Department of Critical Care Medicine, Peking University First Hospital, Beijing, China.
Department of Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
J Vasc Access. 2024 Mar;25(2):592-598. doi: 10.1177/11297298221129000. Epub 2022 Oct 14.
Peripheral arterial catheters (AC) are increasingly used in intensive care units (ICUs). Arterial catheter-related bloodstream infection is a serious complication that can increase patients' morbidity and length of stay. Standardised infection prevention practices are important when using AC. However, the current practices regarding AC insertion, use and removal and the perceived infection prevention attitudes of nurses in ICUs are unknown.
This was a multicentre cross-sectional study; 20 tertiary general hospitals were selected with a stratified random method in Beijing, China, using a self-reported internet survey.
A total of 981 valid questionnaires were collected. Overall, some infection prevention practices, such as AC insertion and disinfection of the blood sample hub, were generally consistent with clinical guidelines, whereas others were inconsistent: eye protection, skin antiseptic solution, dressing choice, blood sample collection and replacement of AC. More than 60% of participants mentioned occasionally or never having used eye protection. Only 6.0% of them stated using the chlorhexidine dressings. Among the participants, 80.6% reported that they replaced AC routinely rather than based on clinical indications, 64.2% self-rated that they did not routinely culture a catheter specimen after removal and 53.4% of participants positively agreed that AC could cause infection. Nurses with a higher education level were more likely to agree that an infection risk with AC exists (trend χ = 5.456, = 0.019*).
Significant heterogeneity exists across hospitals in China in terms of antiseptic techniques and perception of infection prevention during AC insertion, use and removal. Critical care nurses' practices partially complied with guideline recommendations. Educational level was found to be a risk factor for their perceived infection prevention attitudes. Nurses with a lower education level underestimated the infection risk of AC. Future research may examine optimal preventive strategies for reducing infection.
外周动脉导管（AC）在重症监护病房（ICU）中的使用越来越多。动脉导管相关血流感染是一种严重的并发症，会增加患者的发病率和住院时间。使用 AC 时，标准化的感染预防措施非常重要。然而，目前关于 AC 插入、使用和移除的实践以及 ICU 护士对感染预防的看法尚不清楚。
这是一项多中心横断面研究；在中国北京，采用分层随机方法选择了 20 家三级综合医院，通过互联网自我报告调查。
共收集了 981 份有效问卷。总体而言，一些感染预防措施，如 AC 插入和血液样本采集器的消毒，与临床指南基本一致，而其他措施则不一致：眼部保护、皮肤消毒剂、敷料选择、血液样本采集和 AC 更换。超过 60%的参与者提到偶尔或从未使用过眼部保护。只有 6.0%的人表示使用过洗必泰敷料。在参与者中，80.6%的人报告说他们常规更换 AC，而不是根据临床指征，64.2%的人自我评估在移除后没有常规培养导管标本，53.4%的人肯定地认为 AC 会引起感染。教育程度较高的护士更有可能认为 AC 存在感染风险（趋势 χ²=5.456，p=0.019*）。
中国医院在 AC 插入、使用和移除过程中的消毒技术和感染预防观念存在显著异质性。重症监护护士的实践部分符合指南建议。教育程度被发现是他们对感染预防态度的一个风险因素。教育程度较低的护士低估了 AC 的感染风险。未来的研究可能会研究减少感染的最佳预防策略。
