The practice of arterial catheters in ICUs and nurses’ perceptions of infection prevention: A multicentre cross-sectional study

Abstract

Background: Peripheral arterial catheters (AC) are increasingly used in intensive care units (ICUs). Arterial catheter-related bloodstream infection is a serious complication that can increase patients’ morbidity and length of stay. Standardised infection prevention practices are important when using AC. However, the current practices regarding AC insertion, use and removal and the perceived infection prevention attitudes of nurses in ICUs are unknown. Methods: This was a multicentre cross-sectional study; 20 tertiary general hospitals were selected with a stratified random method in Beijing, China, using a self-reported internet survey. Results: A total of 981 valid questionnaires were collected. Overall, some infection prevention practices, such as AC insertion and disinfection of the blood sample hub, were generally consistent with clinical guidelines, whereas others were inconsistent: eye protection, skin antiseptic solution, dressing choice, blood sample collection and replacement of AC. More than 60% of participants mentioned occasionally or never having used eye protection. Only 6.0% of them stated using the chlorhexidine dressings. Among the participants, 80.6% reported that they replaced AC routinely rather than based on clinical indications, 64.2% self-rated that they did not routinely culture a catheter specimen after removal and 53.4% of participants positively agreed that AC could cause infection. Nurses with a higher education level were more likely to agree that an infection risk with AC exists (trend χ2 = 5.456, p = 0.019*). Conclusions: Significant heterogeneity exists across hospitals in China in terms of antiseptic techniques and perception of infection prevention during AC insertion, use and removal. Critical care nurses’ practices partially complied with guideline recommendations. Educational level was found to be a risk factor for their perceived infection prevention attitudes. Nurses with a lower education level underestimated the infection risk of AC. Future research may examine optimal preventive strategies for reducing infection.