Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit

Autor: Pascal Astagneau, F. L’Hériteau, Katiuska Miliani, Jordi Ferrer, Pierre-Yves Boëlle, Jérôme Salomon, Laura Temime
Přispěvatelé: Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires ( MESuRS ), Conservatoire National des Arts et Métiers [CNAM] ( CNAM ) -Pasteur-Cnam risques infectieux et émergents ( PACRI ), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] ( CNAM ) -Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] ( CNAM ), Epidémiologie, systèmes d'information, modélisation, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Regional coordinating centre for nosocomial infection control ( C-CLIN Paris Nord ), École des Hautes Études en Santé Publique [EHESP] ( EHESP ), This work was supported in part by a grant from Région Ile-de-France (MELODIE contract #CP11-616 Project number 110232)., Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Regional coordinating centre for nosocomial infection control (C-CLIN Paris Nord), École des Hautes Études en Santé Publique [EHESP] (EHESP)
Jazyk: angličtina
Rok vydání: 2014
Předmět:
MESH: Cross Infection/epidemiology
Epidemiology
MESH : Cross Infection/epidemiology
Nurses
Infection control
law.invention
MESH : Workload
0302 clinical medicine
Mathematical model
Nosocomial infection
law
030212 general & internal medicine
MESH: Models
Theoretical
Patient transfer
MESH: Workload
0303 health sciences
Cross Infection
Agent-based simulation
Staff management
Workload
[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie
MESH: Intensive Care Units/manpower
Intensive care unit
3. Good health
Intensive Care Units
Infectious Diseases
Nurse shortage
Workforce
Medical emergency
medicine.medical_specialty
Staffing
MESH : Intensive Care Units/manpower
Microbiology
Unit (housing)
lcsh:Infectious and parasitic diseases
03 medical and health sciences
Intensive care
Virology
medicine
Humans
lcsh:RC109-216
Intensive care medicine
MESH: Humans
030306 microbiology
business.industry
MESH : Models
Theoretical
MESH : Humans
Public Health
Environmental and Occupational Health
Models
Theoretical
medicine.disease
MESH: Nurses/statistics & numerical data
MESH : Nurses/statistics & numerical data
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Parasitology
business
Zdroj: Epidemics
Epidemics, 2014, 9, pp.62-69. 〈10.1016/j.epidem.2014.07.002〉
Epidemics, Vol 9, Iss C, Pp 62-69 (2014)
Epidemics, 2014, 9, pp.62-69. ⟨10.1016/j.epidem.2014.07.002⟩
Epidemics, Elsevier, 2014, 9, pp.62-69. ⟨10.1016/j.epidem.2014.07.002⟩
Epidemics (9), 62-9. (2014)
ISSN: 1755-4365
1878-0067
DOI: 10.1016/j.epidem.2014.07.002〉
Popis: Studies provide evidence that reduced nurse staffing resources are associated to an increase in health care-associated infections in intensive care units, but tools to assess the contribution of the mechanisms driving these relations are still lacking. We present an agent-based model of pathogen spread that can be used to evaluate the impact on nosocomial risk of alternative management decisions adopted to deal with transitory nurse shortage.
We constructed a model simulating contact-mediated dissemination of pathogens in an intensive-care unit with explicit staffing where nurse availability could be temporarily reduced while maintaining requisites of patient care. We used the model to explore the impact of alternative management decisions adopted to deal with transitory nurse shortage under different pathogen- and institution-specific scenarios. Three alternative strategies could be adopted: increasing the workload of working nurses, hiring substitute nurses, or transferring patients to other intensive-care units. The impact of these decisions on pathogen spread was examined while varying pathogen transmissibility and severity of nurse shortage.
The model-predicted changes in pathogen prevalence among patients were impacted by management decisions. Simulations showed that increasing nurse workload led to an increase in pathogen spread and that patient transfer could reduce prevalence of pathogens among patients in the intensive-care unit. The outcome of nurse substitution depended on the assumed skills of substitute nurses. Differences between predicted outcomes of each strategy became more evident with increasing transmissibility of the pathogen and with higher rates of nurse shortage.
Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.
Databáze: OpenAIRE
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