Nursing workload, staffing qualifications, and nursing care costs associated with hospital-acquired pressure ulcer days in the ICU: a retrospective cohort study.

BACKGROUND: Hospital-acquired pressure ulcers (HAPUs) are frequent and costly adverse events. Inadequate staffing and missed nursing care may contribute to preventable complications and higher healthcare costs. OBJECTIVE: The aim of this study was to assess the associations between nursing workload, staffing qualifications, and nursing care costs and the occurrence of hospital-acquired pressure ulcer days in ICU patients using retrospective cohort data. METHODS: This study included 1,461 ICU care days from 2019 to 2022. Variables examined were Nursing Hours per Patient Day (NHPPD), patient-days, nursing educational structure, and care complexity assessed using TISS-28. Logistic with Newey-West standard errors evaluated associations of NHPPD and patient-days with HAPU days. Nursing care costs were analyzed separately using non-parametric tests comparisons. RESULTS: A total of 81 days with HAPU were identified (5.4% of). Each one-hour increase in NHPPD was associated with 9% lower odds of a HAPU Day (OR = 0.91; 95% CI: 0.83-1.00; p = 0.035), whereas each additional patient-day was associated with 19% higher odd (OR = 1.19; 95% CI: 1.01-1.40; p = 0.047). Nursing care costs varied significantly across study years. The highest values observed in year 2022 (p < 0.001). Educational structure of the nursing staff, nursing care costs and complexity of care was not statistically significantly associated with HAPU occurrence in this study. CONCLUSION: Nursing workload indicators, particularly NHPPD and patient demand, were significantly associated with HAPU occurrence in the ICU. Adequate nursing staffing may contribute to reducing preventable adverse events and improving patient safety in intensive care settings.