Health care workers' knowledge and practices regarding the prevention of central venous catheter-related infection

Knowledge, practice and associated factors towards intravenous cannula-related infection prevention among nurses working at Northwest Amhara Regional State Comprehensive Specialized Hospitals, Ethiopia

BACKGROUND

Intravenous cannula-related infections are one of the leading causes of healthcare-associated infections. It leads to morbidity and mortality in hospitalized patients. Nurses play a significant role in the prevention of these infections. Whereas in Ethiopia, there is limited information and published studies done on nurses' knowledge, practice, and associated factors and also most of other available studies done only the magnitude it lack associated factors. The purpose of this study was to assess nurses' knowledge, practice, and associated factors toward intravenous cannula-related infection prevention.

METHODS

An institution-based cross-sectional study was conducted at Northwest Amhara Regional State Comprehensive Specialized Hospitals on May 1-30/2022. By using single population proportion formula the sample size was determined; we used a 50% proportion value (0.05), and 95% Confidence Interval 5% margin of error. A simple random sampling method was used to select 423 nurses. The data were collected by using structured pretested self-administered questionnaires. Then coded, and enter into epi-data version 4.6 and exported into the statistical package for social science version 23 for cleaning and analyzing the data. Data were presented by texts, tables, and figures. A binary logistic regression model was used to assess the association between variables. Based on the adjusted odds ratio, variables having a p-value less than 0.05 with a 95% confidence interval were used to state associated with the outcome variables.

RESULTS

A total of 412 nurses participated in this study with 97.4% response rate. The participants had good knowledge and practice in proportions of (54. 9%) and (53. 4%) respectively. Being male, working wards/units, having training, and a higher educational level were factors that were significantly associated to having good knowledge. Working wards/units, having good knowledge, training, and access to guidelines were significantly associated with performing good practice.

CONCLUSION

The finding of this study revealed that nearly half of the nurses had poor knowledge and practice in intravenous cannula-related infection prevention. As a result, hospital administrators and other concerned stakeholders better to prepare and ensure that guidelines are available, provide training, and develop the educational levels of nurses.

Effect of intensive training and education of health care workers on the maintenance bundle of venous access devices in critically ill patients at a tertiary care academic hospital

BACKGROUND

The maintenance bundle of care for all venous access devices (peripheral intravenous catheters, PIVC; central venous catheters, CVCs; hemodialysis ports) is important to prevent secondary sepsis in critically ill patients. This quality improvement project analyzed the effect of intensive training and education of health care workers (HCWs) on maintenance bundles for venous access devices.

METHODS

The study period comprising of preintervention phase (3-months) included 25 random visits to the intensive care unit for point observations regarding maintenance of all venous access devices in-situ in all intensive care unit patients on the day of the visit. The observations were categorized as appropriate or inappropriate practices based on American Society of Anesthesiologists (ASA) guidelines for CVC 2020, INICC guidelines for PIVC 2017, and Australian Commission on Safety and Quality in Health Care (ACQHCS) for PIVC and hemodialysis ports, December 2019. While the intervention phase (1-month) comprised intensive training and education of HCWs, postintervention phase 3 (3-months) included similar visits and point observations as during the preintervention phase.

RESULTS

The maintenance of PIVC improved significantly in terms of the condition of site (from 82.7% appropriate observations to 97.8%, P < .05); condition of connectors (45.7%-56.8%, P < .05), and any attached unused IV sets (90.5%-98.56%, P < .05). For CVC, there was significant improvement in condition of insertion site (66%-94%, P < .01); condition of connectors (0%-44.37%, P < .01); fixation (91%-99.3%, P < .05); any attached unused IV sets (38.9%-97.3%, P < .01) and knowledge of HCW (96.52%-100%, P = .05). For hemodialysis ports, no significant improvement was observed.

CONCLUSIONS

Intensive training and education of HCWs led to significant improvement in the maintenance bundle of care for PIVC and CVC.

Knowledge and Practices for Central Line Infection Prevention Among Brazilian Nurses: A Mixed-Methods Study

BACKGROUND

The risk of central line-associated bloodstream infections (CLABSIs) increases when preventive guidelines are not adhered to. However, studies have generally been quantitative and aimed at determining the effectiveness of CLABSI prevention bundles. Few studies have used a mixed-methods approach to investigate nursing professionals' knowledge and practices regarding CLABSI prevention.

PURPOSE

To determine nursing professionals' knowledge and practices regarding CLABSI prevention and identify facilitators and barriers to adherence to CLABSI prevention strategies in a Brazilian neonatal intensive care unit.

