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Why Is It That Internists Do Not Follow Guidelines for Preventing Intravascular Catheter Infections?

Published online by Cambridge University Press:  21 June 2016

Lewis Rubinson ,
Albert W. Wu ,
Edward F. Haponik  and
Gregory B. Diette
Lewis Rubinson*
Affiliation:
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
Albert W. Wu
Affiliation:
Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Edward F. Haponik
Affiliation:
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
Gregory B. Diette
Affiliation:
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
*
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205.[email protected]
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Abstract

Background and Objective:

High morbidity of CVC-related infections has led to national guidelines for their prevention. Despite recommendations for the use of maximal barrier precautions (mask, sterile gloves, gown, and large drape) and skin antisepsis with 2% Chlorhexidine gluconate during CVC insertion, internists in the United States are not implementing these practices frequently. This study sought to identify and characterize the obstacles to and potential opportunities for improving adherence.

Design:

Cross-sectional survey.

Participants:

One thousand randomly selected physician-members of the American College of Physicians-American Society of Internal Medicine.

Methods:

Several potential determinants of adherence to maximal barrier precautions were assessed, including awareness of, agreement with, and ability to implement the recommendation, as well as the practice and training characteristics of the respondents. Factors influencing antiseptic selection were also recorded.

Results:

Of 526 respondents, 178 (34%) had recently inserted CVCs. Clinician experience and subspecialty, awareness of CDC guidelines, and external influences (eg, time to collect equipment) did not affect maximal barrier precautions adherence. The only independent predictor of adherence was high outcome expectancy for the use of large sterile drapes (OR, 5.3; CI95, 2.2-12.6). Availability had the greatest influence on internists' selection of specific antiseptic agents, whereas cost was the least important determinant.

Conclusions:

Despite established efficacy, use of maximal barrier precautions and Chlorhexidine gluconate is low among internists. Because improved adherence to these practices will require increased outcome expectancy for maximal barrier precautions and availability of Chlorhexidine gluconate, targeting these areas through focused education and systems modifications is essential (Infect Control Hosp Epidemiol 2005;26:525-533).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 6 , June 2005 , pp. 525 - 533
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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