effe tiveness of the implementation of insertion and ... · effectiveness of the implementation of...

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Proef ingediend met het oog op het behalen

van de graad van Master in de Geneeskunde

EFFECTIVENESS OF THE IMPLEMENTATION OF INSERTION AND MAINTENANCE BUNDLES IN PREVENTION OF CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) IN PATIENTS ADMITTED IN A NEONATAL INTENSIVE CARE UNIT (NICU)

LEEMAN MARTINE

2017-2018

Promotor: Prof. Dr. Filip Cools

Researcher: Mevr. Brenda Van Delft

Geneeskunde & Farmacie


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TABLE OF CONTENTS

TABLE OF CONTENTS .................................................................................................................. 2

1. ABSTRACT ........................................................................................................................... 4

2. INTRODUCTION .................................................................................................................. 6

3. METHODOLOGY ..................................................................................................................... 8

3.1 LITERATURE STUDY ........................................................................................................... 8

3.2 DEVELOPMENT OF A CARE BUNDLE ................................................................................. 8

3.2.1 Recommendations regarding checklist and responsibility ............................................ 8

3.2.2 Recommendations regarding hand hygiene and aseptic technique ......................... 8

3.2.3 Recommendations regarding maximal sterile barrier precautions .............................. 8

3.2.4 Recommendations regarding skin preparation ......................................................... 9

3.2.5 Recommendations regarding disinfection of access ports ........................................... 9

3.2.6 Recommendations regarding CVC ................................................................................. 9

3.2.7 Recommendations regarding dressing .................................................................... 10

3.3 STUDY POPULATION ....................................................................................................... 10

3.4 OBSERVATIONS ............................................................................................................... 10

3.5 MEDICAL ETHICAL COMMITTEE...................................................................................... 11

3.6 STATISTICAL DATA ANALYSIS .......................................................................................... 11

4. RESULTS ............................................................................................................................ 12

4.1 GENERAL ......................................................................................................................... 12

4.2 CHARACTERISTICS ........................................................................................................... 12

4.3 CVC PLACEMENT ............................................................................................................. 15

4.3.1 Significant predictors in literature ........................................................................... 15

4.3.2 P value <0,05 (LR or Mann Whitney U test) ............................................................ 15

4.3.3 Checklist ................................................................................................................... 16

4.4 BANDAGE ........................................................................................................................ 18

5. DISCUSSION ...................................................................................................................... 19

6. CONCLUSION ........................................................................................................................ 21


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ACKNOWLEDGMENT ................................................................................................................ 22

REFERENCES ............................................................................................................................. 23

APPENDIX 1: LIST OF ABBREVIATIONS .................................................................................... 27

APPENDIX 2: APPROVAL MEDICAL ETHICAL COMMITTEE ...................................................... 28

APPENDIX 3: CHECKLIST .......................................................................................................... 30

APPENDIX 4: STATISTICAL DATA ANALYSIS CATEGORICAL VARIABLES ................................... 31

APPENDIX 5: STATISTICAL DATA ANALYSIS QUANTITATIVE VARIABLES ................................. 48


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1. ABSTRACT

AIM OF THE STUDY

Numerous studies described in evidence based literature demonstrate that the

implementation of insertion and maintenance bundles has a significant positive effect on the

incidence of central line associated bloodstream infection (CLABSI) in a neonatal intensive

care unit (NICU). This study aims to provide an answer to the following questions:

What are significant independent predictors of CLABSI in NICU patients?

What is the effect of the implementation of insertion and maintenance bundles on the

incidence of central line associated bloodstream infections in patients admitted in the

neonatal intensive care unit UZ Brussels?

METHODS

This prospective, observational, non-randomized, non-experimental trial with pretest posttest

design is executed in 3 phases.

Baseline measurement included collection of data in order to calculate the incidence of

catheter related bloodstream infections before implementation of care bundles.

Phase 2 included creation and implementation of care bundles. This was was proceeded by a

rigorous literature study focusing on insertion and maintenance bundles use in NICU.

Posttest measurement included collection of data in order to calculate the incidence of

catheter related bloodstream infections after implementation of care bundles.

Data was subjected to statistical analysis using SPSS 25. Univariate analysis was applied.

RESULTS

In the comparison of pretest to posttest period a significant result was achieved in the

category of birthweight <1500 grams (p=0,09). Univariate logistic regression confirmed this

result (p=0,028 OR=0,78 95% CI (0,08;0,765)).