METHODS

A mixed-methods approach was used. Nursing professionals answered questionnaires regarding knowledge and practices surrounding CLABSI prevention. Semistructured interviews explored barriers nursing professionals face that hinder adherence to CLABSI preventive practices.

FINDINGS

Nursing professionals had moderate knowledge regarding CLABSI prevention practices. Daily assessment of the continued need for central venous lines (CVLs), hub disinfection before and after handling, and hand hygiene before handling CVLs were practices less adhered to. Interviews revealed barriers to adherence to preventive practices included lack of adequate equipment, resources for hand hygiene, and inadequate physical structure. Increased education and awareness of safe CVL practices and accountability of the entire healthcare team may improve adherence to CLABSI prevention practices. Results of this study reinforce the importance of considering current nursing practices when developing strategies to increase adherence to CLABSI prevention guidelines.

IMPLICATIONS FOR PRACTICE

Providing continuing education may increase adherence to CLABSI prevention strategies.

IMPLICATIONS FOR RESEARCH

Research is needed to develop strategies aimed at increasing nursing adherence to CLABSI prevention strategies.

Adherence to the central line bundle in intensive care: An integrative review

BACKGROUND

Central line-associated bloodstream infections (CLABSI) occurring in intensive care units are associated with increased morbidity and mortality, increased length of hospitalization, and cost of care associated with treating CLABSIs. The Centers for Disease Control and Prevention guidelines and checklist bundle are intended to provide evidence-based recommendations for the prevention of CLABSIs. Despite the promotion of central line bundle policies, wide variability exists in compliance and infection rates in intensive care units.

OBJECTIVE

To evaluate and synthesize the existing literature on adherence to the central line bundle recommendations for the prevention of CLABSI.

DESIGN

Integrative literature review.

DATA SOURCES

CINHAL, PubMed, and SCOPUS databases were searched.

REVIEW METHODS

Whittmore and Knafl's integrative review method.

RESULTS

A total of 608 articles were identified, 407 articles were screened for topic of interest and adherence to the inclusion criteria, and 19 articles were included in this review. None of the 19 studies addressed adherence to all 14 recommendations of the central line bundle checklist.

CONCLUSION

This integrative review identified gaps in adherence to the central line bundle. Research is needed to determine the actual adherence to each item in the bundle, and to investigate factors that contribute to nonadherence. To achieve complete compliance with all the bundle items creative and innovative technology is needed.

Nurses and physicians knowledge of guidelines for preventing catheter-related blood stream infections

BACKGROUND

Catheter-related blood stream infection (CRBSI) is considered a major challenge for health care providers working in intensive care units.

AIM

This study aimed to evaluate and compare the knowledge of evidence-based guidelines for preventing catheter-related blood Stream infections among physicians and nurses working in critical care units in Jordan.

DESIGN

A cross-sectional survey design was utilized.

METHODS

The study was conducted in five intensive care units; 181 nurses and 68 physicians were recruited from four governmental hospitals and one university-affiliated hospital.

RESULTS

The mean total knowledge score for physicians' knowledge was low at 2.6, SD 1.5 (out of 10). While the mean total score for nurses' knowledge was low at 3.3, SD 1.8 (out of 10). The independent t test shows that nurses had a significantly higher mean total knowledge score than physicians (P < .05).

CONCLUSIONS

The current study demonstrates that Jordanian nurses and physicians working in intensive care units have a low level of knowledge of the guidelines for preventing CRBSI. This problem should be addressed through routine assessment and evaluation and adoption and policies that make nurses and physicians comply with the evidence-based guidelines. Finally, conducting regular educational programmes on CRBSI prevention, and evaluation of compliance with the guidelines in daily clinical practice, are strongly recommended.

RELEVANCE TO CLINICAL PRACTICE

The results of the current study suggest the need for regular assessment of physicians' and nurses' knowledge and skills with regard to central venous catheter insertion and maintenance care. Based on this assessment and using the best available evidence, training programmes on the prevention of CRBSI should be developed. Courses might be online, face to face, or using high fidelity simulation. Finally, regular observation and evaluation of compliance with the CRBSI guidelines in daily clinical practice is needed.

