{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T20:46:10Z","timestamp":1786999570132,"version":"build-2736575974"},"reference-count":27,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T00:00:00Z","timestamp":1707350400000},"content-version":"unspecified","delay-in-days":38,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["HI20C1130"],"award-info":[{"award-number":["HI20C1130"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study examined the association between the number of nursing staff in intensive care units (ICUs) and hospital-acquired pneumonia (HAP) among surgical patients in South Korea. Data were obtained between 2008 and 2019 from the Korean National Health Insurance Service Cohort Database; 37,706 surgical patients who received critical care services were included in the analysis. Patients with a history of pneumonia 1 year prior to surgery or those who had undergone lung-related surgery were excluded. The ICU nursing management fee is an admission fee that varies based on the grading determined by nurse-to-bed ratio. Using this grading system, we classified four groups from the highest to the lowest level based on the proportion of beds to nurses (high, high-mid, mid-low, and low group). HAP was defined by the International Classification of Disease, 10th revision (ICD-10) code. Multilevel logistic regression was used to investigate the relationship between the level of ICU nurse staffing and pneumonia, controlling for variables at the individual and hospital levels. Lower levels of nurse staffing were associated with a greater incidence of HAP than higher levels of nurse staffing (mid-high, OR: 1.33, 95% CI: 1.12\u20131.57; mid-low, OR: 1.61, 95% CI: 1.27\u20132.04; low, OR: 2.13, 95% CI: 1.67\u20132.71). The intraclass correlation coefficient value was 0.177, and 17.7% of the variability in HAP was accounted for by the hospital. Higher ICU nursing management fee grades (grade 5 and above) in general and hospital settings were significantly associated with an increased risk of HAP compared to grade 1 admissions. Similarly, in tertiary hospitals, grade 2 and higher ICU nursing management fees were significantly associated with an increased risk of HAP compared to grade 1 admissions. Especially, a lower level of nurse staffing was associated with bacterial pneumonia but not pneumonia due to aspiration. In conclusion, this study found an association between the level of ICU nurse staffing and HAP among surgical patients. A lower level of nurse staffing in the ICU was associated with increased rates of HAP among surgical patients. This indicates that having fewer beds assigned to nurses in the ICU setting is a significant factor in preventing HAP, regardless of the size of the hospital.<\/jats:p>","DOI":"10.1017\/s0950268824000232","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T22:39:31Z","timestamp":1707345571000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":7,"title":["Association between nurse staffing level in intensive care settings and hospital-acquired pneumonia among surgery patients: result from the Korea National Health Insurance cohort"],"prefix":"10.1017","volume":"152","author":[{"given":"Yu Shin","family":"Park","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Il","family":"Yun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suk-Yong","family":"Jang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Cheol","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0760-2878","authenticated-orcid":false,"given":"Sung-In","family":"Jang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,2,8]]},"reference":[{"key":"S0950268824000232_r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2007.03.008"},{"key":"S0950268824000232_r7","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkn162"},{"key":"S0950268824000232_r5","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-6701(03)00150-6"},{"key":"S0950268824000232_r18","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200303000-00003"},{"key":"S0950268824000232_r14","doi-asserted-by":"publisher","DOI":"10.1111\/inr.12143"},{"key":"S0950268824000232_r15","first-page":"e15","article-title":"Cohort profile: The National Health Insurance Service\u2013National Sample Cohort (NHIS-NSC), South Korea","volume":"46","author":"Lee","year":"2017","journal-title":"International Journal of Epidemiology"},{"key":"S0950268824000232_r11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa012247"},{"key":"S0950268824000232_r4","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2014.1216"},{"key":"S0950268824000232_r9","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181e47888"},{"key":"S0950268824000232_r21","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2021.151558"},{"key":"S0950268824000232_r25","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2001.49113.x"},{"key":"S0950268824000232_r1","first-page":"15","article-title":"The risk factors for hospital-acquired pneumonia in the intensive care unit","volume":"70","author":"Wa\u0142aszek","year":"2016","journal-title":"Przegla\u0327d 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Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e62"}}