| Learning Objective #1: The learner will be able to describe one chest tube-related factor, which is an independent predictor of nosocomial infection. | |||
| Learning Objective #2: The learner will be able to describe 3 ways of reducing a critically ill patient’s likelihood of developing a nosocomial infection. |
Purpose: The study was conducted to investigate the impact of chest tube-related factors on the risk for development of nosocomial infections (NI) and to examine the independent predictors of NI in a community based ICU
Significance: Critically ill patients are at high risk of developing NI, which then leads to higher mortality rates, prolonged hospitalization, and increased costs. Chest tubes have been associated with increased risk of nosocomial pneumonia, but only one study reported that the presence of a chest tube was an independent risk factor for the development of nosocomial bloodstream infection (NBSI). Little is known about the specific chest tube-related factors that contribute to NI.
Methods: A retrospective, case-control review of 120 medical records of ICU patients was conducted. Two groups were compared using t-test and chi square comparisons on each of the study variables. Hierarchical logistic regression was used to determine which chest tube-related factors were independent predictors of NI, while adjusting for other known risk factors.
Results: Of the 40 cases, 92.5% (n = 37) had pneumonia, while 7.5% (n = 3) had NBSI. Chest tube-related factors accounted for 7.4% to 10.2% of the explained variance. The variable ‘chest tube days’ was the only chest tube-related factor to be an independent predictor of NI (OR 5.79, 95% CI, 1.459-23.015). Mechanical ventilation (MV) (OR, 4.88; 95%CI, 1.8-13.1) and “outcome length of stay” (LOS) (OR, .724; 95%CI, .624-.839) were also found to be independent predictors of NI. Conclusions: Risk of infection among patients with chest tubes increases as the duration of chest tube use increases. Infection is likely to happen early during admission, which necessitates stringent adherence to infection control strategies from initial phases of treatment.
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