Impact of an Educational Program on Nurses' Performance in Providing Peripherally Inserted Central Catheter Care for Neonates

All nurses who care for neonates with peripherally inserted central catheters require enhanced awareness of the current practice guidelines and standards. This study evaluated the impact of an educational program on nurses' performance from May 2016 to July 2017 at 4 hospitals in Tehran, Iran. The performance of 80 nurses was observed and scored 3 times before the intervention. Four weeks after the last training session, their performance was observed with the same researcher, and the checklist was completed 3 times in different working shifts. Four 35- to 45-minute training sessions were completed with a 4-week follow-up. Results of the study indicated that training courses should be held every 6 months, including permanent or periodic feedback.

Conocimiento y cumplimiento del cuidado de catéteres centrales en un Hospital Mexicano

Introducción: El uso de catéteres intravasculares constituye una herramienta fundamental para el cuidado de los pacientes, mismos que han sido asociados a las bacteriemias nosocomiales entre un 15 y 30%. El objetivo de estudio fue determinar el nivel de conocimiento y cumplimiento del personal de enfermería respecto al protocolo de cuidados de accesos vasculares centrales. Materiales y métodos: estudio descriptivo, transversal, observacional, que incluyó a 67 profesionales de enfermería que tuvieron a su cuidado pacientes con catéter venoso central. Para la recolección de datos se utilizaron dos instrumentos diseñados a partir del protocolo de cuidados emitido por la Comisión Permanente de Enfermería. Resultados: Se encontró personal con antigüedad laboral promedio de 7.9 años. En conocimiento el 58.2% se ubicó en categoría Conoce, en contraste con el cumplimiento resultando el 91% del personal en categoría Cumple. No hubo correlación entre conocimiento y cumplimiento (rho = -0.181, p = 0.797). Discusión: El cumplimiento contrastó con el conocimiento, sin embargo, los enunciados para ambas variables se relacionaron con la falta de lavado de manos, dejar el tiempo adecuado de los antisépticos y la desinfección de lúmenes a la hora de la manipulación. Conclusiones: La falta de conocimiento y cumplimiento de elementos del protocolo se relacionan directamente con situaciones procedimentales que realiza el profesional de enfermería, por lo que la falta de material e insumos no son factores para no seguir la estandarización del cuidado.

Improving Hand Hygiene Practices to Reduce CLABSI Rates: Nurses Education Integral for Success

How to cite this article: Myatra SN. Improving Hand Hygiene Practices to Reduce CLABSI Rates: Nurses Education Integral for Success. Indian J Crit Care Med 2019;23(7):291-293.

Knowledge and behavior of professionals about bundled strategies of central venous catheter

OBJECTIVE

To investigate the factors that influence the knowledge and behavior of professionals of neonatal and pediatric units about bundled strategies of insertion of central venous catheter.

METHOD

This is a cross-sectional study, conducted in one neonatal and one pediatric intensive care units in a public hospital in Belo Horizonte, Brazil, from April to July, 2016. The sample consisted of 255 professionals who answered a structured instrument. Descriptive and comparative analyses were made using the SPSS software.

RESULTS

The category nursing professional (p = 0.010), working hours of 12×36 scale (p < 0.001), training as a form of acquiring knowledge (p < 0.001) and participation in training programs (p < 0.001) are associated to greater knowledge about the bundle. Regarding behavior, no significant associations were observed.

CONCLUSION

The study showed that there are factors that influence the knowledge about bundled strategies of insertion of central venous catheter, reflecting the need to consider these practices for making more effective educational practices in health care.

Effects of a multi-component educational intervention on nurses' knowledge and adherence to standard precautions in intensive care units

Background

The standard precautions (SPs) should be disseminated and implemented by healthcare providers. This study aimed to examine the effects of a multi-component educational intervention on nurses' knowledge and adherence to the SP guidelines in intensive care units (ICUs).

Methods

This small-scale study consisted of a cluster randomised trial. Two ICUs, located in different hospitals, participated in the study. Nurses (n = 15) in one ICU received the multi-component educational intervention. The intervention involved an educational (with multiple instructional media) and a behavioural (with hands-on practice) component. Nurses' knowledge and adherence were assessed at pre-test and two and six weeks after the intervention.

Results

Results showed significant group by time interaction effects for both outcomes: a large improvement was found in the experimental group over time, but not in the control group. The experimental nurses' knowledge improved from 15 ± 2.47 at pre-test to 19 ± 2.65 and 19.53 ± 0.92 at follow-ups. Similarly, their adherence increased from 19.87 ± 4.44 at pre-test to 29.20 ± 5.00 and 28.40 ± 4.37 at two and six weeks post-test, respectively.

