Compliance with a central line-associated blood stream infection bundle in neonatal intensive care units in Greece

Triantafyllou Ch., Kouni S., Chorianopoulou E., Kourlaba G., Gouvias Th., Grivea I., Iosifidis E., Kapetanaki A., Karavana G., Karakopoulou M., Koropouli M., Lithoxopoulou M., Triantafyllidou P., Tsintoni A., Zaoutis ET.  

4th PNAE Congress on Paediatric Nursing
Athens, Greece, 1 & 2 June, 2018

Introduction:  High CLABSI rates are noticed in Greek NICUs, thus there is a great need for intervention. The aim of this study is to describe the rates of compliance with evidencebased practices for insertion and maintenance of central lines (CL) using checklists in 10 NICUs in Greece.

Methods:  Validated CL insertion and maintenance checklists, based on the standard checklist of CDC for prevention of CLABSIs, were completed by nursing and medical staff of NICUs on a random day every week from March to December 2017 at each participating NICU as part of an intervention to reduce CLABSIs. Ten of 17 public NICUs throughout Greece participated in the study. Pooled rates of overall and step-specific compliance were calculated.

Results:  A total number of 287 observations for CL insertion and 786 CL maintenance checklists were completed. Overall compliance with insertion and maintenance checklists was 40.7% and 77.3% respectively. Hand hygiene compliance (HH) was 96.3% and rate of proper skin preparation was 88.2%. Moreover, compliance with the use of maximum sterile barrier precautions was 64.8% and the maintenance of aseptic technique during the insertion process was 92.5%. Concerning the maintenance of CL, the compliance with HH was 98.5% and the disinfection of catheter hubs rate was 79.6%. Furthermore, none of 10 and only 3 of 10 NICUs present ≥95% compliance with all preventive practices at the insertion and maintenance of CL respectively. Finally, compliance with daily assessment of CL necessity was 48.1%.

Conclusions:  This is the first study to examine adherence to insertion and maintenance bundles and use of checklists for CLABSI prevention at national level. The compliance rates of the CLABSI bundle are low and interventions should focus on identifying barriers to adherence.