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Risk factors for ventilator-associated pneumonia: crude and adjusted effect of staffing level |
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| Risk factor |
Early-onset VAP |
Late-onset VAP |
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|
|
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| Crude HR (95% CI) |
Adjusted HR (95% CI) |
Crude HR (95% CI) |
Adjusted HR (95% CI) |
|
|
|
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| Nurse-to-patient ratio |
0.77 (0.42 to 1.40) |
0.78 (0.42 to 1.45) |
0.43 (0.18 to 1.02) |
0.42 (0.18 to 0.99) |
| Patient age |
1.00 (0.99 to 1.01) |
- |
1.00 (0.99 to 1.01) |
- |
| Male gender |
0.92 (0.62 to 1.38) |
- |
1.15 (0.79 to 1.69) |
- |
| Nursing acuity severity score |
0.96 (0.92 to 1.01) |
- |
1.03 (1.00 to 1.07) |
1.04 (1.00 to 1.08) |
| Charlson score |
0.89 (0.81 to 0.99) |
0.89 (0.80 to 0.98) |
0.96 (0.87 to 1.05) |
|
| Admission diagnosis |
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| Infectious disease |
0.75 (0.46 to 1.20) |
- |
1.09 (0.75 to 1.60) |
- |
| Cardiovascular condition |
1.63 (1.10 to 2.41) |
- |
1.47 (0.97 to 2.23) |
- |
| Pulmonary disease |
0.77 (0.44 to 1.33) |
- |
0.56 (0.31 to 1.02) |
0.53 (0.29 to 0.97) |
| Other |
0.87 (0.53 to 1.41) |
- |
0.84 (0.49 to 1.43) |
- |
| APACHE II score |
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| < 26 |
1 |
- |
1 |
- |
| 26 to 30 |
1.12 (0.67 to 1.86) |
- |
0.92 (0.49 to 1.72) |
- |
| > 30 |
0.83 (0.53 to 1.31) |
- |
1.08 (0.70 to 1.67) |
- |
| Nursing training levela |
0.84 (0.60 to 1.18) |
- |
1.19 (0.91 to 1.56) |
- |
| Invasive devices |
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| Central vascular line |
1.50 (0.92 to 2.45) |
1.71 (1.05 to 2.81) |
3.06 (0.97 to 9.70) |
4.14 (1.26 to 13.55) |
| Peripheral venous line |
2.06 (0.76 to 5.61) |
- |
1.47 (0.95 to 2.29) |
1.65 (1.06 to 2.59) |
| Peripheral arterial line |
0.58 (0.32 to 1.06) |
- |
5.65 (0.78 to 40.84) |
- |
| Urinary catheter |
1.86 (0.66 to 5.26) |
- |
1.31 (0.41 to 4.16) |
- |
| Nasogastric tube |
1.40 (0.75 to 2.63) |
- |
2.39 (0.76 to 7.54) |
- |
| Medication |
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| Parenteral nutrition |
0.83 (0.49 to 1.41) |
- |
0.99 (0.65 to 1.51) |
- |
| Therapeutic antibiotic |
0.48 (0.32 to 0.73) |
0.47 (0.31 to 0.71) |
0.51 (0.29 to 0.91) |
0.34 (0.19 to 0.62) |
| Prophylactic antibiotic |
0.58 (0.18 to 1.84) |
- |
1.22 (0.56 to 2.63) |
- |
| Gastric antacid drug |
1.34 (0.90 to 2.00) |
- |
0.98 (0.66 to 1.46) |
- |
|
aNursing training level is the number of intensive care unit certified nurses divided by the number of trainee nurses in critical care. APACHE, Acute Physiology and Chronic Health Evaluation; CI, confidence intervals; HR, hazard ratio; VAP, ventilator-associated pneumonia. | ||||
Hugonnet et al. Critical Care 2007 11:R80 doi:10.1186/cc5974 |
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