Prevention of central venous catheter infections: a survey of paediatric ICU nurses' knowledge and practice

Development of best evidence-based practice protocols for central venous catheter placement and maintenance to reduce CLABSI

Although evidence-based interventions can reduce the incidence of central line-associated bloodstream infection (CLABSI), there is a large gap between evidence-based interventions and the actual practice of central venous catheter (CVC) care. Evidence-based interventions are needed to reduce the incidence of CLABSI in intensive care units (ICU) in China. Professional association, guidelines, and database websites were searched for data relevant to CLABSI in the adult ICUs from inception to February 2020. Checklists were developed for both CVC placement and maintenance. Based on the Integrated Promoting Action on Research Implementation in Health Services framework, a questionnaire collected the cognition and practice of ICU nursing and medical staff on the CLABSI evidence-based prevention guidelines. From January 2018 to December 2021, ICU CLABSI rates were collected monthly. Ten clinical guidelines were included after the screening and evaluation process and used to develop the best evidence-based protocols for CVC placement and maintenance. The CLABSI rates in 2018, 2019, and 2020 were 2.98‰ (9/3021), 1.83‰ (6/3276), and 1.69‰ (4/2364), respectively. Notably, the CLABSI rate in 2021 was 0.38‰ (1/2607). In other words, the ICU CLABSI rate decreased from 1.69‰ to 0.38‰ after implementation of the new protocols. Additionally, our data suggested that the use of ultrasound-guidance for catheter insertion, chlorhexidine body wash, and the use of a checklist for CVC placement and maintenance were important measures for reducing the CLABSI rate. The evidence-based processes developed for CVC placement and maintenance were effective at reducing the CLABSI rate in the ICU.

PiccPed® app impact on nurses' knowledge to prevent adverse events for peripherally inserted central catheters (PICC) in pediatric and neonatal healthcare: A quasi-experimental study

BACKGROUND

The PiccPed® health application was developed to support clinical decision-making in peripherally inserted central catheter (PICC) management. We aimed to evaluate its impact on nurses' knowledge regarding the prevention of PICC-associated adverse events in pediatrics and neonatology.

METHODS

A quasi-experimental, pre-post intervention study, was conducted with a dependent/paired sample of pediatric and neonatal nurses from two tertiary hospitals in South Brazil. Data were collected from October 2022 to January 2023 across three phases: pre-, intervention (use of the PiccPed®) and post-test. Study outcomes were a knowledge test (15 questions) of evidence-based PICC maintenance procedures, and PiccPed® app time spent and screens used.

RESULTS

A total of 56 nurses completed the study. The post-test mean score was significantly higher (12/15; standard deviation (SD) 1.9) in comparison with the pre-test (mean 9/15; SD 2.2). The change in scores was significantly higher for nurses without postgraduate qualifications, in comparison to those with (Mean Difference 1.26; p = 0.039). Each minute using the app resulted in a significant increase of 0.04 points (95% confidence interval 0.01-0.08; p = 0.014) on the mean post-test score (10.94 points).

CONCLUSION

The research demonstrated that PiccPed® enhances nurses' learning regarding the prevention of adverse events associated with PICC maintenance in pediatrics and neonatology.

APPLICATION TO PRACTICE

The app can be safely and effectively used for training and continuing education of nurses who care for children and neonates with PICCs.

Implementation frameworks, strategies and outcomes in optimizing central venous access device practice in paediatrics: A scoping review

Paediatric patients with complex or acute conditions may require a central venous access device, however, almost one-third of these devices have associated complications (e.g. infections). Implementation of evidence-based practices regarding central venous access devices can reduce and potentially prevent complications.

AIMS

This scoping review aimed to explore recent interventional research in CVAD management through an implementation lens.

DESIGN

This scoping review used the Arksey and O'Malley framework. Studies were included if they were written in English, published in 2012 to July 2023, involved children and were relevant to the study aims. Risk of bias was appraised by the Mixed Methods Appraisal Tool.

DATA SOURCES

Searches were undertaken in EMBASE, CINAHL (Ebsco), PubMed, Web of Science and Cochrane Library (CENTRAL).

RESULTS

Of the 1769 studies identified in a systematic search, 46 studies were included. Studies mostly focused on health professionals and central venous access device maintenance and had quantitative pre-post study designs. Adherence to implementation frameworks was lacking, with many studies employing quality improvement approaches. Implementation strategies were typically multipronged, using health-professional education, bundles and working groups. Bundle compliance and reductions in central line-associated bloodstream infections were the most featured outcomes, with most studies primarily focusing on effectiveness outcomes.

CONCLUSION

Translation of evidence-based practices to the clinical setting is difficult and current adoption of implementation frameworks (apart from 'quality improvement') is limited. Implementation strategies are diverse and dependent on the local context, and study outcomes typically focus on the effectiveness of the physical intervention, rather than measuring the implementation effort itself.

IMPLICATIONS FOR PATIENTS

Future intervention research requires a more uniform and deliberate application of implementation frameworks and strategies.

IMPACT

Greater exploration of relationships between frameworks and strategies and implementation and service outcomes is required to increase understanding of their role in maximizing resources to improve health care. Adhered to best reporting guidelines as per PRISMA-ScR (Tricco et al., 2018).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Central Venous Access Device-Associated Skin Complications in Adults with Cancer: A Prospective Observational Study

OBJECTIVES

To identify the prevalence and type of central venous access device-associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device-associated skin complications.

