Insertion of central vascular catheter: adherence to infection prevention bundle

ABSTRACT Objective: To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. Method: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. Results: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. Conclusion: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.摘要 研究目的：评估血液透析患者中心血管导管（central vascular catheter, CVC）置管护理流程的依从性。 研究方法：本研究采用横断面定量研究设计，实施地点为巴西塞尔希培州一所转诊医院的血液透析科室。研究样本包含1342项被评估的操作，对应122份中心血管导管置管监测与控制表单。数据采集工作于2016年7月至12月开展。 研究结果：置管表单的使用依从率为54.9%。本次评估的操作整体依从率达93%。在11项被观察的特定操作中，7项（占比64%）的依从率为100%。每1000患者日的原发性血流感染（primary bloodstream infections）总发病密度从10.6例降至3.1例。 研究结论：尽管观察到的操作达到了特定的预期依从性，但核查表（checklist）的实际使用率低于预期。监测、督导以及教育与组织类策略可助力实现安全护理。