Catheter dwell time shows to be a significant risk factor in the posttest period (p=0,045 OR=

1,27 95% CI (1,003;1,266)).

Analysis of PICC connection sterility as a risk factor showed a significant difference (p=0,006)

in pretest to posttest period comparison. This significant result was also visible in univariate

logistic regression (p=0,023 OR=0,079 95% BI (0,009;0,706)).

The number of times a dressing is reattached, is a significant risk factor in the pretest period

(p=0,013). This significance stays present after using univariate logistic regression (p=0,033

OR=8,039 95% CI (1,187;54,436))


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In the comparison of pretest to posttest period of birthweight as a risk factor, a significant

result was achieved in the category of birthweight <1500 grams (p=0,09). Univariate logistic

regression confirmed this (p=0,028 OR=0,78 95% CI (0,08;0,765))

Temperature of NICU in pretest period shows to be a significant predictor for CLABSI (p pretest period=0,025/p posttest period=0,076). Using univariate logistic regression, this significance is confirmed (p=0,033 OR=3,364 95% CI (1,102;10,267))

CONCLUSION

In the analysis of CLABSI predictors, no significant risk factors could be withheld. CLABSI rate

showed no significant difference in pretest and posttest population after implementation of

an insertion and maintenance bundle.


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2. INTRODUCTION

Newborn infants in critical conditions require a permanent intravenous line to allow for the

administration of fluids, parenteral nutrition and drugs. The use of a central catheter is

associated with an increased risk of morbidity and sepsis, leading to prolonged hospitalization

and increased hospitalization costs in Neonatal intensive care units. (1) Central line associated

bloodstream infection (CLABSI) is estimated to cause up to 70% of all hospital acquired

bloodstream infections in preterm infants. (2) The incidence of infectious complications varies

from a mean of 11.3 per 1000 catheter days in minus 1 kg infants to 6.9,4.0 and 3.8 per 1000

catheter days in 1001-1500g, 1501-2500 g and > 2500 g infants, respectively.(1)

CLABSI is a surveillance definition used by CDC and defined as follows: Recovery of a pathogen

from a blood culture (a single blood culture for organism not commonly present on the skin,

and two or more blood cultures for an organism commonly present on the skin) in a patient

who had a CVC at the time of infection or within 48 hours before development of infection.

The infection cannot be related to any other infection. (10)

Most common found organisms implicated in CLABSI are gram-positive cocci. More specifically, coagulase-negative Staphylococci (Co NS) are the leading cause. They were identified in 42,9% of CLABSI. The second leading cause was found to be Staphylococcus aureus. (9) In the presence of Staphylococcus aureus, fibronectin binding proteins facilitate attachment of Staphylococcus aureus to host cells and to fibronectin-coated biomaterials. Staphylococci also tend to colonize the catheter surface by the formation of a multilayered biofilm, which offers also some protection against antibiotics. Recently, there is a frequent detection of methicillin-resistant Staphylococcus aureus (MRSA), and extended spectrum B-lactamases (ESBL) and carbapenemases producing bacteria. Other less frequent pathogens are gram-negative bacilli (Enterobacter spp. Escherichia Coli, Pseudomonas aeruginosa, Klebsiella spp.) and Candida spp. However, it should be taken into consideration that the incidence of each pathogen isolated from catheters differs among NICU’s. Four distinct pathways in the infection process are possible; internal and external catheter surface colonization, intrinsic contamination and hematogenous spreading. External pathway surface infection occurs mostly after 7-10 days of placement of the central venous catheter. Micro-organisms of the skin flora migrate along the external surface of the catheter from the skin insertion site through the transcutaneous part of the dermal tunnel surrounding the catheter to the intravascular tip of the catheter. Non tunneled catheters are at higher risk for CLABSI.