METHODS

A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital.

RESULTS

Twenty-seven percent (n = 168) of participants had a central venous access device-associated skin complication. In the final multivariable analysis, significant (P < .05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37).

CONCLUSION

Central venous access device-associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies.

IMPLICATIONS FOR PRACTICE

This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury.

Factors influencing peripheral intravenous catheter practice of nurses in small and medium sized hospitals: a cross-sectional study

BACKGROUND

The importance of the peripheral intravenous catheter (PIVC) practices on patient safety is increasing. Small and medium-sized hospitals play a central role in the provision of healthcare services in South Korea, but lack a system for quality improvement, leaving patient safety at risk. This study aimed to identify the extent to which the PIVC practice knowledge of nurses, the nursing working environment, and the patient safety-culture perception affect PIVC practices and thereby provide basic data for improving the PIVC practices in small and medium-sized hospitals.

METHODS

This study had a cross-sectional descriptive design to identify the factors affecting PIVC nursing practices in small and medium-sized hospitals. Questionnaires returned by 149 nurses collected data on general characteristics, practical knowledge of PIVC nursing, nursing working environment, patient safety-culture perception, and PIVC practices. The questionnaire data were analysed using descriptive statistics, the independent t-test, one-way ANOVA, Scheffé's test, Pearson correlation, and hierarchical regression analysis.

RESULTS

The mean score of PIVC practices was 4.60 out of 5. Length of clinical experience, practical knowledge of PIVC nursing and patient safety-culture perception were significant factors affecting the PIVC nursing practices, with these variables explaining 26.2% of the variance therein.

CONCLUSIONS

The PIVC practices of nurses in small and medium-sized hospitals can be improved by providing education and training based on the latest standard or guideline to facilitate the acquisition of knowledge and skills. And campaigns and programs to strengthen patient safety culture perception specific to small and medium-sized hospital should be implemented. to ensure the safety of PIVC practice.

Nursing experiences in antimicrobial optimisation in the intensive care unit: A convergent analysis of a national survey

BACKGROUND

Recent evidence highlights the need for an interdisciplinary approach to antimicrobial stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive care unit (ICU) remains understudied.

OBJECTIVE

The objective of this study was to explore nurses' perceptions and experiences of antimicrobial optimisation or stewardship in ICUs in Australia.

METHODS

An anonymous web-based survey was deployed nationally in early 2021 through two ICU nursing networks. Associations between survey responses were analysed descriptively and by using nonparametric tests (with statistical significance established at p ≤ 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation and reporting of quantitative and qualitative data were integrated.

RESULTS

A total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence of AMS education and training for nurses in their ICUs. Only about half (108/226; 48%) of the nurses were confident to question prescribers when they considered that the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive antimicrobial discussions, moral distress, and potential workload burden were seen as potential barriers/challenges to engagement.

CONCLUSION

The multifactorial barriers identified that inhibit nurses from performing AMS tasks could be addressed by strengthening interprofessional education at all levels and by applying practical AMS interventions that are inclusive for nursing participation. A purposeful culture change that fosters psychological safety and collaborative practice is paramount to supporting nurses in these roles.

Evolution of Pediatric Critical Care Nursing

Pediatric critical care nursing is a key pillar in patient care and outcomes for children who are ill and injured. Tremendous advances have occurred in pediatric critical care and nursing. This article provides an overview of the key advances in pediatric critical care nursing through the decades.

Knowledge, attitudes and practice of infection prevention and control in the CT suite

BACKGROUND

Infection, prevention, and control (IPC) practices are essential to protect patients and staff within healthcare facilities. Radiology departments cater to both inpatients and outpatients, and breaches of IPC practice have led to outbreaks of disease within healthcare facilities. This study aims to examine the knowledge, attitudes and practice (KAP) of computed tomography (CT) radiographers and nurses in their infection, prevention, and control (IPC) practice. The KAP components focuses on the CT environment, contrast injector use, and workplace factors that impact IPC practice.

METHODS

A cross-sectional KAP survey was distributed online to Australian CT radiographers and radiology nurses across different institutions. The survey covered demographics, each KAP component, and workplace culture. Spearman's correlation was used to compare KAP scores. Kruskal-Wallis test was used to compare the KAP scores between demographic categories, and Chi Square was used to compare demographic data with workplace culture.

RESULTS

There were 147 respondents, 127 of which were radiographers and 20 were nurses. There was a moderate positive correlation between knowledge and attitude for radiographers (rho = 0.394, p < 0.001). Radiographers also had a moderate positive relationship between attitudes and practice (rho = 0.466, p < 0.001). Both radiographers and nurses scored high in the knowledge section of the survey, but nurses had statistically significant higher practice scores than radiographers (p = 0.014). CT radiographers who had an IPC team in their workplace or worked in public hospitals, had statistically significant higher attitudes and practice scores. Age, education, and years of experience did not impact on KAP scores.

CONCLUSION

The study found that radiographers and nurses had a good baseline knowledge of standard precautions. IPC teams and continued training is important to positively influence knowledge and attitudes of health professionals towards IPC practice. The KAP survey was a useful tool to assess the knowledge, attitudes, and practice on IPC of CT radiographers and nurses and identified areas for education, interventions, and leadership.

