The Effect of Nurses' Implementation of Central Vascular Catheter Maintenance Care Bundle on Bloodstream Infection among ICU Patients in KFGH and KAAUH

Abstract

Background:Bloodstream infections (BSIs) are the most common type of healthcare-associated infections in clinical settings. Bloodstream infections are a leading known cause to increase the risk of patients' morbidity, mortality and length of hospital stay, and additionally, are typically increased in patients with severe underlying diseases.. The study of CVC bundle implementation has not been adequately explored in Saudi Arabia (SA). This study aimed to assess the effect of nurses' implementation of central vascular catheter maintenance care bundle on blood stream infection among intensive care unit patients at King Fahd General Hospital (KFGH) and King Abdul-Aziz University Hospital (KAAUH).

Objectives:Assess the effect of nurses' implementation of central vascular catheter maintenance care bundle on blood stream infection.

Methods: This study used quantitative research as a cause of defining the relationships between the variables which are the nurses’ implementation of the central vascular catheter maintenance care bundle and the bloodstream infection rate. An observational study were as it enables the researcher to focus on specific behaviours. The tools used in this study were Central vascular catheter maintenance care bundle checklist was used to assess the effect of nurses' implementation of a central vascular catheter maintenance care bundle on blood stream infection. A convenience sample of 63 patients of both sexes with central vascular catheter was selected from the two institutions. Ethical approval was granted from KAUH and KFGH. Data collection was conducted for six months.

Results: A total of 63 patients and 37 nurses participated in this study. The average age of the study population was 51 years old (SD score of 51±20 years). The majority of gender were male (65% )of the admitted patients were male (78%) had poor knowledge scores about contraception before counseling. The study reveals that the majority had diploma level education (87%) while(13%) had a bachelor's degree. As the researcher observed the nurses implementation of central vascular catheter maintenance care bundle, the table revealed that there was statistically significant difference between nurses' performing hand washing in relation to patients' bloodstream infection (P-value=0.001). There were (53.9%) of the nurses at both hospitals didn't perform hand washing techniques which lead to exposure of patients to infection. Other influencing factors included misapplication of chlorhexidine antiseptic at KFGH which increased exposure to infection and showed significant statistical difference (P-value = 0.000). The fourth element of proper central vascular catheter site selection indicated the elevation of infection at  the jugular vein site in (36.5%) of the cases followed by the femoral site (19%) it was not found at the subclavian vein site as recommended in current evidence. In addition, it was also noted that there was no significant correlation between exposure to infection and the daily review of central vascular catheter necessity

Conclusions and Recommendations: The relationship between nurses' implementation of central vascular catheter maintenance care bundle and bloodstream infection has had a positive effect on patients' bloodstream infection rates of intensive care unit As a result, this study recommends sustained efforts to educate the healthcare workers regarding the importance of bundle implementation and central vascular catheter care and provision of prompt feedback on adherence to aseptic technique. Moreover, healthcare providers should be involved in educational sessions on central line insertion, handling and maintenance.