Central Venous Catheter bundle: professional knowledge and behavior in adult Intensive Care Units

Costa, Camila Adriana Barbosa; Araújo, Fernanda Lopes; Costa, Anna Caroline Leite; Corrêa, Allana dos Reis; Kusahara, Denise Miyuki; Manzo, Bruna Figueiredo

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Revista da Escola de Enfermagem da USP

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2019011203629 copy

Central Venous Catheter bundle: professional knowledge and behavior in adult Intensive Care Units ^* * Extracted from the dissertation: “ Bundle de Cateter Venoso Central: conhecimento e comportamento de profissionais de saúde das Unidades de Terapia Intensiva Adulto de um hospital de grande porte”, Universidade Federal de Minas Gerais, 2017.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate knowledge and behavior of professionals in Intensive Care Units regarding the actions recommended in the bundle on preventing central venous catheter-related bloodstream infection.

Method

Cross-sectional descriptive quantitative study, conducted in three Intensive Care Units. The data were collected through a face-to-face questionnaire applied to health professionals. The software R 3.3.1 was used for data analysis.

Results

Two-hundred and ninety-two professionals participated. Regarding knowledge, the hand hygiene item presented a higher level both for the insertion (92.46%) and maintenance (97.27%) moments. Usage of chlorhexidine as an antiseptic, followed by alcohol (47.94%) and providing a date for hub or connectors (19.87%) were the least known items. As for behavior, the professionals reported: using always the correct attire for catheter insertion (84.25%), never waiting for the antiseptic to dry before catheter insertion (25.34%) and never cleaning hub or connectors with 70% alcohol (23.86%).

Conclusion

Results show that the professionals’ knowledge and behavior regarding the central venous catheter bundle present deficiencies, revealing the importance of promoting training programs for this knowledge domain.

Cross Infection; Catheter-Related Infections; Central Venous Catheters; Patient Safety; Intensive Care Units; Critical Care Nursing

Variables		Nursing technician		Nurse		Physician		P-Value

		n	%	N	%	n	%
Knowledge on the CVC insertion bundle
Hand hygiene/asepsis before catheter insertion	Completely agree	169	94.41	49	92.45	57	95.00	0.072 ¹
	Partially agree	10	5.59	4	7.55	3	5.00
	Disagree	0	0.00	0	0.00	0	0.00
Maximal barrier precaution for central venous catheter insertion	Completely agree	123	68.72	38	71.70	33	55.00	0.019 ²
	Partially agree	50	27.93	14	26.42	23	38.33
	Disagree	6	3.35	1	1.88	4	6.67
Maximal barrier precaution by the responsible for procedure assistance	Completely agree	147	82.12	50	94.34	38	63.33	0.001 ²
	Partially agree	21	11.73	3	5.66	12	20.00
	Disagree	11	6.15	0	0.00	10	16.67
Usage of antiseptic and alcoholic solution for skin asepsis	Completely agree	89	49.72	26	49.05	25	41.67	0.043 ²
	Partially agree	27	15.08	16	30.20	20	33.33
	Disagree	63	35.20	11	20.75	15	25.00
Avoiding the femoral vein	Completely agree	93	51.95	37	69.81	43	71.67	0.006 ²
	Partially agree	72	40.23	14	26.42	17	28.33
	Disagree	14	7.82	2	3.77	0	0.00
Self-reported behavior on the CVC-insertion bundle
Full attire during catheter insertion	Always	154	86.52	41	77.36	51	85.00	0.524 ²
	Nearly always	20	11.24	11	20.75	8	13.33
	Sometimes	4	2.25	1	1.89	1	1.67
	Never	0	0.00	0	0.00	0	0.00
Hand hygiene/asepsis before catheter insertion	Always	149	83.24	40	75.47	46	76.67	0.043 ²
	Nearly always	19	10.61	13	24.53	11	18.33
	Sometimes	11	6.15	0	0.00	3	5.00
	Never	0	0.00	0	0.00	0	0.00
Waiting for the antiseptic to dry before catheter insertion	Always	63	35.80	9	16.98	16	26.67	0.003 ¹
	Nearly always	42	23.86	21	39.62	23	38.33
	Sometimes	21	11.93	9	16.98	14	23.33
	Never	50	28.41	14	26.42	7	11.67
Breaking sterile technique during catheter insertion	Always	7	3.91	0	0.00	0	0.00	0.002 ²
	Nearly always	10	5.59	0	0.00	3	5.00
	Sometimes	59	32.96	30	56.60	37	61.67
	Never	103	57.54	23	43.40	20	33.33

