The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Abstract

Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

Adherence to Ventilator-Associated Pneumonia Prevention Measures in Intensive Care

“…The increase in VAP risk in these patients, especially in those who had severe trauma, is due to the fact that as traumas are emergency situations and intubation is often performed in high stress situations (it is an invasive procedure and that compromises the defense barriers of the lower respiratory tract), there is the risk of non-performance under proper technique, which, consequently, makes the mechanical ventilation a risk factor for the development of pneumonia. 11,21 Although various studies highlight the importance of adherence of health staff to Bundle to reduce the occurrence of VAP, [15][16] the present study did not come to the same conclusion when comparing adherence in two groups. Statistically significant difference was not verified in adherence to Bundle between groups of patients with and without VAP.…”

“…On the other hand, the protective factors were the increase in percentage of adequacy of workload and the increase in NAS increment in hospitalization. 11 Furthermore, the Bundle item oral hygiene, that is, the increase of adherence was not confirmed as a protective factor for VAP in these patients, not suffering the effect of other covariables. 11 The main limitation of this study was the assessment of adherence to Bundle from data from patient records or from institutional forms, as such a fact does not allow the data validation, which can cause confounding.…”

“…11 Furthermore, the Bundle item oral hygiene, that is, the increase of adherence was not confirmed as a protective factor for VAP in these patients, not suffering the effect of other covariables. 11 The main limitation of this study was the assessment of adherence to Bundle from data from patient records or from institutional forms, as such a fact does not allow the data validation, which can cause confounding. The assessment in loco would be The results of the present study will be able to subsidize the implementation of educational measures to increase adherence of health professionals to VAP prevention measures, which will reverberate in the improvement of patient care, reduction of infection and mortality rates, length of stay and health care costs.…”

“…10 The occurrence of VAP prolongs hospital stay and increases health care costs. 1,3,[6][7]11 Therefore, the VAP diagnosis is important to provide the proper treatment and, consequently, reduce the mortality. 1 Measures that aim to decrease the incidence of VAP are extremely important and have been increasingly discussed in literature, such as the implementation of so-called VAP prevention Bundles.…”

4-year Experience of Nursing Activities Score Use in a Brazilian Cardiac Intensive Care Unit

“…The results of this study can also provide indications of the applicability of quality indicators assessed for ICUs and specifically for Cardiac ICUs. Knowing the impact of nursing care on the quality of health services is essential, and aspects such as workload and staff dimensioning are important factors to explain these results, as what has been reported (Nogueira et al, 2017;Gomes et al, 2019). Accordingly, the aim of this study is to describe the profile and prevalence of the sub-items of the NAS instrument in the Cardiac Intensive Care Unit of the Clinical Hospital of Uberlândia of the Federal University of Uberlândia based on a four-year experience of using NAS and evaluate its temporal variation since the opening of the unit, and according to years, months and the days of the week.…”