Conclusions

The multi-component educational interventions had demonstrated initial effectiveness in enhancing ICU nurses' knowledge and adherence to the SPs guidelines. The intervention is a promising approach for designing effective continuing education initiatives aimed to improve nurses' practice.

Development of the peripheral and central venous catheter-related bloodstream infection prevention knowledge and attitudes scale

BACKGROUND

Because of the necessities of modern medicine, catheters are frequently used for patients today. Mistakes made in catheter implementation frequently cause nosocomial infections.

AIMS AND OBJECTIVES

The purpose of this study was to develop a scale to be used for the evaluation of nurses' knowledge and attitudes about peripheral and central venous catheter-related bloodstream infection prevention.

DESIGN AND METHODS

This methodological study was conducted between July 2016 and December 2017, with 150 nurses who worked in intensive care units and surgical, internal and paediatric clinics in hospitals located in two different cities in the eastern part of Turkey and who consented to participate in the study.

RESULTS

Item total correlation values of the scale ranged between 0.515 and 0.703. Correlation coefficient between the two measurements as a result of the test-retest reliability was found to be 0.64, and there was a linear relationship between the measurements. The Kaiser-Meyer-Olkin (KMO) value was found to be0.875, which indicates the adequacy of the sample. Barlett's test results indicated a correlation between the items (P < .01). Cronbach's alpha value of the scale was found to be 0.86.

CONCLUSIONS

Results showed that the 5-point Likert scale was formed with 14 items and two factors, which included "general precautions" and "catheter care." Scale total score is obtained by collecting all the items. Higher scores indicate higher knowledge and attitudes. This scale could be used for assessing the knowledge and attitudes of nurses about peripheral and central venous catheter-related bloodstream infection prevention precautions.

RELEVANCE TO CLINICAL PRACTICE

The Peripheral and Central Venous Catheter-Related Bloodstream Infection Prevention Knowledge and Attitudes Scale could be used for infection prevention in the assessment of the knowledge and attitudes of nurses with a view of preventing infections. The scale can be used in intensive care units and surgical, internal and paediatric clinics in order to assess nurses' knowledge and attitudes.

The adherence to guidelines for preventing CVC-related infections: a survey among Italian health-care workers

Background

Since correct maintenance of intravascular catheters is an effective strategy for preventing central-line infections, the aim of this study was to assess the level of adherence to guidelines for CVC maintenance amongst Italian HCWs.

Methods

From July 2016 thru January 2017, a cross sectional survey was carried out in a random sample of 549 HCWs working in different hospitals of Campania region (Italy).

Results

The 68.9% of interviewees returned the questionnaire. Overall, respondents’ level of knowledge about CDC guidelines was low, with only the 20.7% of HCWs acknowledging guidelines main recommendations: the nurse stuff, the availability of hospital internal protocols, the use of guidelines themselves as source of information, and higher number of years of practice were significantly associated with a higher level of knowledge. An extremely positive attitude towards the utility of guidelines for preventing CVC-related infections was shown, with a linear regression model indicating a stronger attitude in physicians, in who knew the CDC main recommendations and correct use of antibiotic ointments, as well as in HCWs needing additional information on the prevention of CVC-related infections. Regarding the behaviors, physicians were more likely to be adherent about recommended evidence-based practices. Two more multivariate logistic and ordinal logistic regression models were built to investigate characteristics associated with correct behavior regarding the removal of catheter dressing if patients have tenderness at insertion site or fever without an obvious source, respectively.

Conclusions

This study reflected an important lack of evidence-based knowledge and practices regarding the CVC management, highlighting the baseline role of education and training programs, as well as pointing out the role of organizational interventions to address the adherence to best practices for the reduction of CLABSIs.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3514-x) contains supplementary material, which is available to authorized users.

Assessment of knowledge and practices of healthcare workers towards infection prevention and associated factors in healthcare facilities of West Arsi District, Southeast Ethiopia: a facility-based cross-sectional study

Background

The prevention of healthcare associated infections is central to the provision of safe, high quality healthcare. Infections acquired in healthcare facilities are a major public health concern, contributing to increased morbidity, mortality, and cost in both developed and developing countries. Although most of these infections can be prevented with relatively inexpensive infection prevention and control measures in many developing countries, in sub-Saharan African healthcare facilities have no effective infection prevention programs. Additionally, there is limited information on healthcare worker infection prevention knowledge and practice in countries such as Ethiopia. The aim of this study was to assess the knowledge and practices of healthcare workers with respect to infection prevention and associated factors in healthcare facilities in southeast Ethiopia.

