6: Patient Volume and Nursing Overtime Increased Risk of Nosocomial Infection in the NICU
Bibliographic record
Abstract
Adult studies have shown that outbreaks in nosocomial infections are associated with understaffing and overcrowding. However, no study has assessed the impact of nurse overtime and patient volume in the neonatal intensive care unit (NICU) on neonatal nosocomial bacteremia. The objective of this study was to assess the impact of patient volume and nurse overtime on neonatal nosocomial bacteremia in all infants hospitalised in the NICU. We conducted a retrospective study on all infants (n=7473) admitted in the CHU de Québec NICU (capacity of 51 beds) from April 1, 2008 to March 31, 2013. Administrative data (nursing overtime hours per day, patient census per day) were obtained from the database Logibec, patient information was obtained from Med-Echo and information on neonatal nosocomial bacteremia was obtained from the local infectious disease database TDR. We assessed the association between administrative data and patient outcomes by using logit and probit models. The average patient volume as percentage of capacity during the study period was 98.7±6.5%. The average overtime as percentage of total daily hours of work was 4.0±3.4%. Overtime is positively related to occupancy levels. For every increase of occupation by one patient, there was an increase of 1.65 h of overtime per day (P<0.001). There were a total of 306 events of nosocomial bacteremia during the study period. Coagulase-negative staphylococcus caused 82% of infections. The overall risk of nosocomial bacteremia was 4.2%. The total number of regular worked hours was not associated with a higher risk of infection. Higher overtime (expressed as percentage of total worked hours) was significantly associated with an increased risk of nosocomial bacteremia (P=0.02). Also, days when overtime was >8% of total worked hours, are significantly associated with an increase risk of nosocomial bacteremia (OR 1.51 [95% CI 1.10 to 2.08]; P=0.01). There was a trend between higher patient volume (100% occupancy compared to 90% capacity) and higher risk of nosocomial bacteremia (OR=1.60; P=0.08). In our study, high patient volume and nursing overtime was directly associated with a higher risk of nosocomial bacteremia in the NICU. This suggests that re-organising the medical workforce to better adapt to periods of high activity in the NICU should become an integral part of nosocomial infection prevention.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".