Ullman Amanda J, Long Debbie A, Rickard Claire M
NH&MRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Centre for Health Practice Innovation Griffith Health Institute, Griffith University, Nathan, QLD, Australia; Paediatric Intensive Care Unit, Royal Children's Hospital, Herston, QLD, Australia.
NH&MRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Centre for Health Practice Innovation Griffith Health Institute, Griffith University, Nathan, QLD, Australia; Paediatric Intensive Care Unit, Royal Children's Hospital, Herston, QLD, Australia.
Nurse Educ Today. 2014 Feb;34(2):202-7. doi: 10.1016/j.nedt.2013.09.002. Epub 2013 Sep 5.
Central venous catheters are important in the management of paediatric intensive care unit patients, but can have serious complications which worsen the patients' health, prolong hospital stays and increase the cost of care. Evidence-based recommendations for preventing catheter-related bloodstream infections are available, but it is unknown how widely these are known or practiced in the paediatric intensive care environment.
To assess nursing knowledge of evidence based guidelines to prevent catheter-related bloodstream infections; the extent to which Australia and New Zealand paediatric intensive cares have adopted prevention practices; and to identify the factors that encouraged their adoption and improve nursing knowledge.
Cross-sectional surveys using convenience sampling.
Tertiary level paediatric intensive care units in Australia and New Zealand.
Paediatric intensive care nursing staff and nurse managers.
Between 2010 and 2011, the 'Paediatric Intensive Care Nurses' Knowledge of Evidence-Based Catheter-Related Bloodstream Infection Prevention Questionnaire' was distributed to paediatric intensive care nursing staff and the 'Catheter-Related Bloodstream Infection Prevention Practices Survey' was distributed to nurse managers to measure knowledge, practices and culture.
The questionnaires were completed by 253 paediatric intensive care nurses (response rate: 34%). The mean total knowledge score was 5.5 (SD=1.4) out of a possible ten, with significant variation of total scores between paediatric intensive care sites (p=0.01). Other demographic characteristics were not significantly associated with variation in total knowledge scores. All nursing managers from Australian and New Zealand paediatric intensive care units participated in the survey (n=8; response rate: 100%). Wide practice variation was reported, with inconsistent adherence to recommendations. Safety culture was not significantly associated with mean knowledge scores per site.
This study has identified that there is variation in the infection prevention approach and nurses' knowledge about catheter-related bloodstream infection prevention. The presence of an improved safety culture, years of paediatric intensive care experience and higher qualifications did not influence the nurses' uptake of recommendations, therefore further factors need to be explored in order to improve understanding and implementation of best practice.
中心静脉导管在儿科重症监护病房患者的管理中至关重要，但可能会引发严重并发症，从而恶化患者健康状况、延长住院时间并增加护理成本。虽然已有关于预防导管相关血流感染的循证建议，但在儿科重症监护环境中，这些建议的知晓程度和实践情况尚不清楚。
评估护士对预防导管相关血流感染循证指南的了解；澳大利亚和新西兰儿科重症监护病房采用预防措施的程度；并确定促使其采用这些措施及提高护士知识水平的因素。
采用便利抽样的横断面调查。
澳大利亚和新西兰的三级儿科重症监护病房。
儿科重症监护护理人员和护士长。
在2010年至2011年期间，向儿科重症监护护理人员发放了“儿科重症监护护士对循证导管相关血流感染预防的知识问卷”，并向护士长发放了“导管相关血流感染预防措施调查”，以衡量知识、措施和文化情况。
253名儿科重症监护护士完成了问卷（回复率：34%）。在满分10分的情况下，平均总知识得分是5.5分（标准差=1.4），儿科重症监护病房之间的总分存在显著差异（p=0.01）。其他人口统计学特征与总知识得分的差异无显著关联。澳大利亚和新西兰儿科重症监护病房的所有护士长都参与了调查（n=8；回复率：100%）。报告显示实践差异很大，对建议的遵守情况不一致。安全文化与每个病房的平均知识得分无显著关联。
本研究发现，预防感染的方法以及护士对导管相关血流感染预防的知识存在差异。安全文化的改善、儿科重症监护经验年限和更高的资质并未影响护士对建议的采纳，因此需要进一步探索其他因素，以提高对最佳实践的理解和实施。
