IntroductionCentral Venous Catheters CVCs play a vital role in infusingmedications withdrawing venous

IntroductionCentral Venous Catheters (CVCs) play a vital role in infusingmedications, withdrawing venous samples and strict monitoring incritically ill patients. (1). Utilization of CVCs has been concerned with various risks and complications. The most common risk is catheter related blood-stream infections (CRBSIs)(2). Several identified risk factors of CRBSI have been categorized into catheter-related factors, patient-related factors or technical related factors. (3). Critical care nurses play an important role in managing their related factors by application of strict aseptic techniques and compliance with evidence-based guidelines that advised by the Centers for Disease Control and Prevention. (4, 5).Gram-positive Cocci followed by Gram-negative bacilli areresponsible for a higher proportion of catheter-related infections in the intensive care unit (ICU) than other clinical settings. (6). Forming of biofilm in device-related infection has not only been reported as a significant factor in a catheter-related infection but also include resistance to antimicrobial therapy. (7). The preventive measures like the utilization of antimicrobial-impregnated catheters and utilization of strict aseptic technique during catheter insertion using maximal sterile barrier (MSB) precautions have been proven to decrease the rate of bloodstream infection. (4) With resulting lowered health carecosts. (8). Due to few data of central venous catheter bloodstream infection (CVCBSI) from health care settings in our country, this study was conducted in one ICU of the ministry of health hospital determining the incidence, risk factors, microbes isolates and investigating antimicrobial susceptibility and resistance by CVC-BSI isolates.Research questions:To fulfill the main objective of this study, the following researchquestions were stated:1-what is the incidence rate of CLABSI among the studied ICU patients?2- What are the predisposing factors to CLABSI among the studied ICU patients?3-what are the microorganisms responsible for incidence of to CLABSI among the studied ICU patients?4- What are the antibiotic sensitivity patterns of the isolated organisms among the studied ICU patients?2-Subjects and methods2.1. Design: a descriptive exploratory design was adopted. Consecutive critically ill patients were engaged into the study between September 2015 and September 20162.2. SettingThe study was conducted at critical care units at a ministry of health hospital in Giza, Egypt . That hospital manages 5000 cases /year. The nurse patient proportion is 1: 32.3. SampleA purposive sample consisting of 120 patients admitted to the intensive care unit and was subjected to insertion of central venous catheters at one of Ministry of Health Hospitals. The inclusion criteria included adult patient over 18 years who had no blood stream infection before insertion of central venous catheters. Blood cultures were collected immediately and seven days after insertion of central venous catheter2.4 .MethodsThe following tools were utilized for data collection-Demographic and patients’ clinical data: They included data such as age, sex, body mass index, , pre-morbid disease, length of hospital stay.-Central venous catheter related data: It included site of insertion number of catheter lumen, use of guide wire, duration of insertion, duration of Cather in situ, and location of insertion.Blood culture Specimen collection: This Procedure was performed by ICU nurses. It included hand washing before the procedure, antisepsis of the puncture local area with 10% povidone and wearing the sterile gloves. Later, Blood samples were collected under aseptic precautions from theperipheral vein for qualitative culture was incubated at 37⁰C. Subcultures were made on MacConkey’s and blood agar plates after 24, 48 and 72 hr and incubated for 24 hrs at 37⁰C. The organisms were identified by colony morphology, gram staining, and biochemical tests performed by routine laboratory techniques (9)Antibiotic sensitivity testing:Antibiotic sensitivity test of bacterial isolates on 23 commonly usedantibiotics were done on MullerHinton agar medium by disk diffusion technique according to National Committee for Clinical Laboratory Standards (NCCLS) as indicated by (10) utilizing Disc of antibiotics such as Erythromycin (15μg), Cephalexin(30μg), Ceftriaxone(30μg), Chloramphenicol(30μg Piperacillin (100μg), Colistin(50μg), Amoxicillin(30μg), Penicillin(10μg), Ceftazidime(30μg) , Cloxacillin(1μg), Nalidixic acid(30μg), Ciprofloxacin(5μg), Cotrimoxazole (25μg) Levofloxacin(5μg), Streptomycin (25μg), Cefotaxime(30μg) , Gentamycin(10μg), Amikacin (30μg), Neomycin(30μg), Vancomycin(30μg), Azithromycin (30μg) Tetracycline (30μg), Imipenem (10μg) and were put on each isolate cultures respectively and incubated at 37°C. Later, after 24 hours of incubation, the diameter of zone of inhibition that surrounds the antibiotics was calculated as recommended by Clinical Laboratory Standard Institute (11).The procedure of data collectionOnce the patients’ inclusion criteria were met, the patients werecontacted and interviewed by the researchers to explain the procedural steps of the CVP insertion and withdrawing sample of blood culture. Later the written consents were obtained from the patients to participate in the study. Next, the patients’ demographic data and clinical profile were completed by the researchers from the medical records including age, sex, body mass index, pre-morbid disease, length of hospital stay. researchers attended the This phase lasted 30 minutes for each patient. Later , the nurse researchers attended the procedure of insertion of Central venous catheters for each patient. Central venous CVCs weresupplied as an available kit and inserted using a Seldinger technique by intensive care physician. Insertion was carried out under strict aseptic techniques (gowns, gloves, and masks). The insertion site ( jugular or subclavian ) was cleaned with 10% povidone-iodine solution for at least 1-2 min and a sterile field ensured with long drapes. After sterilization of the insertion site, the physician underwent the insertion process. During this invasive intervention, the researchers observed the procedural steps and recorded the CVCs related data including the site of insertion, duration of insertion, the use of Guidewire, the number oflumens, and duration of Cather in situ.After immediate completion of CVC insertion, the experienced andtrained nurses withdrew the venous blood culture. The site of insertion was covered by sterile gauze and a transparent adhesive tape was applied. This phase took 30-45 minutes for each patient. Later, collected samples were aseptically transferred to the laboratory to be cultured. Dressings were changed if the gauze became soiled. CVCs were not routinely replaced unless they were suspected of being infected. The blood culture was withdrawn again on the seventh day after insertion. After 72 hours,the researcher got the patients’ blood culture reports and recorded them. In the case of positive blood culture, the bacterial isolates and sensitivity test was carried out and recorded. The overall data collection took 16 months starting from May 2015 to September 2016.Ethical considerationThis study was approved by the ethics committee of faculty of nursing, Cairo University and head of ICU at Al Haram Hospital in Egypt. Each patient / relative was contacted to explain the nature of the study. A written informed consent was obtained from all participants before engagement in the study. Anonymity and Confidentiality of patients’ data were secured throughout the study.Content validity and reliabilityContent validity of the researchers’ developed tools such asobservational checklist of central venous catheter related data andpatients’ clinical profile were reviewed by a panel of nine health care experts in the fields of critical care nursing and microbiology. Based on experts’ opinions, the researchers employed the content validity index (CVI) to investigate the quantitative content validity of the established data collection tools. For calculating content validity index in our study, we sought the elected professionals to investigate, clarity, relevancy and simplicity of each element by using a 4-point Likert scale (12) . The critical value point for CVI was accepted at 0.79 (Polit et al., 2007). Items having a CVI of 0.79 or higher were included in the final form of observational checklist and patient’ clinical profile. Concerning contentvalidity ratio (CVR,) we sought the experts to score each item on a 3- point Likert scale–Essential (scored 1), Useful but not essential (scored 2) and not essential (scored 3). In respect to the number of experts and the critical values of CVR as proposed by (13) .We chose elements having a CVR of 0.5 or more. Reliability for the both checklist of central venous catheter related data and patients’ clinical profile were determined using Cronbach Alpha (r=0.83) method in a pilot study of 12 patientsData AnalysisStatistical analysis was completed involving the statistical package for social sciences (SPSS) version 21. Continuous data was described as the mean and standard deviation (SD), while the categorical and nominal were declared as frequencies and percentages. Chi-square analysis was utilized for correlates qualitative data and a value of p

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