,217 ICU nurses from 320 hospitals, making it one of the largest samples of critical care nurses to date.

“These findings substantiate efforts to focus on the quality of the work environment as a way to minimize the frequency of HAIs,” Kelly told Formulary. “Critical care nurses, as the largest group of clinicians providing direct care in intensive care units, are well positioned to influence the prevalence and prevention of HAIs in critically ill patients.”

Critically ill patients are particularly susceptible to healthcare-associated infections, and the nurse work environment may be a key organizational strategy for preventing them, according to Kelly.

Administrators and nurses should focus their efforts on addressing weaknesses in their critical care work environments by using scores from of the 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI) as a guide, she said.

“Implementing a primary care staffing model, ensuring appropriate support staff and resources are available and providing support for nurse managers are examples of interventions that might lower risk for development of HAIs,” Kelly said.