Evidence-Based Practice in Maintenance of Central Venous Catheters Among Intensive Care Unit Nurses: A...

Area of Science:

• Healthcare Quality Improvement
• Infection Prevention and Control
• Nursing Practice

Background:

• Central Line-Associated Bloodstream Infections (CLABSI) remain a significant concern in intensive care units (ICUs).
• Despite the rise of evidence-based bundles to reduce CLABSI, a gap persists between recommended practices and actual clinical application.
• This study addresses the need to evaluate adherence to central venous catheter (CVC) maintenance bundles in ICUs.

Purpose of the Study:

• To investigate evidence-based practices for CVC maintenance among ICU nurses.
• To examine the rates of adherence to CVC maintenance bundles in 22 selected hospitals.
• To identify areas for improvement in CVC care to reduce CLABSI.

Main Methods:

• A multi-center, cross-sectional study design was employed.
• Data were collected from registered nurses in the ICUs of 22 hospitals using an 11-area, 35-item checklist based on Central Line Bundles.
• Adherence rates were analyzed after accumulating 22,000 central line days, with reporting guided by the STROBE checklist.

Main Results:

• The average adherence rate to CVC maintenance bundles among ICU nurses was 87.40%.
• Adherence exceeded 90% for 'Selection of regulated skin disinfectants,' 'Tube sealing,' 'Tube flushing,' 'Dressing and catheter fixation,' and 'Sterilized skin and catheter.'
• Lowest adherence was observed in 'Catheter and insertion site assessment,' 'Hand hygiene,' and 'Sterilized catheter access hubs,' with 'Assess during multidisciplinary patient care rounds with signature confirmation' being the least followed item. Hospitals with CLABSI events had adherence rates below 90%.

Conclusions:

• ICU nurses demonstrate moderate adherence to CVC maintenance bundles, highlighting the need for interventions to improve compliance.
• Further studies in ICUs are recommended to assess and enhance adherence through targeted interventions.
• Developing and implementing novel strategies, including continuous education and regular evaluation, is essential for minimizing CLABSI and improving patient survival.