title: Using a checklist to identify barriers to compliance with evidence-based guidelines for central line management: a mixed methods study in Mongolia.
abstract: OBJECTIVE
  This study aimed to determine the extent to which a checklist has potential for identifying barriers to compliance with central line management guidelines, to evaluate the potential utility of checklists to improve the management of central lines in Mongolia, and to define the gap between current and best practices.
  
  
  METHODS
  A 22-item checklist was developed based on the Centers for Disease Control and Prevention (CDC, USA) guidelines and existing central line-associated bloodstream infection (CLABSI) checklists. The checklist was used to observe 375 central line procedures performed in the intensive care units of four tertiary hospitals of Mongolia between July and December 2010. In parallel, 36 face-to-face interviews were conducted in six other tertiary hospitals to explain practice variations and identify barriers.
  
  
  RESULTS
  The baseline compliance level across all components of the checklist was 68.5%. The main factors explaining low levels of compliance were outdated local standards, a lack of updated guidelines, poor control over compliance with existing clinical guidelines, poor supply of medical consumables, and insufficient knowledge of contemporary infection control measures among health care providers.
  
  
  CONCLUSIONS
  The health authorities of Mongolia need to adequately address the prevention and control of CLABSIs in their hospitals. Updating local standards and guidelines and implementing adequate multifaceted interventions with behavioral, educational, and logistical components are required. Use of a checklist as a baseline evaluation tool was feasible. It described current practice, showed areas that need urgent attention, and provided important information needed for future planning of CLABSI interventions.
authors.affiliation: School of Population Health, University of Queensland, Room 303, Edith Cavell Building, Herston Road, Herston, QLD 4006, Australia. Ibaterdene@yahoo.com
authors.forename: Bat-Erdene
authors.initials: BE
authors.lastname: Ider
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
authors.forename: Anthony
authors.initials: A
authors.lastname: Morton
authors.forename: Michael
authors.initials: M
authors.lastname: Whitby
authors.forename: Tsolmon
authors.initials: T
authors.lastname: Muugolog
authors.forename: Ganbold
authors.initials: G
authors.lastname: Lundeg
authors.forename: Archie
authors.initials: A
authors.lastname: Clements
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000592:standards*; D057189:Checklist; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008986:Mongolia; D017410:Practice Guidelines as Topic; D055815:Young Adult