Methods

A facility-based cross-sectional study design was used to study healthcare workers in the southeast, Ethiopia. Multi-stage sampling was employed to select 680 healthcare workers from 30 randomly selected healthcare facilities. Data was collected using a self-administered structured questionnaire. Descriptive statistics were computed. Multivariable logistic regression was performed to identify factors associated with healthcare workers infection prevention knowledge and practice.

Results

A total of 648 healthcare workers participated in this study, for a response rate of 95.3%. Of these, 53.7% (95% CI: 49.8, 57.4%) and 36.3% (95% CI: 32.4, 40.1%) of the respondents were assessed as knowledgeable and reported safe infection prevention practices respectively. The likelihood of self-reporting safe infection prevention practice significantly increased if healthcare workers had received training (AOR = 5.31; 95% CI: 2.42,11.63) and had infection prevention guidelines available (AOR = 3.34; 95% CI: 1.65, 6.76). Healthcare workers were more likely to have infection prevention knowledge if they worked longer ten years or more (AOR = 3.41; 95% CI: 1.22, 9.55); worked in facilities with infection prevention committees (AOR = 1.78; 95% CI: 1.01, 3.13), had infection prevention guidelines available (AOR = 2.44; 95% CI: 1.45, 4.12); had training (AOR = 5.02; 95% CI: 1.45, 8.59).

Conclusions

Inadequate infection prevention knowledge and unsafe practices were frequent among study participants, reflecting a potentially common problem at public healthcare facilities in southeast Ethiopia. Healthcare workers have better knowledge and safer practices if they had received infection prevention training and had infection prevention guidelines in their workplace. Interventions should be designed to consider these identified factors.

CONHECIMENTO AUTORREFERIDO DAS EQUIPES MÉDICA E DE ENFERMAGEM QUANTO ÀS MEDIDAS DE PREVENÇÃO DE INFECÇÃO DA CORRENTE SANGUÍNEA

RESUMO Objetivo: avaliar o conhecimento autorreferido das equipes médica e de enfermagem quanto às medidas de prevenção de infecção da corrente sanguínea relacionada ao cateter venoso central. Métodos: estudo transversal realizado na unidade de terapia intensiva de um hospital público de urgência e emergência de Belo Horizonte, Minas Gerais. A população foi composta por médicos, enfermeiros e técnicos de enfermagem responsáveis pela inserção e manutenção dos cateteres venosos centrais. Conduziu-se entrevista face a face, sendo utilizado como instrumento um questionário estruturado. A fim de se conhecer a distribuição dos dados utilizou-se estatística descritiva e para análise dos fatores associados ao conhecimento a regressão de Poisson com variância robusta. O nível de significância considerado foi de 5% (p<0,05) e o intervalo de confiança de 95%. O teste de Shapiro-Wilk foi utilizado para verificar a normalidade dos dados. Resultados: a mediana do conhecimento autorreferido nas diferentes questões pesquisadas foi de 42,8%. Na avaliação do conhecimento sobre a inserção do cateter o percentual autorreferido pelos médicos foi de 100%. Em contrapartida, as medidas de manutenção referidas pela equipe de enfermagem foram inferiores a 50%, destacando-se a desinfecção do hub (35%) e tempo de duração para essa desinfecção (7,2%). Conclusão: na análise global das questões elegíveis para avaliação do conhecimento das equipes, constatou-se um conhecimento limitado às medidas consideradas padrão ouro na prevenção de infecção da corrente sanguínea relacionada ao cateter venoso central, reforçando a importância de mais investimentos na discussão da prevenção dessa infecção, bem como na educação permanente.

Rehabilitation Nurses' Knowledge, Attitudes, and Behaviors for Preventing Urinary Tract Infections From Intermittent Catheterization

PURPOSE

The aim of this study was to develop and examine the reliability of a survey to assess knowledge, attitudes, and behaviors (KAB) of rehabilitation nurses for preventing urinary tract infections in persons requiring intermittent catheterization.

DESIGN

Cross-sectional survey with principal component analysis.

METHODS

Survey development and administration based on national guidelines.

FINDINGS

Principal component analysis produced three reliable components of KAB explaining 54.5% of response variance. Results indicate that nurses report adequate knowledge and training. Although the facility had an evidence-based online catheterization procedure, staff reported that the procedure was not helpful nor useable. Twenty-eight percent incorrectly identified the root cause of urinary tract infection, and 45% reported that other nurses always washed their hands. Barriers to using standard intermittent catheterization technique were staff, time, and patient variables.