Assessment of Knowledge, Attitude, and Adherence to National Guidelines for Preventing Central Line-Associated Bloodstream Infections Among ICU Nurses of Adult Patients in Jeddah, Saudi Arabia: A Cross-Sectional Survey

BACKGROUND

Central line-associated bloodstream infections (CLABSIs) pose a significant burden on patient outcomes in intensive care units (ICUs). Adherence to evidence-based guidelines for CLABSI prevention is crucial in reducing healthcare-associated infections. This study aimed to assess the knowledge, attitude, and practice adherence to national guidelines for preventing CLABSIs among adult ICU nurses in Ministry of Health (MOH) hospitals in Jeddah, Saudi Arabia.  Methods: This cross-sectional survey included all adult ICU nurses with a minimum of one year of experience from the four major MOH hospitals in Jeddah with operational adult ICUs. A self-administered online questionnaire was utilized for data collection. Descriptive statistics, t-tests, ANOVA, and Pearson correlation were employed for data analysis.  Results: A total of 203 nurses completed the questionnaire (response rate: 91.5%). The overall knowledge score was 71%. Only 20% of nurses answered over 90% of the knowledge questions correctly, and merely 8% answered all questions correctly. Higher knowledge levels were significantly associated with older age, longer ICU nursing experience, higher education, holding a head nurse position, and attending educational courses on CLABSI prevention. Regarding attitudes, 58% of respondents had a positive perception of guideline utility for CLABSI prevention. In terms of adherence, the overall score was 65%, with only 5% reporting complete adherence to evidence-based practices for preventing CLABSIs.  Conclusion: This study highlights knowledge gaps, suboptimal adherence, and the need for targeted interventions to enhance nurses' understanding of and adherence to evidence-based guidelines for preventing CLABSIs among adult ICU nurses in Jeddah's MOH hospitals. Enhancing knowledge, attitudes, and practice adherence is crucial for reducing CLABSI risks and improving patient outcomes. Further research investigating the factors influencing nurses' knowledge, acceptance, and application of evidence-based guidelines is warranted to inform the development of tailored interventions and educational strategies.

Risk factors for mechanical complications of peripherally inserted central catheters in children

OBJECTIVE

To determine risk factors for mechanical (noninfectious) complications in peripherally inserted central catheters (PICCs) in children.

DESIGN

Retrospective cohort study.

SETTING

Pediatric tertiary-care center in Nova Scotia, Canada.

PATIENTS

Pediatric patients with a first PICC insertion.

METHODS

All PICCs inserted between January 2001 until 2016 were included. Age-stratified (neonates vs non-neonates) Fine-Grey competing risk proportional hazard models were used to model the association between each putative risk factor and the time to mechanical complication or removal of the PICC for reasons not related to a mechanical complication. Models were adjusted for confounding variables identified through directed acyclic graphs.

RESULTS

Of 3,205 patients with PICCs, 706 had mechanical complications (22% or 14 events/1000 device days). For both neonates and older children, disease group, lumen count, and prior leak were all associated with mechanical complications in the adjusted proportional hazards model. Access vein and prior infection were also associated with mechanical complications for neonates, and age group was associated with mechanical complications among non-neonates.

CONCLUSIONS

We have identified several risk factors for mechanical complications in patients with PICCs that will help improve best practices for PICC insertion and care.

Infant Escherichia coli urinary tract infection: is it associated with meningitis?

OBJECTIVES

Determine the prevalence of coexisting bacterial meningitis (BM) and sterile cerebrospinal fluid (CSF) with raised white cell count relative to age ('pleocytosis') in the presence of Escherichia coli urinary tract infection (UTI), with the addition of CSF E. coli PCR analysis.

DESIGN

Single-centre, retrospective cohort study.

SETTING

Tertiary paediatric hospital.

PARTICIPANTS

Children aged 8 days to 2 years, with a pure growth of E. coli from urine and a CSF sample taken within 48 hours of a positive urine culture between 1 January 2014 and 30 April 2019.

MAIN OUTCOME MEASURE

Prevalence of coexisting E. coli BM with UTI, defined as a pure growth E. coli from urine and a CSF culture with pure growth E. coli and/or positive E. coli PCR.

RESULTS

1903 patients had an E. coli UTI, of which 314 (16%) had a CSF sample taken within 48 hours. No cases of coexisting E. coli BM were identified. There were 71 (23%) cases of pleocytosis, 57 (80%) of these had PCR analysis, all of which were E. coli PCR not detected. Patients aged 1-6 months accounted for 72% of all lumbar punctures (LPs).

CONCLUSION

The risk of E. coli UTI and coexisting E. coli BM is low. There is potential to reduce the number of routine LPs in infants with a diagnosis of E. coli UTI with the greatest impact in children up to 6 months of age. CSF E. coli PCR can help further reduce post-test probability of BM in the setting of pleocytosis.

Prevention of central line-associated bloodstream infections: ICU nurses' knowledge and barriers

BACKGROUND

Central line-associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality.

AIMS AND OBJECTIVES

The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence-based guidelines in practice.

DESIGN

A cross-sectional study.

