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Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside
Charlotte Z Woods-Hill1, Kelly Papili2, Eileen Nelson2
1Division of Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Insights
Pediatric intensive care unit (PICU) nurses know how to prevent central-line associated bloodstream infections (CLABSI) but face barriers. Addressing competing tasks and physician attitudes can improve CLABSI bundle compliance.
Area of Science:
- Healthcare quality improvement
- Pediatric critical care
- Infection prevention
Background:
- Central-line associated bloodstream infections (CLABSI) significantly increase mortality, morbidity, and costs in hospitalized children.
- Evidence-based care bundles effectively reduce CLABSI, yet consistent compliance remains a challenge.
- Understanding factors influencing bundle adherence is crucial for optimizing infection control in pediatric intensive care units (PICUs).
Purpose of the Study:
- To explore factors influencing the performance of CLABSI prevention bundles among bedside nurses in a PICU.
- To identify specific barriers to bundle compliance using the COM-B and Theoretical Domains Framework (TDF) models.
Main Methods:
- A single-center, cross-sectional electronic survey was administered to PICU bedside nurses.
- The COM-B and TDF behavioral models were employed to analyze survey data.
- 160 completed surveys from 226 nurses (71% response rate) were analyzed.
Main Results:
- Nurses demonstrated strong knowledge (capability) regarding CLABSI prevention.
- Significant barriers to opportunity were identified, including competing patient care demands (71%) and the bundle being perceived as stressful and difficult (32%).
- Physician attitude strongly influenced nurse motivation (75%) towards CLABSI bundle completion.
Conclusions:
- PICU nurses are knowledgeable and motivated to prevent CLABSI but encounter practical challenges.
- Competing clinical tasks, resource limitations, and complex family interactions impede bundle compliance.
- Interventions targeting these barriers, particularly enhancing physician engagement, are needed to improve bundle performance and reduce CLABSI in critically ill children.
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.
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