Strategies to enhance nurses' adherence to central line-associated bloodstream infection prevention bundles in the ICU setting: A systematic review

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-03-11 DOI:10.1016/j.hrtlng.2025.02.009

Diaa Bou Hamdan RN, MSN , Sarah Hatahet RN, MSN , Heba Khalil RN, PhD , Khalil M. Yousef RN, PhD

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引用次数: 0

Abstract

Background

The incidence of central line-associated bloodstream infection (CLABSI) in the ICU continues to rise. Despite existing CLABSI bundles to prevent infections, adherence remains suboptimal.

Objective

To identify and synthesize the evidence about strategies used to enhance nurses’ adherence to CLABSI prevention bundles.

Methods

Five databases were searched: CINAHL, MEDLINE, PubMed, Cochrane Library, and SCOPUS. Eligible studies were those published between 2012–2024, and investigated the adherence to central line bundles and strategies to improve adherence in the ICU. Two reviewers independently screened, critically appraised, and extracted data using Joanna Briggs Institute tools. The review protocol was registered on PROSPERO (CRD42024513345).

Results

Seven studies met the inclusion criteria, including four quality improvement projects and three quasi-experimental studies. The studies ranged in quality from moderate to high, with scores between 68.75 %-88.88 %. These studies explored various strategies to enhance nurses' adherence to CLABSI prevention bundles. Strategies included education, leadership, and auditing/feedback mechanisms. Education was the primary strategy utilized and included simulation and online training. Active participation in decision making, transparency in sharing CLABSI outcome data, celebrating achievements, and electronic documentation were essential aspects of leadership support to promote adherence. Implementing these strategies led to significant improvements in nurses’ adherence to bundle (<0.01).

Conclusion

Education, leadership, and audit mechanisms improve adherence to CLABSI bundles. Yet, the current evidence lacks randomized controlled trails that can establish effectiveness of these strategies. Future research should also investigate the long-term effect of these strategies on adherence, and the influence of organizational culture on CLABSI bundle adherence.

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在ICU环境中加强护士对中心线相关血流感染预防束的依从性的策略：一项系统综述

背景：ICU中枢线相关血流感染（CLABSI）的发生率持续上升。尽管现有的CLABSI包可以预防感染，但依从性仍然不够理想。目的识别和综合提高护士对CLABSI预防包依从性的策略证据。方法检索CINAHL、MEDLINE、PubMed、Cochrane Library和SCOPUS 5个数据库。符合条件的研究是在2012-2024年间发表的研究，研究了ICU对中心静脉束的依从性和提高依从性的策略。两位审稿人独立筛选，严格评估，并使用乔安娜布里格斯研究所的工具提取数据。审查方案已在PROSPERO注册（CRD42024513345）。结果7项研究符合纳入标准，包括4项质量改进项目和3项准实验研究。这些研究的质量从中等到高，得分在68.75% - 88.88%之间。这些研究探讨了各种策略来提高护士对CLABSI预防包的依从性。策略包括教育、领导和审计/反馈机制。教育是采用的主要策略，包括模拟和在线培训。积极参与决策、透明分享CLABSI结果数据、庆祝成就和电子文档是领导支持促进遵守的重要方面。实施这些策略可显著提高护士对捆绑包的依从性（<0.01）。结论：教育、领导和审计机制可以提高对CLABSI包的依从性。然而，目前的证据缺乏随机对照试验来确定这些策略的有效性。未来的研究还应该调查这些策略对依从性的长期影响，以及组织文化对CLABSI束依从性的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.