METHODS

Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020.

RESULTS

A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence-based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.

CONCLUSIONS

Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU.

RELEVANCE TO CLINICAL PRACTICE

The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence-based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.

Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals

BACKGROUND

The study of safety culture and its relationship to patient care have been challenged by variation in definition, dimensionality and methods of assessment. This systematic review aimed to map methods to assess safety culture in hospitals, analyse the prevalence of these methods in the published research literature and examine the dimensions of safety culture captured through these processes.

METHODS

We included studies reporting on quantitative, qualitative and mixed methods to assess safety culture in hospitals. The review was conducted using four academic databases (PubMed, CINAHL, Scopus and Web of Science) with studies from January 2008 to May 2020. A formal quality appraisal was not conducted. Study purpose, type of method and safety culture dimensions were extracted from all studies, coded thematically, and summarised narratively and using descriptive statistics where appropriate.

RESULTS

A total of 694 studies were included. A third (n=244, 35.2%) had a descriptive or exploratory purpose, 225 (32.4%) tested relationships among variables, 129 (18.6%) evaluated an intervention, while 13.8% (n=96) had a methodological focus. Most studies exclusively used surveys (n=663; 95.5%), with 88 different surveys identified. Only 31 studies (4.5%) used qualitative or mixed methods. Thematic analysis identified 11 themes related to safety culture dimensions across the methods, with 'Leadership' being the most common. Qualitative and mixed methods approaches were more likely to identify additional dimensions of safety culture not covered by the 11 themes, including improvisation and contextual pressures.

DISCUSSION

We assessed the extent to which safety culture dimensions mapped to specific quantitative and qualitative tools and methods of assessing safety culture. No single method or tool appeared to measure all 11 themes of safety culture. Risk of publication bias was high in this review. Future attempts to assess safety culture in hospitals should consider incorporating qualitative methods into survey studies to evaluate this multi-faceted construct.

Assessing the impact of a new central venous access device training progam for nurses: A quasi-experimental evaluation study

BACKGROUND

Central venous access devices (CVAD) are widely used for both long- and short-term purposes within healthcare and are suitable for both hospital and community management. Training is essential in the prevention of complications such as infection.

OBJECTIVES

To assess the impact of a new standardised education programme on clinical practice and patient care. The new education programme was introduced to all registered nurses working in one care group within an acute healthcare Trust with the aim of improving knowledge and skills and reduce CVAD-related complications.

METHODS

This retrospective quasi-experimental evaluation study analyses the impact of the programme on direct patient care. Secondary data sources such as infection incidence rates and CVAD clinical audits were used to identify and measure the relationship between staff confidence, infection incidence and care audit results. Data spanning a two-year period were used to capture an accurate representation of the patient group.

RESULTS

Improvements in audited care elements and a reduction of infection incidences were evident during and after implementation of the education programme. This was reflective of the self-reported increased confidence and knowledge and skill acquisition from staff who attended the programme.

DISCUSSION

Recommendations have been made including a review of the education content to target all key elements and promotion of an end goal with regular feedback to staff reinforcing the importance. The challenge of using secondary data sources also highlighted the need for quality improvements in the current care audit process.

Paediatric nurses', children's and parents' adherence to infection prevention and control and knowledge of antimicrobial stewardship: A systematic review

INTRODUCTION

Infection prevention and control precautions help to decrease microbial transmission, and through the appropriate use of antibiotics, Antimicrobial Stewardship programs aim to decrease the prevalence and emergence of Antimicrobial Resistance.

METHODS

A systematic review was undertaken to critically appraise and synthesise evidence for nurses', children's and parents' knowledge and understanding of antimicrobial stewardship, and of infection prevention and control in acute paediatric care settings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guided the review. Studies were included if they examined the factors that contributed to nurses' adherence to, or consumers' practice in relation to, antimicrobial stewardship and infection prevention and control.

RESULTS

Of the 16,957 papers identified, 50 studies conducted in acute paediatric settings met the eligibility criteria, and were included. Most studies were of low methodological quality. Fourteen studies evaluated nurses' knowledge and self-reported adherence to Infection Prevention and Control principles and identified consistent practice gaps by nurses. Six studies evaluating the effectiveness of education programs reported modest improvements in nurses' knowledge and adherence to infection prevention and control. There were 15 studies, that investigated consumers' involvement in infection prevention and control that identified the following themes: Consumer knowledge and attitudes to infection prevention and control and transmission-based precautions, and parents' willingness to take an active role in infection prevention. Six studies focused on paediatric nurses' role in antimicrobial stewardship, exploring the following themes: (1) nurses' understanding and beliefs of antimicrobial stewardship roles, and (2) barriers to nurses taking a greater role in antimicrobial stewardship. Nine studies explored the role of consumers in antimicrobial stewardship and identified consumers' misconceptions about the benefits and downplayed concerns regarding antibiotic use.

DISCUSSION

Although consumers articulated a willingness to be actively involved in infection prevention, observed practice remained lower than that required to consistently prevent infection transmission.

CONCLUSION

These findings highlight a critically important gap in current practice. In relation to optimal use of antimicrobials, although paediatric nurses were involved in supporting antimicrobial stewardship processes and educating consumers, they identified limited antimicrobial stewardship knowledge. Consumers appeared to lack understanding about the benefits of antibiotics and negated concerns regarding antibiotic use.

Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit

OBJECTIVE

Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. We explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses.

METHODS

Single-center cross-sectional electronic survey of PICU bedside nurses in an academic tertiary care center; using the COM-B (capability, opportunity, motivation) and TDF (theoretical domains framework) behavioral models to explore CLABSI bundle performance and identify barriers to compliance.

RESULTS

We analyzed 160 completed surveys from 226 nurses (71% response rate). CLABSI knowledge was strong (capability). However, challenges related to opportunity were identified: 71% reported that patient care requirements impact bundle completion; 32% described the bundle as stressful; and CLABSI was viewed as the most difficult of all bundles. Seventy-five percent reported being highly impacted by physician attitude toward the CLABSI bundle (motivation).

CONCLUSIONS

PICU nurses are knowledgeable and motivated to prevent CLABSI, but face challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle. Interventions that address these challenges may improve bundle performance and prevent CLABSI in critically ill children.

Knowledge, perceptions and experiences of nurses in antimicrobial optimization or stewardship in the intensive care unit

There is an urgent and recognized need for an interprofessional collaborative approach to support global action in addressing antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) refers to systematic approaches for antimicrobial optimization within healthcare organizations. In areas with high antimicrobial utilization such as intensive care units (ICUs), specific roles for nurses in AMS are not clearly defined. This review aimed to identify and to critically evaluate primary studies that examined knowledge, perspectives and experiences of nurses associated with antimicrobial use and optimization in ICUs. A systematic search of Medline, CINAHL, PsychINFO, EMBASE, PubMed, SCOPUS, Cochrane Library and Web of Science databases for primary studies published from 1^st January 2000 to 20^th March 2020 was performed. A convergent synthesis design was used to synthesize quantitative and qualitative data. Of the 898 studies initially screened, 26 were included. Most (18/26) studies were quantitative. All qualitative studies (6/26) were of high methodological quality. Studies where interventions were used (10/26) identified significant potential for ICU nurses to reduce antimicrobial use, time-to-antibiotic administration, and error rates. Barriers to nursing engagement included knowledge deficits in antimicrobial use, interprofessional dissonance and the culture of deference to physicians. Enhancing education, technology utilization, strong nursing leadership and robust organizational structures that support nurses were perceived as enablers to strengthen their roles in optimizing antimicrobial use. This review showed that nursing initiatives have significant potential to strengthen antimicrobial optimization in ICUs. Barriers and enablers to active engagement were identified.

Prevention of central line-associated bloodstream infections: a survey of ICU nurses' knowledge and practice in China

Background

Central line-associated bloodstream infections (CLABSI) are largely preventable when evidence-based guidelines are followed. However, it is not clear how well these guidelines are followed in intensive care units (ICUs) in China. This study aimed to evaluate Chinese ICU nurses’ knowledge and practice of evidence-based guidelines for prevention of CLABSIs issued by the Centers for Disease Control and Prevention, US and the Department of Health UK.

Method

Nurses completed online questionnaires regarding their knowledge and practice of evidence-based guidelines for the prevention of CLABSIs from June to July 2019. The questionnaire consisted of 11 questions, and a score of 1 was given for a correct answer (total score = 0–11).

Results

A total of 835 ICU nurses from at least 104 hospitals completed the questionnaires, and 777 were from hospitals in Guangdong Province. The mean score of 11 questions related to evidence-based guidelines for preventing CLABSIs was 4.02. Individual total scores were significantly associated with sex, length of time as an ICU nurse, educational level, professional title, establishment, hospital grade, and incidence of CLABSIs at the participant’s ICU. Importantly, only 43% of nurses reported always using maximum barrier precautions, 14% of nurses reported never using 2% chlorhexidine gluconate for antisepsis at the insertion site, only 40% reported prompt removal of the catheter when it was no longer necessary, and 33% reported frequently and routinely changing catheters even if there was no suspicion of a CLABSI.

Conclusion

Chinese ICU nurses in Guangdong Province lack of knowledge and practice of evidence-based guidelines for the prevention of CLABSIs. National health administrations should adopt policies to train ICU nurses to prevent CLABSIs.

Nursing students' knowledge on the management of peripheral venous catheters at Wollega University

BACKGROUND

Adherence to the best standards of nursing practice is the fundamental principle to improve patient outcome and prevent nursing procedure related-infections. A peripheral venous catheter (PVC) is the most common invasive procedure performed in nursing care. Its poor performance could expose patients to bloodstream-related infections. The present study aimed to assess post-basic nursing students' knowledge of evidence-based guidelines on the management of peripheral venous catheters.

METHODS

A cross-sectional study design was conducted on May 01-03, 2019, using a convenient sample 239 among post-basic nursing students in Wollega University.

RESULTS

The study result showed that nursing students' had a low mean (4.1±1.52) of knowledge about PVC procedure management. Only 41% of the respondents have adhered to recommendations of CDC guidelines. Among the provided options of the items, none achieved 100% correct answers. The majority of nursing students (77%) responded that antiseptic handwashing is always performed before insertion of PVCs. Meanwhile, few students (5%) correctly answered that the infusion set is recommended to be removed after 96 hours when neither lipids nor blood products are administered. In multivariable regression analysis, nursing students who had received training (AOR = 2.9, 95% CI (1.6, 5.1)) and who were younger (AOR = 2.4, 95% CI (1.3, 4.3)) significantly associated with a higher score of knowledge.