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Internal surface pathway infections usually occur after 10 days and are caused by colonization of the hub and intraluminal surface of the catheter. Contamination mostly originates from health care provider’s hands when standard aseptic precautions to access the hub failed. After manipulation of the hub, the pathogens then migrate intraluminally with the potential of reaching the distal tip in the bloodstream. Less common mechanisms are the intrinsic and hematogenous contamination. In intrinsic contamination the source of infection is a contaminated infusate (fluids or drugs intravenously administered). In these circumstances, les common organisms such as Enterobacter spp. , Serratia Marcescens, Malasezia furfur or Candida parapsilosis can be identified. And finally, hematogenous seeding of the catheter during a bloodstream infection of any origin represents the last pathway. (1,2,3) In a study of independent risk factors for CLABSI in NICU patients, catheter hub colonization

was the strongest predictor of subsequent CLABSI followed by exit site colonization, weight at

the time of insertion lower than 1 kg, postnatal age over 7 days and days of total parenteral

nutrition (TPN). (4) NICU patient volume also correlated with CLABSI rate. Higher patient

volume NICU’s tended to have lower CLABSI rates (p=0,02 OR= 0,49 95% BI (0,27;0,90)). (14)

Catheter dwell time also poses an important risk for developing CLABSI. (7) Risk increases

during the first two weeks after catheter placement. The risk remains elevated afterwards as

long as the catheter stays in place. (6)

CLABSI was long thought to be an unavoidable complication of maintaining central venous

access in critically ill newborns. However, recent studies have proven that the use of insertion

and maintenance bundles significantly lowers the incidence of CLABSI. (5, 14, 15, 17, 18)

A bundle is defined as a group of evidence-based care practices that, when implemented

together, result in a better outcome than each individual component separately. (16)

Insertion bundles focus mainly on hand hygiene, use of maximal barrier precautions including

sterile gown, sterile gloves, surgical mask, hat and large sterile drape, proper disinfection, use

of the right dressing or gauze and use of a dedicated team with special training in insertion

and maintenance of central lines. (4)

Maintenance bundles focus mainly on proper hand hygiene, evaluation of catheter insertion

site, correct disinfection, removal of catheter when no longer necessary, addition of 0,5 U/ml

heparin to total parenteral nutrition and minimalization of catheter access ports. (4)

Fisher et. Al reported a 71% CLABI reduction rate from 3.94 infections per 1000 catheterdays

to 1,16 infections per 1000 catheterdays with sustained result one year after implementation

of an insertion and maintenance bundle in a collaboration of 13 neonatal intensive care units.


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3. METHODOLOGY

3.1 LITERATURE STUDY

Data collection was proceeded by a rigorous literature study focussing on insertion and

maintenance bundles use in NICU. The results of this literature study were used to develop a

tailor made insertion and maintenance care bundle for application in the NICU UZ Brussels.

This study and development took place in collaboration with the VIKA (vragen incidenten

klachten aanbevelingen) task force.

3.2 DEVELOPMENT OF A CARE BUNDLE

The CVC care bundle developed by the VIKA task force consists of evidence based guidelines

to improve quality of care and to prevent infection. These guidelines are based on the CDC,

NHS and IHI guidelines regarding central vascular catheters (CVC), and articles. (11,12,13)

3.2.1 Recommendations regarding checklist and responsibility

To improve patient security, to comply with regulations of the local healthcare department, and to induce a change in habits, a checklist should be filled out. (Appendix)

Healthcare personnel should be educated regarding the indications for CVC use and proper procedures for the insertion and maintenance of CVC.

Only trained persons are allowed to place a CVC, in any other case they should be supervised by an expert.

Use of an intravenous (IV) team reduces the risk to develop CLABSI.

3.2.2 Recommendations regarding hand hygiene and aseptic technique

Hand hygiene should be performed according to regulations of the UZ Brussels.

Hand hygiene procedures should be performed, either by washing hands with soap and water or with alcohol-based hand rubs.

Hand hygiene should be performed before and after palpating catheter insertion site as well as before and after inserting, replacing, or rinsing the CVC.

Two pairs of sterile gloves should be used, one before disinfection of the insertion site, one before CVC placement.

Sterile gloves should always be used when manipulating a CVC.

3.2.3 Recommendations regarding maximal sterile barrier precautions

Sterile gloves, a mouth mask, a medical hat and a sterile full body drape should be used for the insertion of a CVC.

A sterile field must cover the complete insertion site.

An adherable sterile sleeve should be used to protect any other invasive catheters.

Two pairs of sterile gloves should be used.

The patient’s environment should be protected by placing panels. This will also give a warning to other persons.


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3.2.4 Recommendations regarding skin preparation

In case of newborns < 1000 grams, Hibidil should be used.

