重症监护室平均与最大患护比对医院感染的影响

Impact of average and maximum nurse-to-patient ratio on hospital-acquired infections in the intensive care unit

    摘要
  • 摘要:
    目的 探讨重症监护室患护比与医院感染的关系, 评估平均患护比和最大患护比对医院感染风险的影响。
    方法 利用某三甲医院信息系统(包括医院管理信息系统、护理敏感质量指标监控系统和医院感染管理系统), 纳入2022年1月1日-2023年12月31日10个监护室≥18岁住院患者, 获取白班、夜班及全天患护比数据, 同时采集医院感染病例信息。采用单因素检验比较感染组与非感染组的差异, 利用logistic回归模型控制协变量评估各患护比指标与医院感染风险的关联。
    结果 共纳入2 742例住院患者, 医院感染发生率18.23%。感染组的平均患护比低于未感染组(2.76±0.82 vs. 3.27±1.16, P＜0.001), 而总体、白班及夜班的最大患护比分别为3.57±1.09(感染) vs. 3.91±1.31(未感染)、3.30±1.12 vs. 3.48±1.16、4.62±1.85 vs. 5.10±2.08(均P＜0.001)。回归分析显示, 总体、白班、夜班的平均患护比与医院感染无显著关联；而总体、白班、夜班的最大护患比>4的OR值分别为2.122(1.355~3.324)、2.061(1.333~3.186)和1.495(1.055~2.118)(参照组均为护患比≤3)。
    结论 最大患护比是监护室医院感染的重要风险因素, 而平均患护比与医院感染关联不显著, 提示高峰时段护理资源不足可能增加感染风险, 优化高峰期护理配置将有助于降低医院感染发生率。

     

    Abstract:
    OBJECTIVE To investigate the relationship between nurse-to-patient ratios and hospital-acquired infections (HAIs) in the intensive care units, and to assess the impact of both average and maximum nurse-to-patient ratios on the risk of HAIs.
    METHODS Data were obtained from the hospital information system (including Hospital Information System, nursing sensitive quality indicator monitoring system and hospital infection management system). Inpatients aged 18 years and older in ten intensive care units from 1 Jan. 2022 to 31 Dec. 2023 were included; data on the nurse-to-patient ratios during day shifts, night shifts and the overall period and HAIs cases were collected. Univariate test was conducted to compare differences between the infection group and the non-infection group. Logistic regression models were utilized to evaluate the association between various nurse-to-patient ratio indicators and the risk of HAIs while controlling the covariates.
    RESULTS A total of 2 742 patients were included, with an HAIs incidence rate of 18.23%. The average patient-to-nurse ratio was significantly lower in the infection group than in the non-infection group (2.76±0.82 vs. 3.27±1.16, P < 0.001), whereas the maximum nurse-to-patient ratios for the overall period, day and night shifts were 3.57±1.09 (infected) vs. 3.91±1.31 (uninfected), 3.30±1.12 vs. 3.48±1.16, and 4.62±1.85 vs. 5.10±2.08, respectively (all P < 0.001). Regression analysis showed that no significant association between the average nurse-to-patient ratios for the overall period, day and night shifts and the risk of HAIs; whereas the odds ratios (ORs) for the maximum patient-to-nurse ratio greater than 4 were 2.122(1.355-3.324)for the overall period, 2.061(1.333-3.186)for the day shift and 1.495(1.055-2.118)for the night shifts (all nurse-to-patient ratios ≤3 in the reference group).
    CONCLUSIONS The maximum nurse-to-patient ratios are important risk factors for HAIs in the intensive care units, whereas the average nurse-to-patient ratios are not significantly associated with HAIs. It is suggested that insufficient nursing resources during peak hours may increase the risk of infection, and optimizing the allocation of nursing care during peak hours will help to reduce the incidence of HAIs.

     

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