CONCLUSION

The modified survey is a reliable measure of KAB.

CLINICAL RELEVANCE

The survey assists with identifying knowledge gaps, customizing education, and changing practice.

Oncology nurses' knowledge of guidelines for preventing catheter-related bloodstream infections

This descriptive cross-sectional survey evaluated Jordanian oncology nurses' knowledge of the guidelines for preventing central venous catheter-associated infection. Poor knowledge was evident from the very low mean total scores and the low percentage of correct answers for each item in the questionnaire.

Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy

The objectives of the cross-sectional study were to delineate the knowledge, attitudes, and behavior among nurses regarding the prevention of central line-associated bloodstream infections (CLABSIs) and to identify their predisposing factors. A questionnaire was self-administered from September to November 2011 to nurses in oncology and outpatient chemotherapy units in 16 teaching and non-teaching public and private hospitals in the Campania region (Italy). The questionnaire gathered information on demographic and occupational characteristics; knowledge about evidence-based practices for the prevention of CLABSIs; attitudes towards guidelines, the risk of transmitting infections, and hand-washing when using central venous catheter (CVC); practices about catheter site care; and sources of information. The vast majority of the 335 nurses answered questions correctly about the main recommendations to prevent CLABSIs (use sterile gauze or sterile transparent semipermeable dressing to cover the catheter site, disinfect the needleless connectors before administer medication or fluid, disinfect with hydrogen peroxide the catheter insertion site, and use routinely anticoagulants solutions). Nurses aged 36 to 50 years were less likely to know these main recommendations to prevent CLABSIs, whereas this knowledge was higher in those who have received information about the prevention of these infections from courses. Nurses with lower education and those who do not know two of the main recommendations on the site’s care to prevent the CLABSIs, were more likely to perceive the risk of transmitting an infection. Higher education, attitude toward the utility allow to dry antiseptic, and the need of washing hands before wearing gloves for access to port infusion were predictors of performing skin antiseptic and aseptic technique for dressing the catheter insertion site. Educational interventions should be implemented to address the gaps regarding knowledge and practice regarding the prevention of CLABSIs and to ensure that nurses use evidence-based prevention interventions.

Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses

OBJECTIVE

The aim of this study is to determine the knowledge levels of oncology nurses about peripheral and central venous catheter during their chemotherapy administration.

METHODS

Data collection of this descriptive study was started on April 15, 2015-July 15, 2015. The data presented in this summary belong to 165 nurses. Data were collected with data collection form including questions related to sociodemographic qualifications and knowledge levels of nurses. Data collection forms were E-mailed to the members of Turkish Oncology Nursing Society. Data presented with numbers, percentages, and mean ± standard deviation.

RESULTS

The mean age of nurses was 33.60 ± 7.34 years and mean duration for oncology nursing experience was 2.65 ± 0.91 years. Nurses had correct information about the importance of selecting peripheral venous catheter and choosing the placement area for chemotherapy administration (63.6%), control of catheter before the administration (93.9%), influence of chemotherapeutic agent on length of catheter (40.6%), and management of extravasation (75.7%). Nurses also had correct information about the first use of port catheter (67.3%) and checking the catheter whether it is working properly or not (75.8%).

CONCLUSIONS

In General, nurses' level of knowledge related to catheter is 50% and higher. It is recommended to increase the knowledge of nurses about evidence-based information for catheter care as a step to safe chemotherapy practice.

Antimicrobial lubricant formulations containing poly(hydroxybenzene)-trimethoprim conjugates synthesized by tyrosinase

Poly(hydroxybenzene)-trimethoprim conjugates were prepared using methylparaben as substrate of the oxidative enzyme tyrosinase. MALDI-TOF MS analysis showed that the enzymatic oxidation of methylparaben alone leads to the poly(hydroxybenzene) formation. In the presence of trimethoprim, the methylparaben tyrosinase oxidation leads poly(hydroxybenzene)-trimethoprim conjugates. All of these compounds were incorporated into lubricant hydroxyethyl cellulose/glycerol mixtures. Poly(hydroxybenzene)-trimethoprim conjugates were the most effective phenolic structures against the bacterial growth reducing by 96 and 97% of Escherichia coli and Staphylococcus epidermidis suspensions, respectively (after 24 h). A novel enzymatic strategy to produce antimicrobial poly(hydroxybenzene)-antibiotic conjugates is proposed here for a wide range of applications on the biomedical field.