In case of newborns > 1000 grams, or after two weeks in case of newborns with birth weight < 1000 grams, Cedium Chlorhexidin should be used.

One should be carefull with heat radiation, eg. phototherapy or an incubator with heat radiation. The effect of the antiseptic will increase and chemical burns are possible.

It should be ensured that dressings are not soaked. Body temperature of the newborn or radiation heat can increase the effect of the antiseptic and cause chemical burns.

A large area has to be disinfected.

A drying time of 30 seconds should be respected when using Cedium Chlorhexidin.

When using Hibidil, which doesn’t dry spontaneously, excess antiseptic can be removed using a sterile gauze.

3.2.5 Recommendations regarding disinfection of access ports

All claves, needleless valves and other intravascular access ports should be disinfected with an appropriate antiseptic before use, change or administration of perfusion.

Access ports should be disinfected during 15 seconds after which a drying time of 30 seconds is imposed.

When manipulating access ports, hand hygiene should be performed. Gloves should be used every time when manipulating an IV system.

Every member of the staff should be informed or trained regarding standard protocol in disinfecting catheter hubs, needleless connectors and access ports before and after every catheter manipulation.

Every member of the staff should be informed regarding the consequences of applying a bad technique while refreshing the correct technique.

Sampling should be performed to supervise disinfection procedures before and after use of CVC. The results should be reported and taken into account.

Every process should be evaluated and new techniques investigated.

A multimodal quality control infection prevention program should be implemented in order to achieve compliance to guidelines and recommendations during all actions.

3.2.6 Recommendations regarding CVC

The need for use of a CVC should be evaluated.

Catheter type should be evaluated, preferably UVC should be used if possible.

Before start of the procedure, distance for UVC and PICC should be measured.

In case of a umbilical venous catheter (UVC), a double lumen catheter should be used. In case of a peripherally inserted central venous catheter (PICC), the necessity of a double lumen catheter should be evaluated.

In case of a double lumen PICC, two bags of total TPN should be ordered.


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A chest x-ray should be performed afterwards to check position.

Necessity of the CVC should be evaluated daily.

Replacement of the CVC should only happen in case of malfunctioning.

3.2.7 Recommendations regarding dressing

A dressing that is applied correctly will limit the need to replace the dressing to a minimum.

A dressing that is applied correctly will minimalize the risk of loosening of the dressing, displacement of the catheter and infection.

Application and replacement of the dressing should always be executed by two nurses in a sterile environment.

Replacement is only recommended in case of loosening, moist or visibly soiled dressing. (dry bloody dressing excluded)

Replacement of the dressing should be executed with care and enough time should be provided.

Before starting the procedure, all steps should be evaluated.

The dressing should be adjusted to the shape of the hand, fingers and joints by cutting the Tegaderm.

This care bundle was implemented between pretest and posttest period.

3.3 STUDY POPULATION

Pretest period extended from 01/12/2016 until 30/06/2017. During this period, catheter

placement was executed in a population of 92 patients. Of this 92 cases, 36 were not included

in the study due to unsigned informed consent or other reasons. 56 cases provided a signed

informed consent and data was collected. Of this 56 cases 13 were excluded based on

congenital malformation (6), early onset infection (EOS) (5) and catheter placement failure

(2). Data of 43 cases was effectively used in data processing.

Posttest period extended from 01/10/2017 until 28/02/2018. 27 patients who had a catheter

placement during this period were not included in the study, due to unsigned informed

consent or other reasons. Data was gathered of 33 cases. After evaluation, 6 cases were

excluded based on congenital malformation (2), EOS (3) and catheter placement failure(1).

Data of the remaining 27 cases was effectively used in the analysis.

3.4 OBSERVATIONS

During the pretest and posttest period, several forms had to be filled out at every procedure: checklist (implemented in care bundle), observation form UVC placement, observation form PICC placement, observation form dressing, observation form manipulations.

CLABSI rate was also monitored. A CLABSI was defined as a culture proven infection or a

clinically documented infection. Clinically documented infection was defined as a combination


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of CRP > 10 occurring > 48u and signs of illness, when this could not be attributed to any other

cause.

3.5 MEDICAL ETHICAL COMMITTEE

Approval was granted by the medical ethical committee of the UZ (Universitair Ziekenhuis)

Brussels on November 23th 2016.

3.6 STATISTICAL DATA ANALYSIS

All data gathered from the checklist and observation forms in pretest and posttest period were

collected in one excel file, which was implemented in SPSS 25. Missing data were coded as

missing values. In case an action was reported as not executed, this was coded as value 0.

A descriptive statistical analysis was then executed. Variables were all coded as categorical or

quantitative.

For categorical variables, frequencies, mode and missing values were summarized.

Since data distribution of quantitative variables tended to be skewed or not normal, median

was reported as a measure of centre of data distribution. Range and interquartile range were

reported as a measure of variability of the data. Frequencies and missing values were also

accounted for. In the pretest and posttest population of patients having CLABSI, interquartile

range was not reported since there were not enough values.

After general summarization of the data, an analysis was made of pretest and posttest data

separately in order to discover predictors for CLABSI.

Given the use of unpaired data, and small expected counts in the crosstabs, Likelihood ratio

(LR) was used to compare two categorical variables.

In order to compare quantitative not normally distributed data, the Mann Whitney U test was

applied.

In case of significance (P < 0,05) , these variables were further submitted to univariate logistic

regression to calculate the odds ratio (OR). Multivariate logistic regression had no place in this

study. The data model didn’t lend itself to this. The OR expresses the risk to develop CLABSI

when exposed to a certain risk factor. An OR smaller than 1 means the risk to develop CLABSI

decreases. On the contrary, an OR >1 expresses an increased risk.

Significant predictors or predictors that showed to be significant in literature research were

then submitted to a pretest posttest comparison in order to analyse whether there was a

difference in CLABSI rate between the pre and post test period. Any significant results were

then again included in a univariate logistic regression analysis.


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4. RESULTS

All entries in the checklist and observation forms provided a huge amount of data that could

be divided into categories: checklist, data baby, data NICU, catheter placement general, period

before catheter placement, period during catheter placement, preparation perfusion lines,

dressing, RX check, manipulations, infection, extra.

General characteristics, variables that showed to be significant predictors in literature,

variables for which a significant result was achieved in the analysis, and checklist data are

discussed in detail.

All other results can be consulted in appendix 4 (statistical data analysis categorical variables)

and in appendix 5 (statistical data analysis quantitative variables).

4.1 GENERAL

3 CLABSI (6,98%) were diagnosed in the pretest period. 6 CLABSI (22,22%) were diagnosed in the posttest period (p=0,067). Total dwell time in the pretest period consisted of 317 days what resulted in a CLABSI rate of 9,5/1000 central-line days. Total dwell time in the posttest period consisted of 351 days, what resulted in a CLABSI rate of 17/1000 central-line days. Microbiological criteria were possible for most clinical infections. Except for 1 clinically

documented infection, all organisms were coagulase negative Staphylococcus (CNS), with a

majority of Staphylococcus Capitis.

In the pretest period 2 cases of culture proven S. Capitis CLABSI were confirmed. 1 case was a

clinically documented infection.

In the posttest period culture proven S. Capitis CLABSI was confirmed in 2 cases, culture

proven S. Epidermis CLABSI in 1 case and the last case showed a culture proven S. Capitis in

combination with a culture proven S. Epidermis CLABSI.

4.2 CHARACTERISTICS

Pretest population consisted of 19 (44,2%) male and 24 (55,8%) female patients. Posttest

population consisted of 16 (59,3%) male and 11 (40,7%) female patients. (table 1)

Gestational age range in the pretest period extended from 24,0 weeks to 40,2 weeks. In the

posttest period we see a comparable range from 24 weeks to 39,4 weeks. (table1) However,

in the pretest period, 30,2% of patients had a gestational age <29 weeks as compared to 44,4%

in the posttest period. Gestational age does not seem to be a significant predictor

(p=0,664/p=0,122). In the comparison of pretest to posttest period a significant result is visible


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in the category 25-28,6 weeks (p=0,034). However, univariate logistic regression refutes this.

(p=0,057)

Birth weight was divided in two categories; < 1500 gram and > 1500 gram. (table 1) In the

pretest period one out of 3 CLABSI (33,3%) occurred in the first category. In the posttest period

all 6 cases of CLABSI (100%) were reported in the first category. Adjusted to the population

size for the first category, there is CLABSI rate of 1/18 (5,56%) in the pretest period and a

CLABSI rate of 6/14 (42,86%) in the posttest period. Evaluation of birth weight as a predictor

value shows a significant result in the posttest period (p=0,754/p=0,002). However no

significance is shown in univariate logistic regression (p=0,076). In the comparison of pretest

to posttest period a significant result was achieved in the first category (p=0,09). Univariate

logistic regression confirms this (p=0,028; OR=0,78; 95% CI 0,08;0,765).