CONCLUSIONS

This study finding shows that an overall level of knowledge of post-basic nursing students is inadequate. Measurements such as an increase in the provision of adequate training by nurses educators based on evidence-based guidelines could improve the post-basic nursing students' knowledge.

Central line-related bloodstream infections and microbiological study in an Egyptian Ministry of Health Hospital

BACKGROUND

Central line-associated bloodstream infections continue to be one of the most important health problems in ICU.

OBJECTIVES

To identify the central line-related bloodstream infections and their microbiological characteristics Specific objectives to the identify the incidence, predisposing factors of central line-related bloodstream Infections and study the antibiotic sensitivity patterns of the isolated organisms.

MATERIAL AND METHODS

Patients' demographic, clinical data, central venous catheter related data,and blood culture specimen collection data were collected utilizing a descriptive exploratory design from a purposive sample of 120 ICU patients underwent insertion central venous catheter.

RESULTS

out of 120 central line catheters sent for culture from patients immediately and seven days after insertion., 13(10.83%) were positive seven days after insertion. Of the 13 infection cases, 10 cases were Staphylococcus epidermis and the others were Staphylococcus aureus. In addition, most infected patients were overweight and obese, diabetic, had sub-clavian route, and their length of hospital stayed more than7 days.

CONCLUSION

10.83 % developed bacterial blood stream infection 7 days after insertion of central venous catheters, and most of bacterial isolates were Staphylococcus epidermis and were sensitive to Vancomycin and Amikain.

'Adiós Bacteriemias': a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs

QUALITY PROBLEM

The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices.

INITIAL ASSESSMENT

The first phase of the 'Adiós Bacteriemias' Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI.

CHOICE OF SOLUTION

Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings.

IMPLEMENTATION

Building on the results of the first phase, we implemented a second phase of the 'Adiós Bacteriemias' Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback.

EVALUATION

Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period.

LESSONS LEARNED

Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.

Current practice in dialysis central venous catheter management: Multi-disciplinary renal team perspectives

AIM

To explore the current practices related to the insertion, management and removal of dialysis central venous catheters (CVCs) used in patients with chronic kidney disease requiring haemodialysis.

METHODS

This qualitative descriptive study involved semi-structured interviews with surgeons, interventional radiologists, renal physicians, dialysis nurses, renal access nurses and renal researchers involved in the care of patients with chronic kidney disease requiring haemodialysis. Data were collected from staff at eight hospitals in six states and territories of Australia. Thirty-eight face-to-face interviews were conducted. A modified five-step qualitative content analysis approach was used to analyse the data.

RESULTS

Improved visualization technology and its use by interventional radiologists has steered insertions to specialist teams in specialist locations. This is thought to have decreased risk and improved patient outcomes. Nurses were identified as the professional group responsible for maintaining catheter access integrity, preventing access failure and reducing access-related complications. While best practice was considered important, justifications for variations in practice related to local patient and environment challenges were identified.

CONCLUSION

The interdisciplinary team is central in the insertion, maintenance, removal and education of patients regarding dialysis CVCs. Clinicians temper research-based decision-making about central dialysis access catheter management with knowledge of individual, environmental and patient factors. Strategies to ensure guidelines are appropriately translated for use in a wide variety of settings are necessary for patient safety.

Impact and Safety Associated with Accidental Dislodgement of Vascular Access Devices: A Survey of Professions, Settings, and Devices

Background: Dislodgement rates with intravenous catheters are reported at 1.8%–24% events per year resulting in failed access, interrupted treatment, and greater resource consumption with catheter replacement. The purpose of this study was to quantitatively evaluate the perceptions of frequency, impact, contributing factors, and safety issues from accidental dislodgement affecting intravenous (IV) devices as reported by healthcare clinicians.

Methodology: A cross-sectional descriptive survey was conducted via a voluntary online web-based survey of clinicians. Subjects were divided as those actively working in a clinical healthcare setting and those no longer active. Analysis of data was performed quantifying responses of clinicians on question of dislodgement.

Results: Survey results indicate clinicians routinely observe a significant percentage of accidental dislodgement, with 68% of the 1561 respondents reporting often, daily, or multiple times daily occurrence and 96.5% identifying peripheral intravenous catheters as most common device experiencing accidental dislodgement. Respondents prioritized 10 contributing factors, with confused patient (80%), patient physically removes catheter (74%), and IV catheter tape or securement loose (65%) as the top 3 causes. Over 95% of respondents consider IV dislodgement a safety risk to patients.

Conclusions: This study reports perceptions and impact of accidental dislodgement with IV devices. Inconsistencies exist with use, application, and management of catheter securement and dressings for IV catheters. Risk of additional complications and complete device failure are increased when dislodgement occurs. Given possible complications, along with necessitating replacement of the IV device in many cases, IV catheter dislodgement was considered a safety risk to patients by nearly all respondents.

