Supervisors info:
Γιαννακοπούλου Μαργαρίτα, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Φιλντίσης Γεώργιος, Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Κατσούλας Θεόδωρος, Αναπληρωτής Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Summary:
Introduction: For the prevention of Central Line-associated BloodStream Infections (CLABSI), the compliance of the healthcare providers in central venous catheter (CVC) care bundle is particularly important.
Purpose: The observation and recording of the compliance in CVC care bundle during the insertion, maintenance, and care in Intensive Care Unit (ICU) for adults and Pediatric ICU (PICU), as well as the examination of the correlation between the nursing workload (NW) and the degree of compliance in CVC care bundle.
Methods: This is a prospective cohort study conducted in an adult ICU (n = 27) (January-February 2020) and a PICU (n = 12) (August-October 2020). For data collection, the following were used: a) checklists for the CVC’s insertion, care and maintenance, which developed in accordance with the Centers for Disease Control and Prevention (CDC) guidelines, for assess healthcarer’s compliance with the CLABSI prevention care bundle b) the Simplified Acute Physiology Score III (SAPS III), the Charlson Comorbidity Index (CCI), and the Sequential Organ Failure Assessment (SOFA) scale for assessing the clinical severity of patients in adult ICUs, c) the Pediatric Index Logistic Organ Dysfunction (PELOD 2) and the Pediatric Risk of Mortality III (PRISM III) for the evaluation of the clinical severity of patients in the PICU, d) the Therapeutic Intervention Scoring System 28 (TISS-28) for the evaluation of NW , and e) patient demographic / clinical data collection form. The data collection was carried out by the same researcher at the Adult ICU and the PICU, where she attended 2 days a week during the morning and once a week during the afternoon shift. In total, in both ICUs, 187 observations were made regarding the implementation of the CVC care bundle, of which 18 concerned the insertion of the CVC, 65 the care of the CVC and 104 the maintenance of the CVC. Descriptive statistics and correlation study were performed at significance level α = 0.05 (SPSS 24.0).
Results: Of the total of 27 Adult ICU patients, 14 (51.9%) were male, and their mean age was 70.37 years (± 10.35). The main cause of admission to the ICU was respiratory diseases, n=15 (55.6%). The median SAPS III was 69.0 (58.0-74.0), the mean CCI score was 6.44 (± 2.94) and the mean SOFA score on admission was 10.07 (± 2, 74). The mean value of TISS-28 on the 1st day of hospitalization was 41.37 (± 7.27). Regarding the demographic-clinical characteristics of the 12 patients of the PICU, 8 (66.7%) were boys and their mean age was 6.47 (± 5.07) years. The main reason for admission to the ICU was postoperative follow-up 4 (33.3%). The mean value of PRISM III was 9.33 (± 6.37) and of PELOD was 6.23 (± 7.09). The mean value of TISS-28 on the 1st day of hospitalization was 32.58 (± 10.09).
In the adult ICU, out of the total of 11 observations on the insertion of the CVC, in 9 (81.8%) observations 5 or 6 practices of care bundle were observed, out of the 58 observations concerning the maintenance of the CVC, in 51 (87.9 %) 4 or fewer practices were observed, and out of the 46 observations concerning the care of CVC in 34 (73.9%) 4 or fewer practices of the care bundle were observed.
In the PICU, out of the total of 7 observations on the insertion of the CVC, in 4 (57.1%) all the practices of the care bundle were observed, out of the 45 observations concerning the maintenance of the CVC, in 26 (57.8%) %) 5 or 6 practices were observed, and out of the 20 observations concerning the care of CVC in 10 (50.0%) 5 or 6 practices of the care bundle were observed.
The number of practices applied during the insertion of CVC (p=0.087) did not differ significantly between the two ICUs, however in the PICU there was statistically significantly greater compliance with the CVC maintenance (p <0.01) and care (p <0.01) bundle in relation to adult ICU. In all the observations, there was a statistically significant correlation between the number of applied practices of the CVC maintenance bundle with the NW at admission (rho =-0.435, p <0.001) and the NW of the observation day (rho=-0.506, p <0.001). Finally, there was a negatively statistically significant correlation between the number of applied practices of the CVC care bundle with NW at admission (rho=-0.517, p <0.001) and NW on observation day (rho=-0.603, p <0.001).
Conclusion: The data show that there is great compliance of health professionals in the insertion CVC’s care bundle in both ICUs. However, the nurses in the PICU had better compliance with the CVC maintenance and care bundle compared to the Adult ICU nurses. Also, the NW seemed be related to the degree of compliance CVC’s care bundle; however, a larger sample is required
Keywords:
Adults ICU, Pediatrics ICU, Central line catheters, Central line catheters care bundles, Compliance in Cvc care bundle, Nurse workload
