Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital

Mukiri Jocyline; Inyama Hannah; Maina Dorcas Waithira

doi:doi:10.11648/j.ajns.20180701.11

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Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital

Mukiri Jocyline, Inyama Hannah, Maina Dorcas Waithira

Published in American Journal of Nursing Science (Volume 7, Issue 1)

Received: 27 October 2017 Accepted: 7 December 2017 Published: 5 January 2018

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Abstract

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.

Published in	American Journal of Nursing Science (Volume 7, Issue 1)
DOI	10.11648/j.ajns.20180701.11
Page(s)	1-13
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Central Line Associated Bloodstream Infection (CLABSI), Prevalence, Predictors, Critical Care Units (CCUs), Kenyatta National Hospital (KNH), Critical Care Nurses (CCNs)

References

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[5]	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.
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[8]	World Health Organization (2009). WHO Guidelines on Hand Hygiene in Health Care.
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[10]	The Joint Commission (2012). Preventing Central Line–Associated Bloodstream Infections: A Global Challenge, a Global Perspective. Oak Brook, Illinois.
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[13]	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.
[14]	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.
[15]	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.
[16]	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.
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APA Style

Mukiri Jocyline, Inyama Hannah, Maina Dorcas Waithira. (2018). 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, 7(1), 1-13. https://doi.org/10.11648/j.ajns.20180701.11

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ACS Style

Mukiri Jocyline; Inyama Hannah; Maina Dorcas Waithira. Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital. Am. J. Nurs. Sci. 2018, 7(1), 1-13. doi: 10.11648/j.ajns.20180701.11

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AMA Style

Mukiri Jocyline, Inyama Hannah, Maina Dorcas Waithira. Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital. Am J Nurs Sci. 2018;7(1):1-13. doi: 10.11648/j.ajns.20180701.11

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@article{10.11648/j.ajns.20180701.11,
  author = {Mukiri Jocyline and Inyama Hannah and Maina Dorcas Waithira},
  title = {Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital},
  journal = {American Journal of Nursing Science},
  volume = {7},
  number = {1},
  pages = {1-13},
  doi = {10.11648/j.ajns.20180701.11},
  url = {https://doi.org/10.11648/j.ajns.20180701.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20180701.11},
  abstract = {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; P2 (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.},
 year = {2018}
}

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TY  - JOUR
T1  - Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital
AU  - Mukiri Jocyline
AU  - Inyama Hannah
AU  - Maina Dorcas Waithira
Y1  - 2018/01/05
PY  - 2018
N1  - https://doi.org/10.11648/j.ajns.20180701.11
DO  - 10.11648/j.ajns.20180701.11
T2  - American Journal of Nursing Science
JF  - American Journal of Nursing Science
JO  - American Journal of Nursing Science
SP  - 1
EP  - 13
PB  - Science Publishing Group
SN  - 2328-5753
UR  - https://doi.org/10.11648/j.ajns.20180701.11
AB  - 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; P2 (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.
VL  - 7
IS  - 1
ER  -

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Author Information

Mukiri Jocyline

School of Nursing Sciences, University of Nairobi, 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

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APA Style

Mukiri Jocyline, Inyama Hannah, Maina Dorcas Waithira. (2018). 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, 7(1), 1-13. https://doi.org/10.11648/j.ajns.20180701.11

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ACS Style

Mukiri Jocyline; Inyama Hannah; Maina Dorcas Waithira. Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital. Am. J. Nurs. Sci. 2018, 7(1), 1-13. doi: 10.11648/j.ajns.20180701.11

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AMA Style

Mukiri Jocyline, Inyama Hannah, Maina Dorcas Waithira. Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital. Am J Nurs Sci. 2018;7(1):1-13. doi: 10.11648/j.ajns.20180701.11

Copy | Download

@article{10.11648/j.ajns.20180701.11,
  author = {Mukiri Jocyline and Inyama Hannah and Maina Dorcas Waithira},
  title = {Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital},
  journal = {American Journal of Nursing Science},
  volume = {7},
  number = {1},
  pages = {1-13},
  doi = {10.11648/j.ajns.20180701.11},
  url = {https://doi.org/10.11648/j.ajns.20180701.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20180701.11},
  abstract = {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; P2 (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.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - Predictors and Prevalence of Central Line Associated Blood Stream Infections Among Adult Patients in Critical Care Units -Kenyatta National Hospital
AU  - Mukiri Jocyline
AU  - Inyama Hannah
AU  - Maina Dorcas Waithira
Y1  - 2018/01/05
PY  - 2018
N1  - https://doi.org/10.11648/j.ajns.20180701.11
DO  - 10.11648/j.ajns.20180701.11
T2  - American Journal of Nursing Science
JF  - American Journal of Nursing Science
JO  - American Journal of Nursing Science
SP  - 1
EP  - 13
PB  - Science Publishing Group
SN  - 2328-5753
UR  - https://doi.org/10.11648/j.ajns.20180701.11
AB  - 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; P2 (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.
VL  - 7
IS  - 1
ER  -

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