Educational interventions to reduce the rate of central catheter-related bloodstream infections in the NICU: a review of the research literature

Assessment knowledge and practices of central line insertion and maintenance in adult intensive care units at a tertiary care hospital in Saudi Arabia

BACKGROUND

Awareness of central line bundle by healthcare workers (HCWs) is essential for preventing catheter-associated bloodstream infections (CLABSI). The objective was to assess the knowledge and practice of insertion and maintenance central line bundles among HCWs in intensive care units (ICUs).

METHODS

A cross-sectional study was conducted at King Abdul-Aziz medical city in Riyadh between November 2017 and April 2018. The target was nurses and physicians working in three ICUs. The knowledge and practice were assessed using a structured study questionnaire that included also demographic characteristics.

RESULTS

A total 171 nurses and 41 physicians were included in the current analysis. More than 90% of HCWs correctly answered 9 out of 12 knowledge questions, specially questions related hand hygiene, maximal barrier, daily assessment, and dressing change. The overall knowledge score was 82% and was significantly higher among those who received central line bundle training. Self-reported compliance (all or most of the time) with 10 different bundle recommendations ranged between 50% and 97%, being highest with hand hygiene, maximal barrier, and using chlorhexidine (97% each) and lowest with using the subclavian site (50%). The overall self-reported compliance score was 87% and was significantly higher among nurses. There was weak positive correlation between knowledge and practice (correlation coefficient 0.266, p=0.001).

CONCLUSION

Knowledge and compliance of central line bundle were generally high in our HCWs. Training is important in improving knowledge of central line bundle. Future educational activities should focus on specific compliance deficiencies such as using the subclavian site and dressing change.

INTERVENTIONS TO DECREASE CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN NEWBORNS: AN INTEGRATIVE REVIEW

ABSTRACT Objective: to perform an integrative review of strategies presented in care bundles to decrease central catheter-associated bloodstream infection among newborns. . Method a search was conducted of the Cochrane Library, IBECS, PubMed, Lilacs, Medline and Scielo catalogues, using the terms "bundle", "catheter-related infection", "infection control", "prevention", "evidence-based nursing"," evidence-based medicine" and" central venous catheter". Inclusion criteria were: papers published from 2009 to April 2014; written in Portuguese, English or Spanish; addressing both neonatal and pediatric populations or just neonatal populations; describing the use and/or assessing care bundles or protocols to control central catheter-associated infection. Results fifteen studies published between 2009 and 2013 were selected. The main information extracted from the studies was systematized as: 1) measures adopted to prevent central catheter-associated bloodstream infection according to level of scientific evidence, and 2) strategies used to implement evidence into health practice. Conclusion there was a variety of practices adopted, some of which are consistent with scientific evidence and some of which are not. Systematization conducted in this study is expected to contribute to practice, facilitating the use of the best evidence in each context, and research indicating gaps in knowledge to be explored in future studies

Defining the Specialty of Vascular Access through Consensus: Shaping the Future of Vascular Access

The Association for Vascular Access (AVA) is an organization of health care professionals founded in 1985 to support and promote the specialty of vascular access. The mission of AVA is to distinguish the vascular access specialty and define standards of vascular access through an evidence-based approach designed to enhance health care. There is little guidance for multidisciplinary procedures/practice, and this is the case for vascular access. There are also inconsistencies and conflicts in terminology. Additionally, there is no consensus of vascular access as a specialty. It is the focus of AVA to promote consistency in vascular access practice. This document embraces a common title for a clinician with knowledge and skills in the area of vascular access. This establishes a new paradigm that will strengthen the advancement of the vascular access specialty.

Prevention of central venous catheter-related infection in the neonatal unit: a literature review

Central venous catheter infections are the leading cause of healthcare-associated bloodstream infections and contribute significantly to mortality and morbidity in neonatal intensive care units. Moreover, infection poses significant economic consequence which increased hospital costs and increased length of hospital stay. Prevention strategies are detailed in guidelines published by the Centers for Disease Control and Prevention (CDC) in the United States; nevertheless, recent surveys in neonatal units in the United States, and Australia and New Zealand demonstrate these are not always followed. This review discusses the numerous evidence-based strategies to prevent catheter infections including hand hygiene, maximal sterile barriers during insertion, skin disinfection, selection of insertion site, dressings, aseptic non-touch technique, disinfection of catheter hubs/ports, administration set management, prompt removal of catheter, antibiotic locks, systemic antibiotic prophylaxis and chlorhexidine bathing. Furthermore, it will describe different strategies that can be implemented into clinical practice to reduce infection rates. These include the use of care bundles including checklists, education and the use of CVC teams.

Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: A four-year surveillance

BACKGROUND

The use of central venous catheters has permitted lifesaving treatment for critically ill neonates; however, the attributable mortality rate for central line-associated bloodstream infections (CLABSIs) has been estimated to be between 4% and 20%. In 2006/2007, the authors' neonatal intensive care unit (NICU) had a CLABSI rate that was nearly twofold higher than that reported by other Canadian NICUs.

OBJECTIVE

To implement a quality improvement collaborative to reduce the incidence of neonatal CLABSI.

METHODS

A retrospective observational study was performed to compare CLABSI in neonates admitted to the authors' level III NICU between August 2007 and March 2011. The entire study period was divided into four time periods to evaluate secular trends. A comprehensive catheter-related bloodstream infection prevention initiative was implemented in August 2007. The initiatives included staff education, standardization of skin preparation protocol, introduction of new antiseptic agents, implementation of central catheter insertion and maintenance checklists, reinforcement of the use of maximal sterile barrier precautions, and revision of the central catheter configuration and maintenance protocols.

RESULTS

The median CLABSI rate of 7.9 per 1000 catheter days at the beginning of the study (period 1 [August 2007 to June 2008]) gradually decreased over the entire study period (P=0.034): period 2 (July 2008 to May 2009), 3.3 per 1000 catheter days; period 3 (June 2009 to April 2010), 2.6 per 1000 catheter days; and period 4 (May 2010 to March 2011), 2.2 per 1000 catheter days.

CONCLUSION

A multidisciplinary evidence-based quality improvement collaborative resulted in a significant reduction in the CLABSI rate. Continuous quality improvement measures are required to reduce catheter-related bloodstream infections among low-birth-weight infants.

Transferring central line care evidence into practice on pediatric acute care units

The purpose of this study was to examine the effectiveness of an educational intervention to implement evidence based guidelines for central line care. Full-time nurses working on pediatric inpatient units were surveyed before and after the multi-component educational intervention directed at implementation of the central line care bundle. There was a statistically significant increase in the nurses' self-reported compliance with components of the care bundle 6 months after the educational intervention (p<.001), thus improving central line care and infection prevention.