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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 23  |  Issue : 2  |  Page : 196-200

Effectiveness of education intervention on nurse's knowledge regarding the prevention of central line-associated bloodstream infection in the intensive care and haemodialysis units in selected hospitals, Kanpur


1 M.Sc Nursing Student, Department of Medical- Surgical Nursing, Faculty of Nursing, Rama University, Kanpur, Uttar Pradesh, India
2 Professor Cum Head, Department of Medical- Surgical Nursing, Faculty of Nursing, Rama University, Kanpur, Uttar Pradesh, India
3 Lecturer, Department of Medical- Surgical Nursing, Faculty of Nursing, Rama University, Kanpur, Uttar Pradesh, India

Date of Submission22-Aug-2022
Date of Decision11-Nov-2022
Date of Acceptance14-Nov-2022
Date of Web Publication24-Jan-2023

Correspondence Address:
Ms. Harshita Sachan
C/o Shobhit Sachan, Kidwai Nagar, Pukhrayan Kanpur Dehat, Kanpur, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_81_22

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  Abstract 

According to the Centres for Disease Control and Prevention, central line-associated bloodstream infection (CLABSI) is defined as recovery of the pathogen from blood culture in the patient who had the central line at the time of infection or within 48 h. The objectives of the study were to evaluate the level of knowledge regarding the prevention of CLABSI among staff nurses, to assess the effectiveness of the educative intervention on knowledge regarding the prevention of central line-associated bloodstream infection among staff nurses and to associate the level of knowledge with selected demographic variables of staff nurses. A pre-test–post-test one-group design was adopted by the researcher, and 60 staff nurses working in the intensive care and haemodialysis units in selected hospitals in Kanpur were selected using a purposive sampling technique. A structured knowledge questionnaire was used to collect data. The result of the study showed that the post-test mean score (17) was high compared to the pre-test mean score (11) of knowledge. There is a statistically significant difference between pre-test and post-test knowledge. The Chi-square test revealed that there was no significant association of knowledge with selected demographic variables such as age, gender, educational status or exposure to previous class on CLABSI. The overall findings of the study clearly showed that there is a need for continuous educational intervention to enhance the knowledge level of nursing staff.

Keywords: Central line-associated bloodstream infection, central venous catheter, educative intervention, haemodialysis unit, intensive care unit


How to cite this article:
Sachan H, Manu J, Monika A. Effectiveness of education intervention on nurse's knowledge regarding the prevention of central line-associated bloodstream infection in the intensive care and haemodialysis units in selected hospitals, Kanpur. Indian J Cont Nsg Edn 2022;23:196-200

How to cite this URL:
Sachan H, Manu J, Monika A. Effectiveness of education intervention on nurse's knowledge regarding the prevention of central line-associated bloodstream infection in the intensive care and haemodialysis units in selected hospitals, Kanpur. Indian J Cont Nsg Edn [serial online] 2022 [cited 2023 Feb 3];23:196-200. Available from: https://www.ijcne.org/text.asp?2022/23/2/196/368424


  Introduction Top


A central line or central venous catheter is an intravascular catheter that terminates at one of the great vessels or close to the heart. It is used to withdraw blood samples, administer intravenous infusion, perform haemodynamic monitoring or provide total parental nutrition.

According to the Centres for Disease Control and Prevention (CDC), central line-associated bloodstream infection (CLABSI) is a surveillance definition and defined as recovery of the pathogen from blood culture in the patient who had the central line at the time of infection or within 48 h before the development of infection. Infection might not have been present earlier or during the admission of the patient to the facility or infection does not move from another body site of patient.[1]

The primary bloodstream infection develops in a patient with a central line in place within 48 h before the development of bloodstream infection that is not an infection from another body site. The secondary bloodstream infection develops from another site of the body like urinary tract infection, surgical site infection or pneumonia. CLABSI results from the colonisation of microorganisms in the fluid pathway when the catheter is inserted or colonisation in the external surface or the course of catheter utilisation.[2] According to the National Health Safety Network, common pathogens causing CLABSI are identified as Gram-negative organisms such as Klebsiella 5.8%, Enterobacter 3.9%, Pseudomonas 3.1%, Escherichia coli 2.7% and Acinetobacter 2.2%, Gram-positive organisms such as coagulase-negative staphylococci 34.1%, enterococci 16% and Staphylococcus aureus 9.9%, Candida species 11.8% and others 10.5%.[1]

