Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital
American Journal of Nursing Science
Volume 7, Issue 1, February 2018, Pages: 1-13
Received: Oct. 27, 2017;
Accepted: Dec. 7, 2017;
Published: Jan. 5, 2018
Views 2248 Downloads 167
Mukiri Jocyline, School of Nursing Sciences, University of Nairobi, Nairobi, Kenya; Social Services League M P Shah Hospital, Medical – Surgical Unit, Nairobi, Kenya
Inyama Hannah, School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
Maina Dorcas Waithira, School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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.
Maina Dorcas Waithira,
Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital, American Journal of Nursing Science.
Vol. 7, No. 1,
2018, pp. 1-13.
Centers for Disease Control and Prevention (2013). National Healthcare Safety Network. Device-Associated Module. Protocol and Instructions: Central Line- Associated Bloodstream Infection Event. http://www.cdc.gov/nhsn/psc_da.html.
Higuera F, Rosenthal VD, Duarte P, Ruiz J, Franco G, Safdar N, (2007). The effect of process control on the incidence of central venous catheter–associated bloodstream infections and mortality in intensive care units in Mexico. Journal of Critical Care Medicine. 33(9):2022–2027.
Edgeworth J., (2009). Intravascular catheter infections. Journal of Hospital Infection. 73(4):323–330.
Zingg W, Sax H, Inan C, Cartier V, Diby M, Clergue F, Pittet D, Walder B., (2008). Hospital-wide surveillance of catheter-related bloodstream infection: From the expected to the unexpected. Journal of Hospital Infection. 73(1):41–46.
Gurses AP, Seidl KL, Vaidya V, Bochicchio G, Harris AD, Hebden J, Xiao Y., (2008). Systems ambiguity and guideline compliance: A qualitative study of how intensive care units follow evidence-based guidelines to reduce healthcare-associated infections. Quality and Safety in Health Care Journal. 17(5):351–359.
Rosenthal VD., (2009). Central line–associated bloodstream infections in limited-resource countries: A review of the literature. Journal of Clinical Infectious Diseases. 49(12):1899–1907.
European Commission (2008). Communication from the Commission to the European Parliament and the Council on Patient Safety, Including Prevention and Control of Healthcare-Associated Infections. Commission of the European Communities.
World Health Organization (2009). WHO Guidelines on Hand Hygiene in Health Care.
Seko M, (2007). The Prevalence of Central Line Associated Infections at the Intensive Care Units of Kenyatta National Hospital. The University of Nairobi Research Archive. (Thesis document).
The Joint Commission (2012). Preventing Central Line–Associated Bloodstream Infections: A Global Challenge, a Global Perspective. Oak Brook, Illinois.
Rosenthal VD., Lynch P, Jarvis WR., (2011). Socioeconomic impact on device-associated infections in limited resource neonatal intensive care units: Journal of International Nosocomial Infection Control Consortium. 39(5):439–450.
Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D., (2011). Burden of endemic health-care associated infection in developing countries: Systematic review and meta-analysis. The Lancet Journal 377(9761):228–241.
Kritchevsky SB, Braun BI, Kusek L, Wong ES, Solomon SL, Parry MF, Richards CL, Simmons B, (2008). Evaluation of Processes and Indicators in Infection Control Study Group. The impact of hospital practice on central venous catheter associated bloodstream infection rates at the patient and unit level: A multicenter study. American Journal of Medicine. 23(1):24–38.
Mollee P, Jones M, Stackelroth J, van Kuilenburg R, Joubert W, Faoagali J, Looke D, Harper J, Clements A., (2011). Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: A prospective cohort study. Journal of Hospital Infection. 78(1):26–30.
Niedner MF., (2010). National Association of Children’s Hospitals and Related Institutions Pediatric Intensive Care Unit Patient Care FOCUS Group. The harder you look, the more you find: Catheter-associated bloodstream infection surveillance variability. American Journal of Infection Control. 38(8):585–595.
Almuneef MA, Memish ZA, Balkhy HH, Hijazi O, Cunningham G, Francis C., (2005). Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. Journal of Hospital Infections. 62(2):207–213.
O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S; Healthcare Infection Control Practices Advisory Committee (HICPAC) (2011). Guidelines for the prevention of intravascular catheter-related infections. Journal of Clinical Infectious Diseases. 52(9):e162–193.
Mimoz O, Pieroni L, Lawrence C, Edouard A, Costa Y, Samii K, Brun-Buisson C. (2007). Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Journal of Critical Care Medicine. 24(11):1818–23.
Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S., (2002). Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: A meta-analysis. Annals of Internal Medicine Journal. 136(11):792–801.
Milstone AM. Tamma PD, Aucott SW., (2010). Chlorhexidine use in the neonatal intensive care unit: Results from a national survey. Journal of Infection Control and Hospital Epidemiology. 31(8):846–849.
Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SR, McDougall C, Wilcox MH., (2007). National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection. 65 Suppl 1:S1–64.
Mermel LA., (2009). Prevention of intravascular catheter- related infections. Annals of Internal Medicine. 132(5), 391-402.
Zingg W, Walder B, Pittet D., (2011). Prevention of catheter-related infection: Toward zero risk? Journal of Current Opinion in Infectious Diseases. 24(4):377–384.
Trick WE, Vernon MO, Welbel SF, Wisniewski MF, Jernigan JA, Weinstein RA., (2008). Unnecessary use of central venous catheters: The need to look outside the intensive care unit. Journal of Infection Control and Hospital Epidemiology. 25(3):266–268.
Infusion Nurses Society (2016). Infusion Nursing Standards of Practice. Journal of Infusion Nursing. Jan–Feb;39Suppl 1:S1–64.