799 - Organizational Risk Factors for Nosocomial Infection in the Neonatal Intensive Care Unit

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 799
Publication Number: 799.249

Marissa A. Fazio, McGill University Faculty of Medicine and Health Sciences, Richmond Hill, ON, Canada; Elias Jabbour, McGill University Health Center, Montreal, PQ, Canada; Valérie Bertelle, Université de Sherbrooke; Anie Lapointe, CHU Ste-Justine, Montreal, PQ, Canada; Guy Lacroix, Université Laval, Québec, PQ, Canada; Sophie Gravel, CHU Sainte-Justine, CHU Sainte-Justine, PQ, Canada; Michèle Cabot, CHU de Québec - Université Laval, Lévis, PQ, Canada; Bruno Piedboeuf, Faculty of Medicine Université Laval, Québec, PQ, Canada; Marc Beltempo, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada

Presenting Author(s)

Marissa A. Fazio, BSc (she/her/hers)

Master's Student
McGill University Faculty of Medicine and Health Sciences
Richmond Hill, Ontario, Canada

Background:

Organizational factors such as unit occupancy, nursing overtime and nursing ratios may influence the risk of nosocomial infection (NI) among very preterm infants in the Neonatal Intensive Care Unit (NICU).

Objective:

To assess the association between unit occupancy, nursing overtime and nursing ratios with NI risk among very preterm infants in the NICU.

Design/Methods: A retrospective cohort study of infants born < 33 weeks and admitted in 3 tertiary-level NICUs in Quebec (Canada) between 2014-2018 was conducted. The three organizational variables of unit occupancy, nursing overtime ratios (OTR; overtime hours/total hours worked), and nursing provision ratios (NPR; available/recommended nurses) were obtained from administrative databases for each shift. Patient data was obtained from the Canadian Neonatal Network database and the primary outcome was NI (defined as positive blood and/or cerebrospinal fluid culture taken >72 hours after birth). Mean values of the organizational factors were calculated in 3-day intervals between admission and the 45^thday without NI, discharge prior to day 45 without NI, or day of first documented NI within 45 days. Analysis was conducted using mixed-effect logistic regression models adjusted for patient characteristics (gestational age, birth weight, sex, outborn status, small for gestational age, SNAP-II score >20) and site (random effect).

Results: The rate of NI was 238/2046 infants (11.6%) with a median time to infection of 11 days [IQR 7, 21]. Median unit occupancy was 89.1% [IQR 81.7%-94.7%], median OTR was 4.7% [IQR 2.4%-7.3%] and median NPR was 101.2% [IQR 86.4%-126.3%]. Median gestational age of infants with an infection was 26 weeks [IQR 25-28] (Table 1). Unit occupancy and NPR were not associated with the odds of NI (adjusted Odds Ratio (aOR); 1.01 (95% CI 0.99–1.04) and 0.98 (95% CI 0.97–1.00) respectively; Table 2). The OTR was associated with the odds of NI (aOR 1.09 (95% CI 1.04–1.14). A sensitivity analysis using 2-day intervals yielded similar results (Table 2).

Conclusion(s):

Nursing overtime is associated with the odds of NI among very preterm infants in the NICU. Future studies on organizational factors and infant outcomes should account for nursing overtime.