Co-infections among COVID-19 adult patients admitted to intensive care units: results from a retrospective study.

Background: Co-infection rates increase in patients admitted to the Intensive Care Units. The aim of this study was to examine the Healthcare Associated Infections in critically ill adult patients infected with SARS-CoV-2. Methods: A retrospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit admission was performed. From February 2020 to September 2021, healthcare records from a total of 118 patients were evaluated. Results: In the study period, 39 patients were diagnosed with at least 1 Healthcare Associated Infection (33.1%). The co-infection/co-colonisation rate >48 hours after admission was 29.0 per 1,000 person/days (95 % CI 19.1-33.9). A total of 94 isolates were identified, the most common being Klebsiella spp, Clostridium difficile, Acinetobacter baumanii and Enterococcus spp. Associated outcomes for Healthcare Associated Infections have been identified: age >64 years (p= .003), length of Intensive Care Unit stay> 7 days (p= .002), Type 2 Diabetes mellitus (p= .019), cardiovascular disease (p= .021), inserted central venous catheter (p= .014), intubation (p< .001), APACHE II score >25 (p< .001), mechanical ventilation 48 hours (p= .003), and inserted urinary catheter (p= .002). The overall fatality rate of patients included in the study was 41.5% (n= 49), and it was found to be significantly higher in patients who acquired a Healthcare Associated Infection (n=26/39, 66.7%) compared to those who did not acquire it (n= 23/79, 29.1%) (OR= 4.87; 95% CI = 2.14-11.10; p< .001). Conclusions: Our study showed high rates of Healthcare Associated Infections in critically ill adults with COVID-19. Associated factors for Healthcare Associated Infections acquisition and fatality in Intensive Care Units patients were identified as a good reason for a revision of existing infection control policies.

Knowledge and attitude of pain management among Italian nurses in intensive care unit: a multicentric descriptive study.

Aim: The main objective of the study was to document the current knowledge and attitudes towards pain management among Italian nurses working in intensive care unit (ICU). Methods: A multicenter cross-sectional study design was carried out. In order to assess the knowledge and attitudes of pain management, the KASRP questionnaire was used. The questionnaire was submitted online through Google Forms platform. Results: A total of 864 nurses completed and returned the study questionnaire (58% were males). The mean of the total correct answers was 31.21 (SD 2.92) out of 40 (total score if all items answered correctly) with range of 22-38. No significant differences were observed with regard to gender (t = 1.875, P = .061). Spearman's correlation test showed a positive significant relationship between knowledge and attitude of pain management and years of ICU experience (r = -.424, P <.001) and between knowledge and attitude of pain management and the attendance of a pain update course in the last 3 years (r= -0.83, P =.014). We haven't found any correlation neither between age and knowledge nor between age and attitude score (r = -0.32, P = .351). Conclusions: This study has shown that Italian ICU nurses have good level of pain management knowledge and attitudes of pain medication. It is recommended to consider pain management in the context of continuing professional development.

Incidence of pain at rest and during nursing procedures in ICU patients: a longitudinal observational study.

AIM: To evaluate pain monitoring in surgical and no-surgical ICU patients and to observe the presence of pain at rest and during nursing procedures. METHODS: A longitudinal, observational study was conducted at an intensive care unit in Italy. Based on the specific conditions of the patient the best rating scale was used (Numerical Rating Scale or the Critical-Care Pain Observation Tool). Two ICU nurses performed pain assessments before and during some nursing procedures that are considered nociceptive. RESULTS: The pain incidence rate in 1,602 days of observation was 0.06 patient/day (59/1000 days of observation). The incidence rate of intense pain was 0.012 patient/day (12/1000 days of observation). Pain at rest was detected in 67 (27.6%) patients. Pain during procedures was found 134 (36.1%) times. In the 96 patients who were in pain the ICU stay (15.4 days + 7.8 vs 11.4 days + 5.6) and the days of mechanical ventilation (13.4 + 7.9 vs 9.7 + 4.9) was increased. Surgical patients had an increased pain risk than non-surgical patients (RR = 2.7, CI = 2.0-3.6; p<.001). CONCLUSIONS: The incidence of pain was recorded in 39.5% of ICU patients. However further studies of larger patient samples are needed.