A Survey of Adherence to Guidelines to Prevent Healthcare-Associated Infections in Iranian Intensive Care Units.
BACKGROUND
Healthcare-associated infections (HAIs) are acquired by patients while receiving care. The highest incidence of HAIs has been documented in admissions to intensive care units. Adherence to evidence-based practices is the most important step for preventing HAIs.


OBJECTIVE
To determine the rate of adherence to evidence-based post-insertion recommended care practices after admission into the intensive care unit for the following devices: central line catheter, indwelling urinary catheter, and mechanical ventilator.


METHODS
A structured observational cross-sectional research design was used. Data were collected using a checklist and a self-report questionnaire. The minimum sample size required for this study was 276 post-insertion care episodes, and 332 episodes were observed. The ANOVA test was used to identify any significant differences among the mean scores of the three devices.


RESULTS
Overall observed adherence rates were 18.3%, 59.1%, and 43.1% for central line catheters, indwelling urinary catheter, and mechanical ventilator, respectively. Of the observed episodes of device care, only in 9.4% of the episodes was regular oral care performed for patients on mechanical ventilators and only in 19.3% of the episodes were indwelling urinary catheters properly secure after insertion. More so, in none (0.0%) of the episodes was the central line catheter hub disinfected before being accessed.


CONCLUSIONS
Evidence-based post-insertion recommended care practices were not consistently and uniformly implemented in the intensive care units. Establishment of a program for the surveillance of adherence to recommended guidelines is required for improving compliance by health professionals and the quality of preventive care.
Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, IR Iran.
Mahmood
M
Shamshiri
Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences-International Campus, Tehran, IR Iran.
Boudouin
B
Fuh Suh
Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, IR Iran.
Nooredin
N
Mohammadi
Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran.
Reza
R
Nabi Amjad
Catheter-Related Infections; Clinical Practice Guideline; Evidence-Based Practice; Ventilator-Associated Pneumonia