Bijarania Sunil Kumar, Kaur Rupinder, Biswal Manisha, Maheshwar Sangeeta, Ganesan Rajarajan, Puri Goverdhan D, Konar Sushant, Thingnam Shyam
Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India.
Department of Medical Microbiology, PGIMER, Chandigarh, India.
Infect Prev Pract. 2024 Dec 5;7(1):100423. doi: 10.1016/j.infpip.2024.100423. eCollection 2025 Mar.
Infection prevention and control (IPC) practices by critical care nurses are crucial in preventing ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI).
To implement an integrative approach to developing a set of IPC practices and disseminating information on the IPC practices through an educational multimedia tool to improve compliance with the practices.
This participatory interventional before-after study was conducted in a single tertiary care centre's cardiac surgical intensive care unit (ICU) from May 2022 to March 2023. Thirty-seven nursing IPC practices related to VAP and eight for CLABSI were finalized through a three-step process: systematized review, focused group discussions (five rounds), and Delphi rounds (three rounds). The IPC practices were disseminated through a multimedia tool, displayed continuously in the ICU. Nurses' compliance with the IPC practices observed directly was compared before and after implementing the multimedia tool.
A total of 6043 observations for practices related to VAP and 1957 observations for those of CLABSI were performed. There was an increase in compliance post implementation for 11 IPC practices related to VAP and two IPC for those of CLABSI. There was an increase in compliance with practices relevant to chlorhexidine baths, oral care, cuff pressure maintenance, hypertonic saline nebulization, endotracheal suctioning, scrubbing the hub for central line access, and assessment of the central line for removal.
Through a participatory approach, we developed a set of IPC nursing practices for VAP and CLABSI. Implementing a multimedia tool, which encompasses the newly implemented IPC practices, improved compliance with many practices.
重症护理护士的感染预防与控制（IPC）措施对于预防呼吸机相关性肺炎（VAP）和中心静脉导管相关血流感染（CLABSI）至关重要。
采用综合方法制定一套IPC措施，并通过教育多媒体工具传播有关IPC措施的信息，以提高对这些措施的依从性。
这项前后对照的参与性研究于2022年5月至2023年3月在一家三级护理中心的心脏外科重症监护病房（ICU）进行。通过系统评价、焦点小组讨论（五轮）和德尔菲法（三轮）这三个步骤，最终确定了37项与VAP相关的护理IPC措施和8项与CLABSI相关的措施。这些IPC措施通过一个多媒体工具进行传播，并在ICU中持续展示。比较了实施多媒体工具前后护士对IPC措施的直接观察依从性。
共对与VAP相关的措施进行了6043次观察，对与CLABSI相关的措施进行了1957次观察。实施后，11项与VAP相关的IPC措施和2项与CLABSI相关的IPC措施的依从性有所提高。与洗必泰浴、口腔护理、袖带压力维持、高渗盐水雾化、气管内吸痰、中心静脉导管接入处的消毒、中心静脉导管拔除评估等相关措施的依从性有所提高。
通过参与性方法，我们制定了一套针对VAP和CLABSI的IPC护理措施。实施一个包含新实施的IPC措施的多媒体工具，提高了对许多措施的依从性。