Clavanin A-bioconjugated Fe3O4/Silane core-shell nanoparticles for thermal ablation of bacterial biofilms

The use of central venous catheters (CVC) is highly associated with nosocomial blood infections and its use largely requires a systematic assessment of benefits and risks. Bacterial contamination of these tubes is frequent and may result in development of microbial consortia also known as biofilm. The woven nature of biofilm provides a practical defense against antimicrobial agents, facilitating bacterial dissemination through the patient's body and development of antimicrobial resistance. In this work, the authors describe the modification of CVC tubing by immobilizing Fe₃O₄-aminosilane core-shell nanoparticles functionalized with antimicrobial peptide clavanin A (clavA) as an antimicrobial prophylactic towards Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Its anti-biofilm-attachment characteristic relies in clavA natural activity to disrupt the bacterial lipidic membrane. The aminosilane shell prevents iron leaching, which is an important nutrient for bacterial growth. Fe₃O₄-clavA-modified CVCs showed to decrease Gram-negative bacteria attachment up to 90% when compared to control clean CVC. Additionally, when hyperthermal treatment is triggered for 5 min at 80 °C in a tubing that already presents bacterial biofilm (CVC-BF), the viability of attached bacteria reduces up to 88%, providing an efficient solution to avoid changing catheter.

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.

Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care

AIM

To identify the prevalence, management and complications associated with central venous access devices (CVADs) within Australian paediatric facilities, providing a map for clinicians, researchers and managers to focus solutions.

METHODS

A point prevalence audit and survey of CVAD practices in Australian tertiary paediatric hospitals between September and November 2015, using validated data collection tools.

RESULTS

Across the six sites, 1027 patients were screened with CVADs prevalent in 26.1% (n = 268), and 261 CVADs in 248 patients available for audit. Variations in management were evident with dressings not meeting the basic criteria of clean, dry and intact for 13.5% of CVADs (n = 35), and non-sterile dressings used to reinforce 26.4% of CVADs (n = 69). Almost half of CVADs (49.4%; n = 132) had no documentation regarding site assessment in the previous 4 h, and 13.4% had no planned use in the next 24 h (35 CVAD). CVAD-associated complications within the previous 7 days were evident in 9.5% of CVADs (n = 27), most commonly catheter blockage (5.7% CVAD, n = 15), and bloodstream infection (1.9% CVAD, n = 5). Peripherally inserted central catheters (16.9%) in comparison to other catheter types (7.4%; P = 0.04), and subsequent CVADs (14.1%) in comparison to initial CVADs (6.5%; P = 0.04), had significantly higher proportions of CVAD-associated complications in the previous 7 days. Variation between the sites' guidelines was evident across many practices.

CONCLUSIONS

CVADs are prevalent and essential for paediatric health care; however, complications remain a significant problem. Areas identified for improvement were local CVAD guidelines, regular documentation of CVAD site assessment and review of dressing products to improve integrity.

Central venous Access device SeCurement And Dressing Effectiveness (CASCADE) in paediatrics: protocol for pilot randomised controlled trials

INTRODUCTION

Paediatric central venous access devices (CVADs) are associated with a 25% incidence of failure. Securement and dressing are strategies used to reduce failure and complication; however, innovative technologies have not been evaluated for their effectiveness across device types. The primary aim of this research is to evaluate the feasibility of launching a full-scale randomised controlled efficacy trial across three CVAD types regarding CVAD securement and dressing, using predefined feasibility criteria.

METHODS AND ANALYSIS

Three feasibility randomised, controlled trials are to be undertaken at the Royal Children's Hospital and the Lady Cilento Children's Hospital, Brisbane, Australia. CVAD securement and dressing interventions under examination compare current practice with sutureless securement devices, integrated securement dressings and tissue adhesive. In total, 328 paediatric patients requiring a peripherally inserted central catheter (n=100); non-tunnelled CVAD (n=180) and tunnelled CVAD (n=48) to be inserted will be recruited and randomly allocated to CVAD securement and dressing products. Primary outcomes will be study feasibility measured by eligibility, recruitment, retention, attrition, missing data, parent/staff satisfaction and effect size. CVAD failure and complication (catheter-associated bloodstream infection, local infection, venous thrombosis, occlusion, dislodgement and breakage) will be compared between groups.

ETHICS AND DISSEMINATION

Ethical approval to conduct the research has been obtained. All dissemination will be undertaken using the CONSORT Statement recommendations. Additionally, the results will be sent to the relevant organisations which lead CVAD focused clinical practice guidelines development.

TRIAL REGISTRATION NUMBERS

ACTRN12614001327673; ACTRN12615000977572; ACTRN12614000280606.

Health Care Professionals' Knowledge Regarding Patient Safety

This study looks to describe health care professionals' knowledge regarding patient safety. A quantitative study using questionnaires was conducted in three multi-disciplinary hospitals in Western Lithuania. Data were collected in 2014 from physicians, nurses, and nurse assistants. The overall results indicated quite a low level of safety knowledge, especially in regard to knowledge concerning general patient safety. The health care professionals' background factors such as their profession, education, the information about patient safety they were given during their vocational and continuing education, as well as their experience in their primary speciality seemed to be associated with several patient safety knowledge areas. Despite a wide variation in background factors, the knowledge level of respondents was generally found to be low. This requires that further research into health care professionals' safety knowledge related to specific issues such as medication, infection, falls, and pressure sore prevention should be undertaken in Lithuania.

Complications of Central Venous Access Devices: A Systematic Review

CONTEXT

The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources.

OBJECTIVE

To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics.

DATA SOURCES

Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015.

STUDY SELECTION

Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage.

DATA EXTRACTION

Data were independently extracted and critiqued for quality by 2 authors.

RESULTS

Seventy-four cohort studies met the inclusion criteria, with mixed quality of reporting and methods. Overall, 25% of CVADs failed before completion of therapy (95% confidence interval [CI] 20.9%-29.2%) at a rate of 1.97 per 1000 catheter days (95% CI 1.71-2.23). The failure per CVAD device was highest proportionally in hemodialysis catheters (46.4% [95% CI 29.6%-63.6%]) and per 1000 catheter days in umbilical catheters (28.6 per 1000 catheter days [95% CI 17.4-39.8]). Totally implanted devices had the lowest rate of failure per 1000 catheter days (0.15 [95% CI 0.09-0.20]).

LIMITATIONS

The inclusion of nonrandomized and noncomparator studies may have affected the robustness of the research.

CONCLUSIONS

CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.

Examining the Role of Securement and Dressing Products to Prevent Central Venous Access Device Failure: A Narrative Review

Objective: To describe the underpinning principles involved in central venous access device (CVAD) securement and dressing products to prevent CVAD failure and complications through a synthesis of research studies.

Background: Functional, dependable CVADs are a necessary part of patient care. Dressing and securement products are used to prevent CVAD failure and complications, but there is a large variety of products available for clinicians to access, with variable effectiveness.

Methods: A narrative review of studies describing the mechanisms for CVAD securement and dressing products to prevent failure and complication was undertaken. After a systematic search, 20 clinical and laboratory studies were included in the review.

Discussion: The major mechanisms by which CVAD dressing and securement products prevent failure are providing a barrier to microbial contamination and motion reduction. CVAD securement and dressing products provide these functions using coating, adhesion, antimicrobial properties, absorbency, and moisture vapor transmission without causing irritation to skin and maintaining visibility of the insertion site. The complexity of patients requiring CVAD securement and dressing means that universal recommendations across CVAD populations and broad generalization of studies from single populations (eg, intensive care) or devices (eg, peripherally inserted central catheters) are ill advised.

Conclusions: CVAD securement and dressing products provide important, multifaceted functions to prevent CVAD failure and complication.

Central Venous Access Devices Site Care Practices: An International Survey of 34 Countries

Purpose

Effective postinsertion management of central venous access devices (CVADs) is important to prevent CVAD-associated complications, including catheter-associated bloodstream infections. Although there is a wealth of evidence-based guidelines available to guide the care of CVADs, applying their recommendations to the clinical setting across variable patient groups, CVAD types and international healthcare settings is challenging. This may result in patients receiving suboptimal care.

Methods

A cross-sectional descriptive study using an online survey was performed with an aim to determine current CVAD site care practices internationally. The CVAD site care domains included skin antisepsis, dressing selection, frequency of dressing change and device securement practices across impaired and unimpaired CVAD sites.

Results

Clinicians (n = 1044) residing in 34 countries reported diversity in their practice, with the majority of respondents practicing as nurses (89%) from North America (81%) as vascular access specialists (52%). The respondents’ reported practice was variant, with differing inconsistency to guidelines throughout each of the domains. There was wide variance in the management of CVAD sites with impaired skin integrity, such as rash, skin stripping/adhesive-related injuries and drainage. Vascular access clinicians reported high levels of confidence in managing CVAD sites, including those with impaired skin.

Conclusions

These inconsistencies are reflective of the complex and heterogeneous populations requiring CVADs, the evidence available to support practice in this area, the skills and knowledge of the clinicians caring for them and the resources of the healthcare setting. Further research and education is necessary to ensure that CVAD site care is undertaken effectively to minimise preventable complications.

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

BACKGROUND

Central venous catheter-related infection (CVC-RI) is considered a common cause of increased morbidity, mortality, and medical care costs in intensive care units (ICUs). The objective in this descriptive study was to assess the knowledge of health care workers in ICUs about guidelines for the prevention of CVC-RI and their adherence to these guidelines in practices.

METHODS

Health care workers were assessed for their actual practices during central venous catheter (CVC) insertion and care. Then a questionnaire was distributed to the health care workers to assess their knowledge regarding the prevention of CVC-RI.

RESULTS

All the health care workers (N = 100; 40 physicians, 60 nurses) in the ICUs (levels I and III and triage) of Alexandria Main University Hospital participated in the present study. The response rate was 100%. The total percentage of correct answers of the health care workers about the guidelines for the prevention of CVC-RI was low. There was no significant difference between physicians' and nurses' knowledge regarding the total score on the questionnaire (P = .134). However, physicians had a significantly higher knowledge about the pathophysiology of CVC-RI and skin antisepsis items than nurses. There were no significant differences between the knowledge of physicians and nurses in other items except for CVC care, where nurses showed significantly higher knowledge than physicians (P = .001).

CONCLUSION

The results of the present study revealed health care worker's low knowledge regarding the prevention of CVC-RI and low compliance with the standard guidelines of CVC care. Therefore, health care workers should be periodically evaluated for their knowledge and practices regarding guidelines for the prevention of CVC-RI.