Abstract
The objectives of the cross-sectional study were to delineate the knowledge, attitudes, and behavior among nurses regarding the prevention of central line-associated bloodstream infections (CLABSIs) and to identify their predisposing factors. A questionnaire was self-administered from September to November 2011 to nurses in oncology and outpatient chemotherapy units in 16 teaching and non-teaching public and private hospitals in the Campania region (Italy). The questionnaire gathered information on demographic and occupational characteristics; knowledge about evidence-based practices for the prevention of CLABSIs; attitudes towards guidelines, the risk of transmitting infections, and hand-washing when using central venous catheter (CVC); practices about catheter site care; and sources of information. The vast majority of the 335 nurses answered questions correctly about the main recommendations to prevent CLABSIs (use sterile gauze or sterile transparent semipermeable dressing to cover the catheter site, disinfect the needleless connectors before administer medication or fluid, disinfect with hydrogen peroxide the catheter insertion site, and use routinely anticoagulants solutions). Nurses aged 36 to 50 years were less likely to know these main recommendations to prevent CLABSIs, whereas this knowledge was higher in those who have received information about the prevention of these infections from courses. Nurses with lower education and those who do not know two of the main recommendations on the site’s care to prevent the CLABSIs, were more likely to perceive the risk of transmitting an infection. Higher education, attitude toward the utility allow to dry antiseptic, and the need of washing hands before wearing gloves for access to port infusion were predictors of performing skin antiseptic and aseptic technique for dressing the catheter insertion site. Educational interventions should be implemented to address the gaps regarding knowledge and practice regarding the prevention of CLABSIs and to ensure that nurses use evidence-based prevention interventions.
Highlights
The issue of Health Care-Associated Infections (HAIs) continues to be one of the most important public health problems in many countries throughout the world [1,2], and these infections remain a leading cause of morbidity and mortality among hospitalized patients [3] with an increase consumption of resources and add to cost [4,5]
Central line-associated bloodstream infections (CLABSIs), the majority related with the use of the central venous catheter (CVC) [6,7], are the most important complications in critical care [8,9,10] and in cancer settings [11,12]
Clinical practice guidelines have been published by several international organisms for the prevention of CLABSIs [18,19,20,21] that generally include specific actions to be implemented by health care workers (HCWs) who insert and handle a CVC
Summary
The issue of Health Care-Associated Infections (HAIs) continues to be one of the most important public health problems in many countries throughout the world [1,2], and these infections remain a leading cause of morbidity and mortality among hospitalized patients [3] with an increase consumption of resources and add to cost [4,5]. Among the HCWs, nurses in cancer settings have the most direct and continuous role in performing high-risk CVC procedures and they should be knowledgeable and compliant in the insertion assistance, care, and maintenance of central lines. They are well positioned to implement the recommendations and have a unique opportunity to contribute to primary prevention of these infections via evidence-based best practices [22]. To improve the appropriate use of CVCs, in-depth knowledge of the issues by nurses is essential and obtaining this information will contribute to develop preventive programs in order to reduce the frequency of CLABSIs in the cancer setting. The second objective was to identify the predisposing factors for the knowledge, attitudes, and behavior
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