As part of a larger clinical trial on handwashing practices, researchers examined data on nurse staffing levels and the incidence of bloodstream infections in two neonatal ICUs (NICUs) in New York City. Over a two-year period, more than 2,600 infants (56% male) were admitted to the units, with gestational ages ranging from 23 to 42 weeks. Of these infants, 224 (8.4%) developed a bloodstream infection; of these, 7% died. The most common pathogens were coagulase-negative staphylococci (45%), Gram-negative bacteria (23%), and yeast (14%). Significant risk factors for infection included low birth weight and a greater number of days with either a peripherally inserted central line or total parenteral nutrition. In one of the NICUs, more RN hours per infant day was associated with up to a 79% decrease in the risk of infection. In the other NICU (NICU1), no association was found between RN hours and infections. Jeannie Cimiotti, the lead researcher, noted in an e-mail message that NICU1 was consistently understaffed and that because there was no variation in the numbers of nurses, it was difficult to detect a significant association between RN staffing and bloodstream infections.
Cimiotti says that nurse understaffing and increased workload in critical care could result in lapses in aseptic technique that increase the risk of patients acquiring a nosocomial infection.
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Traveler's advisory. Traveling for more than four hours-whether by air, car, bus, or train-doubles the risk of venous thrombosis, according to a Dutch study published in the August issue of PLoS Medicine. Being overweight, taking oral contraceptives, and carrying the factor V Leiden mutation (a gene mutation that predisposes the carrier to blood clotting disorders) significantly increase the risk; people who are taller or shorter than the norm may be at somewhat heightened risk. Preventive measures range from performing exercises while traveling to taking anticoagulants, depending on the degree of risk. The report is available at http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/jour