Adherence to guidelines and central-line-associated bloodstream infection occurrence during insertion and maintenance of intravascular catheters: evidence from 20 tertiary hospitals

F Zang; J Liu; Y Wen; X Jin; Y Yang; L Li; J Di; H Tang; J Wu; J Liu; H Liu; J Huang; J Zhang; S Li; L Yang; X Wang; S Geng; H Xing; J Xie; J Hua; X Xue; Y Zhao; L Ouyang; P Song; G Zhuang; W Chen

doi:10.1016/j.jhin.2024.05.011

Adherence to guidelines and central-line-associated bloodstream infection occurrence during insertion and maintenance of intravascular catheters: evidence from 20 tertiary hospitals

J Hosp Infect. 2024 Aug:150:17-25. doi: 10.1016/j.jhin.2024.05.011. Epub 2024 Jun 3.

Authors

F Zang¹, J Liu¹, Y Wen¹, X Jin¹, Y Yang¹, L Li², J Di³, H Tang⁴, J Wu⁵, J Liu⁶, H Liu⁷, J Huang⁸, J Zhang⁹, S Li¹⁰, L Yang¹¹, X Wang¹², S Geng¹³, H Xing¹⁴, J Xie¹⁵, J Hua¹⁶, X Xue¹⁷, Y Zhao¹⁸, L Ouyang¹⁹, P Song²⁰, G Zhuang²¹, W Chen²²

Affiliations

¹ Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
² Department of Infection Management, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
³ Department of Infection Management, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
⁴ Department of Infection Management, Qidong People's Hospital, Nantong, Jiangsu, China.
⁵ Department of Infection Management, Suqian First People's Hospital, Suqian, Jiangsu, China.
⁶ Department of Infection Management, Lianyungang First People's Hospital, Lianyungang, Jiangsu, China.
⁷ Department of Infection Management, Wuxi Second People's Hospital, Wuxi, Jiangsu, China.
⁸ Department of Infection Management, Taizhou People's Hospital, Taizhou, Jiangsu, China.
⁹ Department of Infection Management, Suzhou Municipal Hospital, Suzhou, Jiangsu, China.
¹⁰ Department of Infection Management, Huaian First People's Hospital, Huaian, Jiangsu, China.
¹¹ Department of Infection Management, Changzhou Second People's Hospital, Changzhou, Jiangsu, China.
¹² Department of Infection Management, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu, China.
¹³ Department of Infection Management, Nantong First People's Hospital, Nantong, Jiangsu, China.
¹⁴ Department of Infection Management, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
¹⁵ Department of Infection Management, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China.
¹⁶ Department of Infection Management, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.
¹⁷ Department of Infection Management, Yancheng First People's Hospital, Yancheng, Jiangsu, China.
¹⁸ Department of Infection Management, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China.
¹⁹ Department of Infection Management, Xuzhou First People's Hospital, Xuzhou, Jiangsu, China.
²⁰ Department of Infection Management, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
²¹ Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiao tong University Health Science Center, Xi'an, Shaanxi, China.
²² Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiao tong University Health Science Center, Xi'an, Shaanxi, China. Electronic address: [email protected].

PMID: 38838743
DOI: 10.1016/j.jhin.2024.05.011

Abstract

Objective: To investigate adherence to intravascular catheter (IVC) insertion and maintenance guidelines in Chinese tertiary hospitals.

Methods: A cross-sectional questionnaire survey of adult inpatients with IVC placements was conducted from July to September 2022 in 20 tertiary hospitals in China. One clinical staff member from each department in each hospital was assigned to participate in the survey. Questionnaires were uniformly collected and reviewed after three months.

Results: This study included 1815 cases (62.69%) of central venous catheter, 471 cases (16.27%) of peripherally inserted central catheter, 461 cases (15.92%) of PORT, and 147 cases (5.08%) of haemodialysis catheter insertions. Statistically significant differences in compliance were observed across the four IVC types, specifically in relation to the insertion checklist, standard operating procedure, and insertion environment (P<0.05). Practice adherence during IVC maintenance differed significantly across the four IVC types in aspects such as availability of IVC maintenance verification forms, daily scrubbing of the catheterized patients, and catheter connection methods (P<0.05). A total of 386 (13.34%) patients developed fever, 1086 (37.53%) were treated with therapeutic antibiotics, 16 (0.55%) developed central-line-associated bloodstream infections, two (0.07%) developed local skin infections, and six (0.21%) developed deep vein thrombosis.

Conclusions: Adherence to guidelines regarding insertion and maintenance differed across the four IVC types; there is a gap between the recommended measures and the actual operation of the guidelines. Therefore, it is necessary to further enhance training and develop checklists to prevent central-line-associated bloodstream infections.

Keywords: Adherence; Central line-associated bloodstream infections; Intravascular catheters.

MeSH terms

Adult
Aged
Aged, 80 and over
Catheter-Related Infections* / epidemiology
Catheter-Related Infections* / prevention & control
Catheterization, Central Venous / adverse effects
Central Venous Catheters / adverse effects
China / epidemiology
Cross-Sectional Studies
Female
Guideline Adherence* / statistics & numerical data
Humans
Male
Middle Aged
Sepsis / etiology
Sepsis / prevention & control
Surveys and Questionnaires
Tertiary Care Centers*
Young Adult