Variables		Nursing Technician		Nurse		Physician		P-Value

		N	%	N	%	n	%
Knowledge on the CVC maintenance bundle
Daily verification of the need for catheter permanence	Completely agree	168	93.86	51	96.23	56	93.33	0.543 ¹
	Partially agree	6	3.35	2	3.77	1	1.67
	Disagree	5	2.79	0	0.00	3	5.00
Hand hygiene before catheter manipulation	Completely agree	174	97.21	53	100.00	57	95.00	0.071 ¹
	Partially agree	5	2.79	0	0.00	1	1.67
	Disagree	0	0.00	0	0.00	2	3.33
Cleaning hub or connectors with 70% alcohol	Completely agree	149	83.24	48	90.57	41	68.33	0.032 ¹
	Partially agree	20	11.17	4	7.55	13	21.67
	Disagree	10	5.59	1	1.89	6	10.00
Changing the infusion set	Completely agree	151	84.36	51	96.23	39	66.10	0.002 ¹
	Partially agree	16	8.94	2	3.77	12	20.34
	Disagree	12	6.70	0	0.00	8	13.56
Providing dates for hub or connectors	Completely agree	107	60.11	36	67.92	42	70.00	0.001 ¹
	Partially agree	22	11.80	14	26.42	13	21.66
	Disagree	50	28.09	3	5.66	5	8.34
Excessive catheter manipulation	Completely agree	128	71.51	48	90.57	53	88.33	0.006 ¹
	Partially agree	28	15.64	5	9.43	5	8.34
	Disagree	23	12.85	0	0.00	2	3.33
Providing dates for the infusion set	Completely agree	150	83.80	49	92.45	44	75.86	0.076 ¹
	Partially agree	21	11.73	4	7.55	8	13.79
	Disagree	8	4.47	0	0.00	6	10.34
Self-reported behavior on the CVC maintenance bundle
Daily verification of the need for catheter permanence	Always	143	80.34	37	69.81	40	66.67	0.112 ¹
	Nearly always	20	11.24	11	20.75	16	26.66
	Sometimes	13	7.30	5	9.44	4	6.67
	Never	2	1.12	0	0.00	0	0.00
Cleaning hub or connector with 70% alcohol	Always	43	24.02	2	3.77	7	11.60	0.005 ¹
	Nearly always	36	20.11	10	18.87	11	18.40
	Sometimes	55	30.73	30	56.60	26	43.40
	Never	45	25.14	11	20.76	16	26.60
Previous hand hygiene before catheter manipulation	Always	101	56.42	12	23.08	14	23.34	0.000 ¹
	Nearly always	46	25.70	18	34.62	17	28.33
	Sometimes	25	13.97	18	34.61	20	33.33
	Never	7	3.91	4	7.69	9	15.00
Infusion set change practice	Always	159	88.82	41	77.36	35	61.41	0.000 ¹
	Nearly always	17	9.50	12	22.64	12	21.05
	Sometimes	3	1.68	0	0.00	10	17.54
	Never	0	0.00	0	0.00	0	0.00
Previous hand hygiene for bandage change	Always	130	73.03	36	67.92	38	63.30	0.162 ²
	Nearly always	27	15.17	13	24.53	13	21.70
	Sometimes	14	7.87	4	7.55	9	15.00
	Never	7	3.93	0	0.00	0	0.00
Using hood and mask before bandage change	Always	101	56.43	37	69.81	28	47.67	0.039 ²
	Nearly always	35	19.55	9	16.98	8	13.33
	Sometimes	27	15.08	5	9.44	12	20.00
	Never	16	8.94	2	3.77	12	20.00

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Anna Caroline Leite Costa Avenida Professor Alfredo Balena, 190, Santa Efigênia CEP 30130-100 Belo Horizonte, MG, Brazil anna.leitebh@gmail.com