NEED FOR STUDY:

Intravascular devices are essential in the care of critically-ill patients. Approximately 150 million vascular catheters are sold in the United States every year. Of these 5 million are central venous catheters (CVCs).

These can lead to mechanical, thrombotic or infectious complications. Center for Disease Control and Prevention (CDC) and National Nosocomial Infection Surveillance system(NNIS)data estimates 3-8% catheter lead to blood stream infections(CRBSI). Empiric evidence suggests more than 50% of these infections are preventable. AJCC (2007)

Central venous catheters (CVCs) are being used increasingly in inpatient and outpatient settings to provide long-term venous access. CVCs disrupt skin integrity making infections possible. Infection may spread to the bloodstream and hemodynamic changes and organ dysfunction (severe sepsis) may results, possibly leading to death. (Mark. E, Rupp and Rita, 2004)

Infection control Hospital Epidemol (2003) reported that central line-associated bloodstream infections are considered to be an avoidable complication of health care delivery. Central line-associated bloodstream infections carry an attributable morality between 12% and 25%. The estimated cost per infection is approximately 25,000 US dollars. Research over the last decade has focused on a number of care activities that have been shown to reduce the incidence of bloodstream infections related to central line placement in the critically ill patient.

Central venous catheters (CVCs) are widely used in critically ill patients throughout the developed world. Approximately 5 million CVCs are used in the United States each year. Each year in the United States, approximately 80,000 CVC-associated bloodstream infections (BSIs) occur in patients in ICUs and up to 250,000 occur throughout the health care system. Increased use of CVC over the past 20 years has been associated with at least a doubling of resultant CVC-associated bacteremias. (Mark E, Rupp and Rita, 2004)

Nosocomial infections surveillance system summary (2004) reported that in the world CVC-associated BSI rates ranging from 2.7/1000 to 7.4/1000 central-line-days in ICUs and 3.5/1000 to 9.1/1000 central-line-days in high-risk nurseries

A retrospective study stated that patients with CVC are at risk of catheter-related blood stream infections or central line associated bacteraemia (CLAB) which can be fatal. The site for central venous catheter insertion is intrajugular, femoral and subclavian and methods and techniques used during CVC insertion by medical staff and management by nurses are critically important to preventing CLAB. (O’grady et. al., 2002)

Patients with a central venous catheter (CVC) are more prone to get infection. The incidence of BSI (blood stream infections) among patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.(Grothe C

, Silva Belasco AG and Bittencourt AR, 2009)

Central venous catheters are frequently used in intensive care and they are the main sources for infection. Healthcare-associated infections are a significant problem and 15-25 percent of healthcare-associated bloodstream infections may be linked to a central venous catheter. This infection is referred to as central line associated bacteremia (CLAB) (NSWH,2005).

Center for disease control and prevention (2007) reported that during the period of 1997 to 2007, 1687 ICU reported 33587 central line associated blood stream infections of which 7.4 percentage were MRSA and 4.7 percentage MSSA. Central line associated blood stream infections due to MRSA is increased 25.8 percentage from 1997 to 2007.

Escort heart institute and research center New Delhi, India (2005) stated that out of 1314 cardiac patients were admitted in ICU,35 percentage had central venous catheter associated blood stream infections (CVC BSI ) and mortality rate in CVC-BSI was 2.9 percentage.

Verghese SL, Padmaja P, Koshi G, Madras Medical Mission hospital (2003) reported that a semi quantitative method of culture of central venous catheters (CVC) were done from January to December 2003, total of 119 catheter tips sent to the microbiology department were cultured and 11 (9.24%) showed significant growth with associated blood stream infection which include klebsiella species, enterobacter species, E. coli species, Serratia and non-fermenting Gram negative bacilli.

Infections associated with central venous catheters account for 10% to 20% of all nosocomial infections. The mean rate of CVC-related bloodstream infection in the intensive care unit (ICU) is 5.3 per 1000 catheter days. From 10% to 70% of all CVC-related infections are preventable. (Patte .R, Drouvot. V, Quenon.J, 2008)

Central venous Catheter related complication range from local exist site or tunnel infection to frank bacteremias and it include infections, hemorrhage thrombosis and pain. The skin is the main source of infection causing CVC-BSI. Nosocomial bloodstream infections (BSI) are an important cause of morbidity and mortality in severely ill patients, and a significant proportion of these infections are associated with the presence of central venous catheters (Langley et.al. 2005)

Nursing management of a central venous catheter is complex and includes: 1) catheter site care such as dressings; 2) line changes; 3) daily assessment; and 4) prevention of error. 5) Frequency of line changes; 6) The most effective solutions/antiseptics for cleaning lines and ports; 7) Dressing techniques in terms of type, frequency and method of dressing; and 8. Competencies required by nursing staff. Lack of adherence to recommended evidence-based guide-lines for preventing infections associated with use of central venous catheters may be due to nurse’s lack of knowledge of the guidelines. (Pawan Kapoor, Jitendra Sharma, 2006)

A study reveals that central venous catheter-related infections are a major problem in healthcare and up-to-date guidance of evidence-based recommendations for the prevention of intravascular catheter-related infections with special focus on strategies relevant for nurses working in emergency and critical care environments responsible for control of infections. (Vandijck DM.et.al., 2007)

A study to determine European intensive care unit (ICU) nurses' knowledge of guidelines for preventing central venous catheter-related infection and reported that to optimize knowledge of central venous catheter-related infection and prevention among European ICU nurses and recommendations include central venous catheter-related infection prevention guidelines in educational curricula and continuing refresher education programs. (Labeau S.O

