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. 2025 Jul 23:14:e74985.
doi: 10.2196/74985.

Epidemiology and Impact of Staff Training in Controlling Complications Related to Central Venous Catheters in 4 Intensive Care Units in a French University Hospital: Protocol of a Prospective, Quasi-Experimental, Before-After Study

Nagham Khanafer  1   2 , Anne-Claire Lukaszewicz  3 , Elisabetta Kuczewski  1 , Laurent Argaud  4 , Philippe Vanhems  1   2
Affiliations

Epidemiology and Impact of Staff Training in Controlling Complications Related to Central Venous Catheters in 4 Intensive Care Units in a French University Hospital: Protocol of a Prospective, Quasi-Experimental, Before-After Study

Nagham Khanafer et al. JMIR Res Protoc. .

Abstract

Background: Central venous catheters (CVCs) are essential tools in the management of critically ill patients in intensive care units (ICUs). However, their use is associated with several preventable complications, including central line-associated bloodstream infections (CLABSIs), catheter-related thrombosis, and mechanical events (eg, occlusion and rupture). Despite the availability of evidence-based guidelines from the French Society of Hospital Hygiene for CVC insertion and maintenance, adherence variability persists across health care settings, contributing to prolonged hospitalization, increased morbidity and mortality, and even increased health care costs. In 2022, an audit conducted at Edouard Herriot Hospital (Hospices Civils de Lyon, Lyon, France) revealed a degree of variation in adherence to current protocols. Specific deficits were noted in practices such as hand hygiene, flushing procedures, and aseptic techniques, among others.

Objective: This study aims to (1) evaluate the effectiveness of a multifaceted educational intervention in improving health care workers' adherence to national CVC management guidelines; (2) assess changes in complication rates (CLABSIs, thrombosis, and mechanical events) and patient outcomes (readmissions and mortality); and (3) identify factors associated with CVC-related complications through multivariate analysis.

Methods: We are conducting a prospective, quasi-experimental, before-after study in 4 adult ICUs at a French university hospital. The protocol includes preintervention and postintervention audits using a digital tool to capture real-time compliance data, as well as standardized educational sessions based on French Society of Hospital Hygiene recommendations. The intervention consists of face-to-face training, posters, and digital reminders, all delivered by the same team to ensure consistency. Clinical data include demographics, comorbidities, CVC type and duration of use, administered medications, and complications. All patients with CVCs, including centrally inserted catheters (jugular or subclavian), femoral lines, and peripherally inserted central catheters, are eligible. The primary outcome is the incidence rate of CVC-related complications per 1000 catheter-days. Secondary outcomes include rates of hospital readmission, ICU and in-hospital mortality, and the degree of improvement in guideline adherence across participating units.

Results: As of submission, 640 patients have been included in the study. Data collection remains ongoing. Data entry and final statistical analyses are expected to be completed in the third quarter of 2025.

Conclusions: By combining audits, education, and feedback, this study will provide key insights into the effectiveness of education-based interventions for improving CVC-related practices in critical care settings. It may serve as a scalable model for enhancing patient safety and care quality in ICU settings. Results will be disseminated through peer-reviewed publications and international conferences.

International registered report identifier (irrid): DERR1-10.2196/74985.

Keywords: audit; central venous catheter; complications; education; guidelines; practices; training.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Study design of a prospective before-after study conducted in the 4 intensive care units of Edouard Herriot Hospital, Lyon, France. Audits were performed using Becton Dickinson Signature Solutions. The intervention was an educational program. The second audit was completed after a washout period of 2-3 months following the last session of the educational intervention. The follow-up was 30 days per central venous catheter to track complications (eg, central line–associated bloodstream infections, catheter-related thrombosis, mechanical damage, readmission for central venous catheter–related complications, and related death).
Figure 2
Figure 2
Structure of the observation framework used in the study. The audit tool followed the guidelines set by the French Society of Hospital Hygiene. CVC: central venous catheter; HCW: health care worker.
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