الفهرس 
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Abstract
Central venous catheters (CVCs) are integral to the care of adult patients in Intensive Care Units (ICUs). CVCs provide vascular access for the administration of fluids, medications, total parenteral nutrition (TPN), blood products, and for hemodynamic monitoring and blood sampling. Central venous catheter (CVC), peripherally inserted central catheter (PICC) and implanted port are types of central venous access devices (Kim, Holtom, &Vigen, 2011).
Critical care nurses play a vital role in the care of critically ill patients, since they spend more time beside the patient. Nurses’ role related to the catheter include preparing the patient before the procedures, changing the dressing, monitoring the flow rate, administering the medications and total parental nutrition through catheter, and preventing the complications (Ali, 2010).
Like any invasive therapeutic devices, central venous access devices offer risks as well as benefits. the most common risk associated with CVCs is central line-associated blood stream infections (CLABSIs) caused by microorganisms colonizing the external surface of the device or the fluid pathway when the device is inserted, or in the course of its use. According to the IHI (2012), approximately 90% of all CLABSIs occur due to CVC use, resulting in increased lengths of stay, increased costs, and higher mortality rates (Institute for Health care Improvement [IHI], 2012).
The Centers for Disease Control and Prevention emphasize the major areas for prevention of CVC-RI, which include educating and training health care workers who insert and maintain CVCs. These areas include the following: using maximal sterile barrier precautions during CVC insertion, using a 2% chlorhexidine skin preparation with alcohol for antisepsis, avoiding routine replacement of CVCs as a strategy to prevent infection, and using chlorhexidine-impregnated sponge dressings (Centers for Disease Control and Prevention (CDC), 2014).
Aim of the Study:
This study was aimed to assess nurses’ performance regarding infection control measures for patient with central line through the following:
1) Assess the level of nurses’ knowledge regarding infection control measures for patient with central line in critical care unit.
2) Assess the level of nurses’ practice regarding infection control measures for patient with central line in critical care unit.
3) Assess the level of nurses’ attitude regarding infection control measures for patient with central line in critical care unit.
Research Questions:
• What is the level of nurses’ knowledge toward infection control measures for patient with central line in the critical care unit?
• What is the level of nurses’ practice toward infection control measures for patient with central line in the critical care unit?
• What is the level of nurses’ attitude toward infection control measures for patient with central line in the critical care unit?
Research design:
Descriptive exploratory design was used in this study.
Setting:
This study was carried out at Intensive Care Unit at El-Fayoum University Hospital.
Subjects:
Purposive sample of critical care nurses (40 nurses) in Intensive Care Unit who were providing direct care for critically ill patients in the previous study settings included in the study.
Tools for data Collection:
Three tools were developed by the investigator after reviewing the relevant literatures and used to collect data of this study.
1- Self-administered nurses’ questionnaire:
Part (1): Nurses’ Demographic Data:
It was developed by the investigator including data about nurses’ age, gender, the level of education and years of experience in critical care unit (ICU, Emergency).
Part (2): Nurses’ Knowledge:
This tool adapted from Grove, Burns, & Gray, (2013), and it was modified by the investigator after reviewing the relevant literature, to assess nurses’ knowledge regarding infection control measures for patient with central line.
2-Nurses’ observational checklist:
This tool adapted from The Joint Commission, (2013) and it was modified by the investigator after reviewing the relevant literature, to assess nurses’ practice regarding infection control measures for patient with central line.
3)-Nurses’ attitudes Likert Scale:
This tool adapted from Bianco, Coscarelli, Nobile, Pavia, (2013) and it was modified by the investigator. It consisted of 20 statements to assess nurses’ attitudes toward infection control measures for patient with central line. Participants were asked to response on a 3-point Likert scale.
Results:
The results of the study showed that:
• More than two-thirds of studied nurses (67.5%) had age less than 30 years with mean age 32.47±3.68. Also it revealed that more than half(52.5%) of them were females.
• About two-thirds of studied nurses (60%) had Bachelor’s degree. in addition; it revealed that the majority (87.5%) of nurses under the study had less than 5 years of experience.
• Slightly less than three-quarters (72.5%) of them had unsatisfactory in their total knowledge regarding infection control measures for patient with central line.
• More than two-thirds(70%) of them had incompetent total practice level regarding infection control measures for patient with central line.
• More than three-quarters(77.5%) of them had negative total attitude regarding infection control measures for patient with central line.
• There was no statistical significant difference between nurses’ knowledge and their gender (x2=0.025 and p-value=0.873).
• There was statistical significant relation between nurses’ knowledge and their age (x2 =12.135 and p-value=0.002).
• There was statistical significant relation between nurses’ knowledge and level of education (x2 12.338 and p-value=0.006).
• There was statistical significant relation between nurses’ knowledge and their years of experience (x2 =7.900 and p-value=0.005).
• There was statistical significant relation between nurses’ practice and age (x2 =11.076 and p-value=0.004).
• There was statistical significant relation between nurses’ practice and educational level (x2 =10.761 and p-value=0.013).
• There was statistical significant relation between nurses’ practice and experience (x2 =6.803 and p-value=0.009).
• There were statistical significant relations between total knowledge, total practice and nurses’ total attitude.
• There were statistically significant relations between nurses’ attitude, level of education and age(p≤0.05).
Conclusion
In the light of the present study findings, it can be concluded that:
About more than two-thirds of studied nurses had unsatisfactory knowledge and practice regarding infection control measures related to central venous catheters. Moreover, more than three-quarter had negative attitude. In addition, there were statistical significant relations between total knowledge, total practice, total attitude and their socio-demographic characteristics as regards age, education and years of experience.
Recommendations:
Based on the results of the present study, the following recommendations are suggested:
For nurses:
• Policies and guidelines related to infection control measures must be informed to the nurses in order to prevent complications.
• Importance of implementing an educational training courses conducted for nurses in critical care units regarding guidelines for prevention of infection related to central line.
• Orientation program for all newly employed nurses in ICU.
• Periodical and continuous, evaluation of nurse’s performance should be done to improve quality of their performance.
• Replication of the study on a large sample acquired from different hospital settings in Egypt in order to generalize the results.