Despite all the advantages, the central line also provides direct access to foreign bodies into the bloodstream and increases the risk of various complications. This complication includes catheter fracture, incorrect position, thrombosis, catheter occlusion and catheter-related infection. CLABSI is one of the serious complications of catheter-related infection. It is a nosocomial infection associated with a device used in a medical procedure and an important cause of the increase in morbidity, mortality, health cost and hospital stay. Risk factors associated with the occurrence of CLABSI include insertion site, type of device, hospital and practice followed in handling care central venous catheter, duration of the placement of the catheter, patient hygiene and previous incidence of CLABSI. Other risk factors include immunocompromised patients, iron overload, S. aureus nasal carriage and hypoalbuminemia.[2]

The prevention of CLABSI is a key for successful parenteral nutrition. The catheter hub or exit site is responsible for the contamination that leads to most infections. Healthcare providers need to put conscious efforts to follow protocols and guidelines for the care of the central venous catheter device before, during and after its insertion. The most important way to prevent CLABSI is the strict adherence to aseptic technique and hand-washing.[3]

The healthcare professional must follow a strict protocol during the insertion of a central venous catheter to maintain sterility of the procedure and prevention of CLABSI. During the maintenance of the central line, healthcare professionals must follow infection control practices every time they assess the line or dressing change. Patients may show symptoms, red skin and soreness around the insertion site central line in case of CLABSI.[4]

Need of the study

According to the CDC's checklist, there are three main phases that need to be considered to prevent central line-associated bloodstream infection – insertion, maintenance and removal of the central line. Insertion of central line practice must be followed diligently, following hand hygiene using aseptic technique, following the maximal sterile barrier precautions, selecting the best insertion site, preparing the site of insertion with >0.5% chlorhexidine with alcohol and applying sterile gauze dressing over the insertion site. For the maintenance of the central line, proper handling complying to hand hygiene requirements is mandatory. Performing a routine dressing change with aseptic technique, replacing soiled dressing immediately, scrubbing the assess port thoroughly, bathing the patient with chlorhexidine preparation and properly changing of administration set for continuous infusion are other necessary steps in the prevention of infection. The need for a central line should be assessed continuously, and the unnecessary central line should be removed promptly.[5]

CLABSI is a very dangerous yet preventable infection. Nurses play an essential role in the proper maintenance of central lines, also in the prevention of CLABSI. Nursing personnel assesses the central line daily for medication administration, administration of parenteral nutrition and blood products, blood sample collection and haemodynamic monitoring. By implementing evidence-based practice into nursing care, the incidence of CLABSI can be reduced, and patient outcomes can be enhanced.[6]

A study conducted by Kadium reported that studies provided evidence of reducing CLABSI by improving nurses' knowledge. Some studies implement training modules to improve skills for health workers required for the prevention of CLABSI. Many reviewed literature provided evidence of the effect of educational and/or intervention programmes for intensive care unit (ICU) doctors and nurses on the theoretical knowledge to the prevention rate of CLABSI. The majority part of the studies suggests that educational intervention could improve nurses' knowledge to prevent CLABSI. While the CDC guidelines have been there, a very limited data are available for nurses to follow the guidelines effectively in their practice. It is also assumed that nurses working in critical care settings have a good knowledge on CASBI. However, there is a great need to explore nurse's knowledge, practice and attitude while caring for patients with the central line. Therefore, the current study was conducted to increase the knowledge of nurses to prevent central line-associated bloodstream infection.[7]

Objectives

  • To evaluate the level of knowledge regarding the prevention of CLABSI among staff nurses
  • To assess the effectiveness of educative intervention on knowledge regarding the prevention of CLABSI among staff nurses
  • To determine the association of the level of knowledge with selected demographic variables of staff nurses.


Hypothesis

H1 – There is a significant difference in the level of knowledge of staff nurses after the educational intervention.

H2 – There is a significant association between the level of knowledge of staff nurses and with selected demographic variables of staff nurses.


  Methods Top


An evaluative research approach and pre-experimental one-group pre-test–post-test design were adopted by the researcher to assess the effectiveness of the educative intervention on knowledge regarding the prevention of CLABSI among staff nurses. The study was conducted in a family hospital and research centre and a super speciality hospital in Kanpur. Nurses working in the ICU and haemodialysis unit were the population. The sample for the study was staff nurses working in the ICU and haemodialysis units in the selected hospitals in Kanpur. The sample size was determined by calculating the power of the study at 80% and alpha error probability of 5%. In this study, 60 participants were selected using non-probability purposive sampling technique. Nurses working in the ICU and the haemodialysis unit and were willing to participate in the study were included in the study.