, et.al. 2008)

A study aimed to investigate nurses' knowledge and practice of central venous access infection control among patients in the Republic of Ireland and reported that 92% of them had been developed policies by their units and 47% had received infection control education in the previous year. Knowledge and adherence to best practice demonstrated significant scope for improvement. (Higgins M, Evans DS, 2003)

A significant reduction or elimination of central line-associated bloodstream infections can occur with implementation of a comprehensive central line-associated bloodstream infection prevention program that includes staff education, hand hygiene, use of maximal sterile barrier precautions and focuses on strategies for implementing a comprehensive central line-associated bloodstream infections prevention program (Critical Care Med.2002 )

1000 device-days. (Toki M. Tsuchida T, Makimoto K.2005)

During the clinical experience, the investigator observed that staff nurses those who are working in ICU are not having enough knowledge regarding central venous catheter related blood stream infections and its preventions. Hence the investigator felt that the video assisted teaching module will be effective to improve their knowledge regarding central venous catheter related blood stream infections and its prevention.

OBJECTIVES:

1) To assess the,

a) Knowledge of staff nurses regarding central venous catheter related blood stream infections and its prevention before the implementation of video assisted teaching module

b) Effectiveness of video assisted teaching module on knowledge of staff nurses regarding central venous catheter related blood stream infections and its prevention.

2) To find out the association between the posttest knowledge scores of staff nurses regarding central venous catheter related blood stream infections and its prevention with selected demographic variables .

MATERIALS AND METHODS:

Research Design and approach

A quasi – experimental design, where pre and post test without control group and experimental approach was used

O₁------ X------O₂

O₂ − O₁ = E

The symbols used are explained as follows

O₁- Pretest = Assessment of knowledge on central venous catheter related blood stream infections and its prevention among staff nurses before implementation of video assisted teaching module.

X–Treatment = Presentation of video assisted teaching module regarding central venous catheter related blood stream infections and its prevention to staff nurses.

O₂– Post test = Assessment of knowledge on central venous catheter related blood stream infections and its prevention among staff nurses after implementation of video assisted teaching module

E = Effectiveness of video assisted teaching module.

SETTING OF THE STUDY:

The study was conducted in Vinayaka Missions hospital Salem which is located at Chinnaseeragapadi, about 12km away from Salem town. Vinayaka Missions hospital is a 410 bedded multi specialty hospital with different type of ICUs .

SAMPLE AND SAMPLING TECHNIQUE:

Staff nurses working in ICUs, Vinayaka Missions hospital, Salem, were the sample for the present study ,The sample size was 50 staff nurses. Purposive sampling indicates selection by choice, not by chance. In purposive sampling a sample is chosen which is thought to be typical of the universe with regard to the characteristics under investigation.

PLANED DATA ANALYSIS:

The collected data were organized, tabulated and analyzed by using descriptive statistics i.e. percentage, mean and standard deviation and inferential statistics i.e. Chi-square test and paired ‘t’ test. The paired ‘t’ test was used to find out the difference in knowledge between pre and post test. The chi- square test was used to test the association between demographic variables of staff nurses with their post test knowledge scores.

RESULTS:

Majority of the staff nurses in the age group of 21-25 years (82%), 78% were female and 22% were males, 80% of staff nurses had B.Sc nursing degree and 20% had diploma in nursing Pre and posttest level of knowledge of of staff nurses regarding central venous catheter related blood stream infection and its prevention shows that pretest 22% of staff nurses had poor knowledge, whereas 52% had average knowledge. Further, during posttest 68% of staff nurses had good knowledge, whereas only 32% had excellent knowledge.

In pretest, the mean score was 19.5(S.D=4.71) and in post test it was mean score 29.6(S.D=3.21) which indicated an improvement in the knowledge level of staff nurses after the implementation of video assisted teaching module Paired ‘t’ value was computed to evaluate the effectiveness of assisted teaching module on central venous catheter related blood stream infections and its prevention. The obtained value was 16.17, which was highly significant at p<0.001 level indicating the effectiveness of video assisted teaching module

Chi-sqaure value was computed to determine the association between post test knowledge score of the respondents with selected variables such as gender,age, education ,etc

From the findings, it can be concluded that highest percentage (82%) of them were in the age group of 21-25 years, were females (78%) were having B.Sc. nursing degree (80%). Highest percentage were having less than 1 years of experience (52%)and department of working 28% were working in surgical intensive care units; 24% were working in medical intensive care units; whereas 26% were working in intensive coronary care unit and 22% were working in cardio thoracic intensive care units and did not attend in-service program (82%).

Prior to implementation of video assisted teaching module the staff nurses’ average knowledge whereas, after implementation of video assisted teaching module the staff nurses had good knowledge with the difference of 24% revealing effectiveness of video assisted teaching module.

DISCUSSION:

Highly significant difference found between the pretest and posttest knowledge scores (P<0.01) but no significant association was found between the posttest knowledge scores when compared with the demographic variables of staff nurses (P<0.05).

DELIMITATIONS:

The study is limited to staff nurses who will be,

Ø of both sexes

Ø willing to participate in the study.

Ø present during the period of data collection.

Ø completed any one of the basic nursing programme

RECOMMENDATIONS:

· A large scale study can be done for replication to standardize the video assisted teaching module on central venous catheter related blood stream infection and its prevention

· A comparative study can be carried out to generalize the finding

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Received on 07.02.2013 Modified on 10.03.2013

Asian J. Nur. Edu. and Research 3(2): April.-June 2013; Page 61-65