key: cord-0844879-dbkkt3i8
authors: Reper, P.; Delaere, S.; Yimbou, JJ; Labrique, S.; Massaut, J
title: Not only ICU workload and activities but also ICU quality indicators are influenced by the Covid-19 epidemic
date: 2020-12-16
journal: Intensive Crit Care Nurs
DOI: 10.1016/j.iccn.2020.103008
sha: 5b99ed9f026a95e30792bf51b18a0164b25f6b9d
doc_id: 844879
cord_uid: dbkkt3i8

nan

 Covid 19 pandemic is associated with higher workload which needs more staff at the bedside.

 Covid 19 is associated with more intrahospital infections.

 Covid 19 pandemic also influences quality indicators in ICU practice.

 It is necessary to adapt and ICU staffs and clinical practice in ICU to maintain the same quality level of ICU care than without Covid 19 pandemic To the Editor This retrospective case series includes adults with severe Covid-19 respiratory infection (2, 3) consecutively admitted in the ICU between March 14 and April 30, 2020, at a regional hospital in Hainaut Province, one pandemic epicenter in Belgium.

All Covid-19 diagnoses were confirmed through reverse-transcriptase-polymerase-chainreaction assays performed on ICU admission (1) . We compare the Covid-19 period data with two different registration periods before the Covid-19 outbreak.

Most of the collected data confirmed significant differences between the Covid-19 period and the non Covid-19 periods (Table 1 ) without significant differences in populations characteristics. Covid-19 patients need more and longer aggressive supports like artificial ventilation and renal replacement therapy, reflected by longer ICU stay and higher SAPS 3 and SOFA scores determined on day 1 (2).

The nursing workload in Covid-19 critically ill population assessed by the Nursing Activities Score (NAS) registration (3) not only reflects the higher workload in Covid-19 ICU but also the various complications (1, 2, 3) developed by these critical patients.

Medicine (4) are therefore significantly different during the Covid-19 pandemic with higher readmission rate and more adverse events principally related to ventilatory support and vascular accesses.

Nosocomial infection rate is significantly higher with more ventilator acquired infectious events (VAE or ventilator acquired pneumonia (VAP) and catheter related infection (Central Line-associated Bloodstream Infection -CLABSI) (5).

We did not observe a significantly higher absolute mortality but Standardized mortality ratio (SMR) was significantly influenced by the pandemic episode.

Covid-19 infection leads to more dramatic situations with extreme workload for the ICU teams and higher complications rate. But Covid-19 outbreak also significantly influences ICU quality indicators particularly observed incidents, inhospital infections rates and SMR.

Further studies are necessary to determine if this influence on quality indictors is related to the ICU management of this higher workload with limited resources or to the specificities of Covid-19 infection leading to more frequent complications in the most critical patients.

-Ethical Approval and Consent to participate: Data proceeding has been approved by the ethical committee of CHR Haute Senne (Dehout F, MD, president) -Consent for publication: not applicable -Availability of supporting data: not applicable -Competing interests: none -Funding: none -Authors' contributions: every authors have participated to write this publication and approved the content -Acknowledgements: none 

Clinical characteristics of coronavirus disease 2019 in China

Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China

Nursing activities score is increased in COVID-19 patients

Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM)

Ventilator-Associated Events: What They Are and What They Are Not. Respir Care

LOS (length of ICU stay); SAPS score (Simplify acute physiology score); SOFA score (Sequential Organ Failure Assessment score)

VAP (ventilator associated pneumonia)

SMR (Standardized mortality ratio)