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. 2021 Mar;49(3):345-351.
doi: 10.1016/j.ajic.2020.08.019. Epub 2020 Aug 18.

Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit

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Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit

Charlotte Z Woods-Hill et al. Am J Infect Control. 2021 Mar.

Abstract

Objective: Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. We explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses.

Methods: Single-center cross-sectional electronic survey of PICU bedside nurses in an academic tertiary care center; using the COM-B (capability, opportunity, motivation) and TDF (theoretical domains framework) behavioral models to explore CLABSI bundle performance and identify barriers to compliance.

Results: We analyzed 160 completed surveys from 226 nurses (71% response rate). CLABSI knowledge was strong (capability). However, challenges related to opportunity were identified: 71% reported that patient care requirements impact bundle completion; 32% described the bundle as stressful; and CLABSI was viewed as the most difficult of all bundles. Seventy-five percent reported being highly impacted by physician attitude toward the CLABSI bundle (motivation).

Conclusions: PICU nurses are knowledgeable and motivated to prevent CLABSI, but face challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle. Interventions that address these challenges may improve bundle performance and prevent CLABSI in critically ill children.

Keywords: Bacteremia; Behavioral science; Central-line associated bloodstream infection; Hospital-acquired infection; Infection prevention.

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Conflict of interest statement

Financial Disclosure and Conflicts Statement: Dr. Beidas receives royalties from Oxford University Press and has provided consultation to Merck and Camden Coalition of Healthcare Providers. The authors have no other financial relationships or conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. The Capability, Opportunity, Motivation Behavioral Model (COM-B) (A) and the Behavior Change Wheel (B).
Adapted from: Michie S, van Stralen MM, West R. The behavior change wheel: a new method for characterizing and designing behavior change interventions. Implementation Science: IS. 2011; 6;42.
Figure 2.
Figure 2.. Proposed COM-B Model for CLABSI
Adapted from: Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, “Psychological Theory” Group. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 14(1):26-33, 2005; and Michie S. The Behaviour Change Wheel, Theoretical Domains Framework, Behaviour Change Techniques. KT Terminology Meeting. 2012, Ottawa, Canada: Conference proceedings
Figure 3.
Figure 3.
Results of survey questions about A) Capability, B) Opportunity, and C) Motivation

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