Volume 37, Issue 150 (November 2024)                   IJN 2024, 37(150): 350-363 | Back to browse issues page

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Edalati Nasab M, Bozorgnejad M, Najafi Ghezeljeh T, Haghani S. Nurses' Knowledge and Practice regarding the Prevention of Central Line-Associated Bloodstream Infections in Intensive Care Units of Hospitals for Iran University of Medical Sciences. IJN 2024; 37 (150) :350-363
URL: http://ijn.iums.ac.ir/article-1-3743-en.html
Nurses' Knowledge and Practice regarding the Prevention of Central Line-Associated Bloodstream Infections in Intensive Care Units of Hospitals for Iran University of Medical Sciences
Mahla Edalati Nasab1 , Mehri Bozorgnejad 2, Tahereh Najafi Ghezeljeh3 , Shima Haghani4
1- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. , bozorgnejad.m@iums.ac.ir
3- Department of Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
4- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran.
Keywords: Knowledge, Nurses, Catheter-related infections, Intensive care units (ICU)
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Introduction
Central line-associated bloodstream infections (CLABSI) are a common type of nosocomial infections that can lead to morbidity, mortality, prolonged hospital stays, and increased healthcare costs. These infections represent a serious threat with a high prevalence among healthcare providers. Patients admitted to intensive care units (ICUs) are particularly susceptible to CLABSIs. Statistics revealed that 48% of ICU patients have central venous catheters (CVCs). CLABSI is primarily a preventable event, often resulting not only from CVC insertion but also from nursing care practices. Nurses play a crucial role in intravenous therapy. Enhanced knowledge and skills among nurses can significantly reduce complications from catheter-related infections, ultimately impacting patient safety, satisfaction, healthcare costs, and length of hospital stay.
The Centers for Disease Control and Prevention (CDC) has provided extensive guidelines for preventing CLABSIs, focusing on hand hygiene, sterile precautions (including the use of caps, gowns, masks, and gloves), the use of 2% chlorhexidine and alcohol for catheter insertion site disinfection, as well as daily assessments and care routines for CVCs. Maintenance guidelines include hand hygiene prior to accessing CVCs, the use of semi-permeable dressings or sterile pads at the insertion site, appropriate frequency for changing dressings and pressure transducers, and employing aseptic techniques during dressing changes and CVC access. Regular evaluations of nurses' knowledge and adherence to evidence-based guidelines for CLABSI prevention are imperative to identify training needs and gaps in the knowledge and practice of nursing staff.
Given the limited research conducted in Iran on nurses' knowledge and practices concerning CVC-related infections, as well as the contradictory findings from studies in other countries, there is a need for local investigation on the knowledge and practices of Iranian nurses regarding the prevention of CLABSIs. This research aims to assess nurses' knowledge and practice regarding the prevention of CLABSIs in the ICUs of hospitals affiliated to Iran University of Medical Sciences (IUMS). 

Methods
This descriptive study was conducted on 200 nurses working in the ICUs of hospitals affiliated to the IUMS in 2023. A convenience sampling method was used to select participants. Data collection tools included a demographic form, a researcher-made knowledge scale assessing nurses' knowledge of preventing CLABSIs (CVC-related infections), and a practice checklist designed by the researcher based on the clinical care guidelines proposed by the New South Wales Institute for Clinical Innovation & Emergency Care to monitor nursing practices. After completion of the questionnaires, the data were entered into SPSS software, version 16 for statistical analysis using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent t-test and ANOVA).

Results
The mean age of nurses was 37.39±6.84 years. Their work experience was 10.4±5.6 years, and their ICU work experience was 6.95±3.95 years. Among the nurses, 94.5% were female, 92.5% held a bachelor's degree, and 96% worked in the ICU. The mean knowledge score was 6.44±1.44. There was a significant difference in knowledge score based on age (P=0.006), work experience (P=0.001) and ICU work experience (P=0.006). Regarding nursing practices, the observations showed that none of the nurses used 2% chlorhexidine gluconate with 70% isopropyl alcohol for changing a dressing. Only 20.5% (n=41) employed sterile gloves during the application of new dressings. None of the nurses properly disinfected injection ports and vascular access tools.

Conclusion
This study showed that the knowledge of nurses working in the ICUs of hospitals affiliated to the IUMS regarding the prevention of CLABSIs is at a moderate to high level. Older nurses and those with more work experience and ICU work experience had higher knowledge. Although many nurses demonstrated proper practices regarding the prevention of CLABSIs, a minority had poor practices that could negatively affect infection control, quality of care, and patient safety. Therefore, hospital managers should provide targeted educational interventions to these nurses through the CVC care retraining courses. Additionally, comprehensive guidelines for CVC care should be made available for all departments of the ICU hospitals, especially ICUs, to enhance patient safety and reduce infection risks in these stings.

Ethical Considerations

Compliance with ethical guidelines
Ethical approval was obtained from the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1401.743). The study objectives were explained to the participants, and a written informed consent was obtained from them.

Funding
This article was extracted from the master’s thesis of Mahla Edalati Nasab, funded by Iran University of Medical Sciences.

Authors' contributions
Preparing initial draft: Mehri Bozorgnejad, Mahla Edalati Nasab, Tahereh Najafi Ghezeljeh; Statistical analysis: Shima Haghani; Writing: Mahla Edalati Nasab.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all the nurses who participated in this study for their cooperation.
 


 
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Type of Study: کیفی | Subject: nursing
Received: 2024/05/10 | Accepted: 2024/09/25 | Published: 2024/10/31
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