A 75-year-old male with chronic obstructive pulmonary disease: Nursing ratio

A 75-year-old male has a chronic obstructive pulmonary disease (COPD) exacerbation. He is treated with steroids, gatifloxacin and help in breathing (mechanical ventilation). An initial X-ray showed his chest was clear, but on the fifth day of ventilation he got a fever and a raised white blood cell count, indicating an infection. The diagnosis was late-onset ventilator-associated pneumonia (VAP).

This man, the subject of a case study in a medical journal, survived. But many patients who get pneumonias that are associated with long times on a ventilator, i.e., late onset ventilator associated pneumonia, do not survive.

In the Intensive Care Unit (ICU), when managers allot fewer nurses to cover patients, late-onset VAP occurs more often, according to a study by Dr. Stephane Hugonnet and others that was published in Critical Care on July 19. Dr. Hugonnet calls VAP the most frequent preventable adverse event affecting critically ill patients, and says it prolongs the length of stay by up to 50 days, lengthens the duration of mechanical ventilation by 5 to 7 days, and generates substantial extra costs, of $10,000 to $40,000 per episode.

He thinks the reason is that rushed nurses take less time to wash their hands and skip other infection control recommendations. Time constraints can increase the probability of error by creating a busy, stressful environment with distractions and interruptions, leading to low compliance with hand hygiene recommendations and isolation procedures, or inadequate care for the ventilated patient. Cross-transmission of micro-organisms from one patient or the environment to another patient, or from one body site to another in the same patient, leads to colonization and infection, he reports.

Almost a quarter of patients on ventilators in the Intensive Care Unit (ICU) got pneumonia, and most of these were late-onset.

Advice to those with a family member in the ICU: Ask the ICU Nurse Manager the nurse staffing ratio.

Read one of our tired nurse stories, or read Dr. Hugonnet’s source article.