Tianjun Zhou, Chunlei Li, Zhe Wang, Mayi Yang, Xiaofeng He, Yan Hu
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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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Trial registration: </strong>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. 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引用次数: 0
摘要
目的和目的：调查22家选定医院的重症监护病房护士在中心静脉导管维持方面的循证实践和依从率。背景：尽管以证据为基础的实践在减少中枢线相关血流感染（也称为束）方面的应用有了压倒性的增长，但临床实践和证据之间仍然存在相当大的差距。设计：本研究采用多中心横断面设计。方法：选取22家医院icu注册护士为研究对象。以证据为基础的程序是根据“中心线包”制定的，其中包括11个区域和35个项目的清单。在22个单位达到22,000中心线日后，计算和分析对束的粘附率。研究报告采用STROBE检查表。结果：22个科室ICU护士CVC维持循证程序的平均依从率为87.40%。基于Central Line bundle的循证程序的5个方面，包括“选择受管制的皮肤消毒剂”、“管道密封”、“管道冲洗”、“敷料和导管固定”和“消毒皮肤和导管”的依从率均在90%以上。“导管和插入部位评估”、“手卫生”和“消毒导管接入中心”是三个最差的领域。捆绑包中实现最低的项目是“在多学科患者护理查房期间进行签名确认评估”。发生CLABSI的医院依从率均低于90%。结论：ICU护士对CVC维持包的依从性中等，提示提高依从率对改善结果至关重要。因此，应该在已经部署了捆绑治疗的icu中进行可比研究，以通过有效的干预来评估和提高依从率。为了在未来的实践中最大限度地减少CLABSI，必须通过继续教育和定期评估来制定和实施新的策略。试验注册：我们在美国临床试验注册中心注册了该试验（ID: NCT06085690，名称：基于改进科学的“ICU-NO CRBSI”多中心临床转化研究，https://ichgcp.net/clinical-trials-registry/NCT06085690）对患者护理的影响：护士管理者和决策者可以制定策略和干预措施，以改善循证实践的CVC护理质量。尽量减少证据与实践之间的差距将减少CLABSI的发生率，以提高危重患者的生存率。影响：在解决ICU护士循证实践的现状方面，本研究提高了医疗质量和结果。患者或公众捐款：没有患者或公众捐款。
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.
期刊介绍：
The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.
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