Instruments

A structured knowledge questionnaire was developed by the investigator and validated by the experts.

Section A

It consists of demographic variables such as age, gender, educational status, years of experience and previously attended any training programme on the prevention of CLABSI.

Section B

It consists of a structured knowledge questionnaire containing 25 multiple choice questions including domains such as introduction and definition of CLABSI, risk factors, preventive measures before, during and after insertion of central line, treatment, diagnostic tests, CDC guidelines and bundle care. Every question had four options, with one correct option. Example – what are the non-modifiable risk factors of CLABSI? Or what are the pathogens associated with CLABSI?

A score '1' was given to correct answer and '0' was given for every wrong answer. The total score was 25.

The content validity was ensured by submitting each item to the experts of related fields. The pilot study was conducted on six samples having similar characteristics. The reliability of tool was calculated using the Karl Pearson's correlation coefficient formula, and r value was r = 0.81 (acceptable range is 0.7–1).

Data collection

The information booklet and video-assisted teaching were developed by a rough planning of the content regarding the prevention of CLABSI. A rough content of the information booklet and video-assisted teaching were shown to the guide for an expert opinion. The suggestions and recommendations were incorporated. The information booklet and video-assisted teaching content were then edited into the final shape by the researcher. After the preparation of the final information booklet and video-assisted teaching, it was used by the researcher to educate the staff nurses working in the ICU and haemodialysis units after their pre-test.

The data were collected from 30 March 2022 to 30 April 2022. Written ethical and hospital permission was obtained before data collection. A total of 60 participants were selected using purposive sampling method. A structured knowledge questionnaire was administered to the participants after pre-test knowledge regarding the prevention of CLABSI. The nurses participated in the study after their shift hours. After pre-test of 30 min, an educative intervention that includes video-assisted teaching and information booklet was given to the participants in group sessions. Seven days following the pre-test, a post-test was conducted with the same structured knowledge questionnaire to the same group of staff nurses to evaluate the effectiveness of the educative intervention on knowledge regarding the prevention of CLABSI.

Ethical consideration

Ethical permission was obtained from the Ethical Committee of the Faculty of Nursing, Rama University. The participants were explained the nature and purpose of the study. They were assured about the anonymity and confidentiality of the data obtained from them. Written informed consent was obtained from the participants.


  Results Top


In pre-test, 4 (6.7%) of the staff nurses had an inadequate knowledge, 54 (90%) of the staff nurses had a moderate knowledge and 2 (3.3%) of the staff nurses had an adequate knowledge. The data show that the proportion of nurses with an adequate knowledge increased from 3.3% to 60% in the post-test [Table 1].
Table 1: Frequency and percentage distribution of the pre- and post-test level of knowledge score among staff nurses working in the intensive care unit and haemodialysis unit

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The mean and standard deviation of pre-test knowledge score was 11 and 2.75, respectively, and for the post-test, 17 and 2.54, respectively. It can be clearly seen that the paired “t” value was 14.49 and P value was 0.001 at 0.05 level, which shows that educational intervention was very effective in increasing the knowledge regarding the prevention of CLABSI. H1, i.e., there is a significant difference between the level of knowledge of staff nurses after the intervention of educative intervention is accepted [Table 2].
Table 2: Pre- and post-test level of knowledge regarding the prevention of central line-associated bloodstream infection among the staff nurses working in the intensive care unit and haemodialysis unit (n=60)

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The association between pre-test knowledge score with selected demographic variables such as age, gender, previous knowledge and source of previous knowledge show non-significance [Table 3].
Table 3: Association between pre-test knowledge score with selected demographic variables

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  Discussion Top


The study findings revealed that among 60 staff nurses, 54 (90%) had a moderate knowledge, 4 (6.67%) had inadequate knowledge and 2 (3.33%) had adequate knowledge in pre-test, and 36 (60%) had adequate knowledge, 24 (40%) had a moderate knowledge and no one had inadequate knowledge in post-test. It was inferred that most of the staff nurses had inadequate knowledge in pre-test and most of the staff nurses had adequate knowledge in post-test.

A similar descriptive study was conducted by Nighat Gowhar in 2018 in a selected hospital of Srinagar (J and K). The researcher concluded that most of the study participants, i.e., 21 (70%) had an inadequate knowledge regarding CLABSI. The mean and standard deviation (SD) knowledge score was 12.93 and 4.25.[8] Another study in China was done among Eight hundred and thirty-five ICU nurses to assess their knowledge and practice regarding CLABSI. Eight hundred and thirty-five ICU nurses had participated in the study. Forty-three per cent of nurses were using maximum barrier precaution, 40% of nurses reported a prompt removal of central line and 14% of nurses never used 2% chlorhexidine. Researcher concluded that nurses had a lack of knowledge and practice for the prevention of CLABSI.[8]

The current study findings showed that the pre-test mean knowledge score was 11 with SD 2.75 and the post-test mean knowledge score was 17 with SD 2.54. Paired t-test applied to compare the pre-test and post-test mean knowledge score indicates that there is a statistically significant increase in post-test knowledge (P < 0.005). There was an enhancement of post-test knowledge score compared to pre-test knowledge on the prevention of CLABSI. The educational intervention was found to be much needed and effective.

A similar study was conducted to assess the effectiveness of the educational programme to prevent CLABSI in adult patients admitted to the ICU. Researcher found that the rate of CLABSI reduced and the quality of the care delivery was improved after the implementation of educational programme. The standard for central line utilisation ratio had decreased, and the documentation for the change in central line dressing increases by 32.9%. Nurses' knowledge was also increased by 7.8% regarding CLABSI. The study concluded that educational programme results in a positive outcome in relation to increase the knowledge level of nurses, central line indication and central line care policy.[9]

There was no statistically significant association of the pre-test knowledge scores of the participants with their selected sociodemographic variables such as age, gender, educational status, year of experience and previously attended any teaching programme on CLABSI in this study. While one study found a significant association between knowledge and sex, educational level, hospital grade, duration of shift, professional title and incidence of CLABSI.[9] Another study reported no association between the knowledge score and selected demographic variables (age, gender, educational qualification, years of experience in ICU and in-service education attended).[8]

Limitations

Small sample without a control group becomes a limitation of the study as it prevents generalisability. Practice, which is an important part of the application of knowledge, was not assessed.


  Conclusion Top


Educative intervention was effective in improving the knowledge of staff nurses regarding the prevention of CLABSI. Ongoing teaching and demonstration regarding the prevention of CLABSI is mandatory in high-use clinical areas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Atilla A, Doğanay Z, Kefeli Çelik H, Demirağ MD, S Kiliç S. Central line-associated blood stream infections: Characteristics and risk factors for mortality over a 5.5-year period. Turk J Med Sci 2017;47:646-52.  Back to cited text no. 1
    
2.
Wright MO, Decker SG, Allen-Bridson K, Hebden JN, Leaptrot D. Healthcare-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: Location mapping. Am J Infect Control 2018;46:577-8.  Back to cited text no. 2
    
3.
Weinstein RA. Prevention of Central Line-Associated Bloodstream Infections in Hospitalized Patients: Introduction; 2010. Available from: http://www.medscape.org/viewarticle/705882_2. [Last accessed on 2020 Apr 08].  Back to cited text no. 3
    
4.
Bell T, O'Grady NP. Prevention of central line-associated bloodstream infections. Infect Dis Clin North Am 2017;31:551-9.  Back to cited text no. 4
    
5.
Centers for Disease Control and Prevention. Checklist for Prevention of Central Line Associated Blood Stream Infections; 2011. Available from: https://www.cdc.gov/hai/pdfs/bsi/checklist-for-CLABSI.pdf. [Last accessed on 2020 Apr 08].  Back to cited text no. 5
    
6.
Al-Somali FO, Abu-Salem L, Al-Afghani S. Assessment of nurses' adherence to the centers for disease control and prevention (CDC) guidelines regarding central line care for children with cancer. J Educ Pract 2014;5:112-9.  Back to cited text no. 6
    
7.
Kadium MJ. Improving Nurses'Knowledge to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Unit. Published Doctoral of Nursing Practice, Walden University, College of Health Sciences; 2015. p. 5-23.  Back to cited text no. 7
    
8.
Gowhar N. A descriptive study to assess the knowledge of staff nurses regarding central line associated blood stream infections (CLABSI) with a view to develop information booklet on prevention of (CLABSI) in selected hospital of Srinagar (J&K). Int J Med Sci Diagn Res 2018;2:63-70.  Back to cited text no. 8
    
9.
Chi X, Guo J, Niu X, He R, Wu L, Xu H. Prevention of central line-associated bloodstream infections: A survey of ICU nurses' knowledge and practice in China. Antimicrob Resist Infect Control 2020;9:186.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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