Healthcare-associated infections in adult intensive care units : A multisource study examining nurses’ safety attitudes, quality of care, missed care, and nurse staffing

Journal article

Alanazi, Faisal Khalaf, Lapkin, Samuel, Molloy, Luke and Sim, Jenny. (2023). Healthcare-associated infections in adult intensive care units : A multisource study examining nurses’ safety attitudes, quality of care, missed care, and nurse staffing. Intensive and Critical Care Nursing. 78, p. Article 103480. https://doi.org/10.1016/j.iccn.2023.103480
AuthorsAlanazi, Faisal Khalaf, Lapkin, Samuel, Molloy, Luke and Sim, Jenny
Abstract

Objectives
This study examined the association between safety attitudes, quality of care, missed care, nurse staffing levels, and the rate of healthcare-associated infection (HAI) in adult intensive care units (ICUs).

Methods
A cross-sectional study was conducted in five hospitals. Nurses completed a validated survey on safety attitudes, quality of care, missed care, nurse staffing levels, and the frequency of HAIs. Secondary data were collected on the incidence of central line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) in participating units. Descriptive analysis and generalized linear models were performed.

Results
A total of 314 nurses from eight ICUs participated in this study. The mean safety culture score was 60.85 (SD = 3.53). ICUs with strong job satisfaction had lower incidence and nurse-reported frequency of CLABSI, CAUTI, and VAP. Missed care was common, with 73.11% of nurses reporting missing at least one required care activity on their last shift. The mean patient-to-nurse ratio was 1.95. Increased missed care and higher workload were associated with higher HAIs. Nurses’ perceptions of CLABSI and VAP frequency were positively associated with the actual occurrence of CLABSI and VAP in participating units.

Conclusion
Positive safety culture and better nurse staffing levels can lower the rates of HAIs in ICUs. Improvements to nurse staffing will reduce nursing workloads, which may reduce missed care, increase job satisfaction, and, ultimately, reduce HAIs.

Implications for clinical practice
Higher levels of job satisfaction among ICU nurses, lower proportions of missed nursing care and higher nurse staffing are associated with lower rates of HAIs. Nurse-reported HAI frequency was positively associated with the incidence of HAIs; therefore, nurses provide reliable data on infection control outcomes in ICU settings.

Keywordsadults; CAUTI; CLABSI; critical care nurses; healthcare-associated infections; missed care; nurse staffing; safety attitudes; VAP
Year2023
JournalIntensive and Critical Care Nursing
Journal citation78, p. Article 103480
PublisherElsevier Ltd
ISSN0964-3397
Digital Object Identifier (DOI)https://doi.org/10.1016/j.iccn.2023.103480
PubMed ID37379679
Scopus EID2-s2.0-85164506806
Page range1-7
FunderMinistry of Education, Kingdom of Saudi Arabia
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online26 Jun 2023
Publication process dates
Accepted08 Jun 2023
Deposited22 May 2025
Additional information

© 2023 Elsevier Ltd. All rights reserved.

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