Evidence-Based Practice in Maintenance of Central Venous Catheters Among Intensive Care Unit Nurses: A Cross-Sectional Multi-Center Study.

AIMS AND OBJECTIVES

To investigate evidence-based practices and examine rates of adherence to bundles on maintenance of central venous catheters among intensive care unit nurses in 22 selected hospitals.

BACKGROUND

Although there has been an overwhelming increase in the use of evidence-based practices to reduce Central Line-Associated Bloodstream Infections, also known as bundles, there continues to be a considerable gap between clinical practice and evidence.

DESIGN

This study employs a multi-center cross-sectional design.

METHODS

Registered nurses who worked in the ICUs of 22 selected hospitals were included. Evidence-based procedures were developed based on Central Line Bundles, which include an 11-area and 35-item checklist. Rates of adherence to bundles were calculated and analysed after reaching 22,000 central line days in 22 units. The study was reported using the STROBE checklist.

RESULTS

The average adherence rate to evidence-based procedures for CVC maintenance among ICU nurses in the 22 units was 87.40%. The adherence rate of five areas of the evidence-based procedure based on the Central Line bundle was above 90%, including 'Selection of regulated skin disinfectants', 'Tube sealing', 'Tube flushing', 'Dressing and catheter fixation' and 'Sterilized skin and catheter'. The three lowest-achieving areas of bundles were 'Catheter and insertion site assessment,' 'Hand hygiene' and 'Sterilized catheter access hubs'. The lowest-achieving item of bundles is 'Assess during multidisciplinary patient care rounds with signature confirmation'. The adherence rates in hospitals where CLABSI occurred were all less than 90%.

CONCLUSION

ICU nurses' adherence to maintenance bundles for CVC is moderate, implying that boosting adherence rates is critical for improved results. As a result, comparable studies should be done in ICUs where the bundle has been deployed to assess and improve adherence rates through effective interventions. To minimise CLABSI in future practice, novel strategies must be developed and implemented via continued education and regular evaluation.

TRIAL REGISTRATION

We registered the trial with the US Clinical Trials Registry (ID: NCT06085690, Name: Multicenter Clinical Translational Study of 'ICU-NO CRBSI' Based on Improvement Science, https://ichgcp.net/clinical-trials-registry/NCT06085690) IMPLICATIONS FOR PATIENT CARE: Nurse administrators and policymakers can develop strategies and interventions for improving the quality of CVC care toward evidence-based practice. Minimising the gaps between evidence and practice will reduce the incidence of CLABSI to enhance the survival of critically ill patients.

IMPACT

In addressing the status of evidence-based practices among ICU nurses, this study enhances healthcare quality and outcomes.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.