Why is it that internists do not follow guidelines for preventing intravascular catheter infections?
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.


METHODS
Cross-sectional survey.


METHODS
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.
Rubinson
Lewis
L
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA. lrubinso@jhmi.edu
Wu
Albert W
AW
Haponik
Edward E
EE
Diette
Gregory B
GB
D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D000985:Antisepsis / Q000592:standards; D001291:Attitude of Health Personnel; D001364:Awareness; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D002983:Clinical Competence / Q000592:standards; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004502:Education, Medical, Continuing; D004866:Equipment Contamination / Q000517:prevention & control; D019983:Guideline Adherence / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D017053:Infection Control / Q000592:standards*; D007388:Internal Medicine / Q000193:education / Q000592:standards*; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States
D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine