Good practices in central venous catheter maintenance in time of covid-19: an observational study.
Taís Oliveira Dias, Luciana Guimarães Assad, Vanessa Galdino de Paula and 3 others
PMID 36197429WHAT IT FOUND
In a COVID ICU, nurses, residents and technicians followed 57.4% of observed central-line maintenance procedures.
Hand hygiene was correct in 8% of observations; PPE use was 94%.
Key findings
01Of 700 observed procedures, 402 (57.4%) met the adherence definition and 298 (42.6%) did not.
02Hand hygiene adherence was 8%, scrub-the-hub adherence was 46%, and PPE use was 94%.
03Records were weak: connector replacement was recorded in 0% of observations, equipment change in 38%, phlogistic signs in 64%, and dressing changes in 72%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was conducted in one adult ICU in Rio de Janeiro during early pandemic reorganisation, so it may not represent other units or later practice. Procedures were selected by convenience, not random sampling, and the observation form was developed for the study and not validated. The study measured staff adherence to maintenance steps, not whether patients developed catheter-related bloodstream infections or other outcomes. The observer was part of the team, which may have influenced behaviour despite efforts to reduce that effect. Pandemic conditions, including PPE, prone positioning and restricted paper records, may have made some steps harder and affected adherence.
The easy way to misread this
Do not read the 94% PPE adherence as evidence that central-line care was safe. The study observed staff practices and did not measure bloodstream infections, and hand hygiene was correct in only 8% of observations.