Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital

Abstract

Most adult patients admitted in Critical Care Units (CCUs) have central venous catheters (CVCs). These catheters mostly remain in place for the entire period of hospitalization, hence the risk of developing Central Line Associated Bloodstream Infection (CLABSI). The burden of CLABSI has remained high despite the introduction of CLABSI care bundles increasing the morbidity, mortality, hospital stay and cost. Most CLABSIs are caused by factors attributed to patient characteristics, clinical care and institutional factors. The aim of this study was to determine the prevalence and predictors of CLABSIs among critically ill adult patients at CCUs of Kenyatta National Hospital. The study applied a cross-sectional descriptive design with stratified sampling and simple random sampling for each stratum. 86critical care nurses were selected from a total of 110 nurses using Yamane formulae. Medical records of critically ill patients’ that met the inclusion criteria were reviewed for the year 2015. An interviewee administered questionnaire and observation checklist were used to collect data from the nurses, and a data collection sheet was used to collect data from the medical records on prevalence of CLABSIs and patient characteristics. Descriptive statistics was used to summarize the data and inferential statistics (Chi-square test, Pearsons’ correlation) was used to establish relationships between variables. Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 21.0. This study revealed that the prevalence of CLABSIs was 3.53%. Stepwise logistic regression revealed that, the patient predictors of CLABSIs in KNH CCUs were as follows; Neurological disorders as the underlying disease X2 (52) =15.249; 95% CI -0.199-0.158; P=0.946, increased length of hospitalization with CVC in situ X2 (52) =40.639; 95% CI 0.612-0.874; P< 0.001 and parenteral nutrition use X2 (52) =9.826; 95% CI 0.041-0.759; P=0.013. In addition, the nursing care related factors that predispose critically ill patients to CLABSIs in KNH CCUs were; Poor practices on hand hygiene before manipulation of infusion line which was observed in 81.8% of the CCNs, failure to remove unnecessary CVCs promptly, poor knowledge and practices on CVC maintenance and inadequate knowledge and outdated practices on changing intravenous administration system components.