Abstract
The use of central catheters in intensive care is essential, but exposes the patient to the risk of a bloodstream infection. Although there is evidence to improve the care for these patients, there is a gap between knowledge and healthcare practices. This study was designed to describe the bundle implementation for central catheters in light of the knowledge translation (KT) conceptual framework in a neonatal unit and assess its impact on care practices with catheters. A time-series quasi-experimental study design was conducted in a Brazilian neonatal unit, through 289 non-participant observations of professional practices before and after the implementation of the bundles. The deployment of two bundles was guided through the steps of a careful selection of adopting KT evidence and context-related and investment factors in the facilitation process. The implementation of the bundles was planned by a group manager, mediated by a facilitator, and guided by targets established by professionals. The biggest impact was on the maintenance of catheters; seven of eleven practices improved significantly (p < 0.01). The insertion of catheters showed lesser impact of change, with high adequacy ratios before implementation, but also presented satisfactory adherence to recommendations. This is the first Brazilian study using the KT conceptual framework to develop, implement, and evaluate the impact of central line bundles in a neonatal care environment, detailing the implementation process. It highlights the importance of accountability and staff involvement in all stages of the study.
Highlights
The use of central catheters in intensive care is essential, but exposes the patient to the risk of a bloodstream infection
Considering the complexity of the changing processes and the conceptual model adopted, this study aimed to describe the implementation process of two bundles for the insertion and maintenance of central venous catheter (CVCs) in the light of the knowledge translation (KT) conceptual benchmark in a neonatal unit, and to assess the impact of these bundles on care practices for the insertion and maintenance of catheters
The manager group was made up of people strategically chosen based on their complementary views about the drive: two nurses, a resident of neonatal nursing, a nurse technician, a neonatologist, a pediatric infectious disease physician, and a nurse on the hospital infection control committee, who voluntarily accepted the mission of defining implementation strategies, mediated by a facilitator role played by one of the researchers
Summary
The use of central catheters in intensive care is essential, but exposes the patient to the risk of a bloodstream infection. This study was designed to describe the bundle implementation for central catheters in light of the knowledge translation (KT) conceptual framework in a neonatal unit and assess its impact on care practices with catheters. Conclusions: This is the first Brazilian study using the KT conceptual framework to develop, implement, and evaluate the impact of central line bundles in a neonatal care environment, detailing the implementation process. It highlights the importance of accountability and staff involvement in all stages of the study. It is estimated that approximately half (48%) of the patients in intensive care have at least one central catheter, totaling 15 million catheter-days per year in ICUs in the United States [1]. These figures are high compared to the international ones [37]
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