Reason of admission was mostly comparable in pretest and posttest period. (table1) Main indication was prematurity; 58,1% in pretest period, 51,9% in posttest period. Second main cause was premature rupture of membranes (PROM). Reason of admission shows no significance as a predictor value (p=0,650/p=0,378). In both pretest and posttest period the majority of patients received respiratory support; 79,1% in pretest period, 88,5 % in posttest period. (table1) In neither population, respiratory support was a significant risk factor for CLABSI (p=0,226/p=0,194). When comparing different types of mechanical ventilation, there was also no significant result (p=0,738/p=0,620). In both populations, TPN was the main indication for placement of a CVC; 93% in pretest period, 100 % in posttest period. (table 1) In the pretest period all 3 CLABSI (100%) occurred in the patients with TPN. In the posttest period 6 CLABSI (100%) were reported in the TPN group. When adjusting to population size a rate of 7,5% (3/40) was reported in the pretest period versus a rate of 24% (6/25) in posttest period. In this study, TPN as a risk factor shows no significance (p=0,816/p=0,696). Catheter period range extended from 1-42 days in the pretest period, and from 2-65 days in the posttest period. (table1) A duration of > 9 catheterdays is present in 11,6 % of the pretest population. However, in the posttest population, this number increases to 40,7% of the population. An explanation could possibly be the presence of a large number of patients with very low birth weight (VLBW) <1000 grams in the posttest population (40,7% in posttest vs 26,6% in pretest). In the pretest period, 33,33% of total CLABSI is situated in the patient group with dwell time >9 days. In the posttest period the incidence rises to 100%. Dwell time seems to have a significant effect in pretest and posttest period (p=0,028/p=0,003). When applying univariate logistic regression, significance in the pretest period is no longer present (p=0,093). However, significance in posttest period remains valid. (p=0,045 OR= 1,27 95% CI (1,003;1,266)). Between pretest and posttest period, a significant difference could not be confirmed.


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TABLE 1: Characteristics

PRE PERIOD

(n=43) POST PERIODE

(n=27)

Gender (N(%)) Male 24 (55,8) 11 (40,7)

Female 19 (44,2) 16 (59,3)

Gestational Age (weeks) (N(%))

modus (range) <25 weeks 25 - 28,6 29 - 32,6 weeks 33 - 36,6 >37 weeks

32,6 (24 - 40,2) 1 (2,3)

12 (28,0) 9 (21,0)

16 (37,2) 5 (11,6)

29,6 (24 _ 39,4) 4 (14,8) 8 (29,6) 9 (33,3) 3 (11,1) 5 (18,1)

Birthweight (grams) modus(range)

1770 (695 - 4663)

1463,5 (667 - 4370)

Reason of admission NICU Prematurity 25 (58,1) 14 (52,0)

N(%) PPROM 5 (11,6) 6 (22,2)

Asphyxia 2 (4,6) 2 (7,4)

Infection 5 (11,6) 0

Respiratory 4 (9,3) 2 (7,4)

Other 2 (4,6) 3 (11,1)

Respiratory support: Yes (N(%)) 34 (79,1) 23 (85,2)

Indication catheter (N(%)) TPN 37 (86,0) 22 (81,5)

Long term medication 2 (4,7) 0

Impossible Peripheral infusion 1 (2,3) 0

TPN + medication 3 (7,0) 3 (11,1)

Catheter type (N(%)) PICC 18 (41,9) 14 (52,0)

UVC 25 (58,1) 13 (48,1)

Duration Catheter (days) modus (range)

6 (1 - 42) 7 (2 - 65)

Duration procedure (minutes) modus (range)

45 (15 - 78) 32,5 (15 - 20)


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4.3 CVC PLACEMENT

4.3.1 Significant predictors in literature

In the pretest period, weight at the moment of insertion extended from 695 to 4663 grams,

in the posttest period a comparable range from 667 to 4370 grams was noted. Analysis

showed a significance in the posttest period (p=0,371/p=0,046). This significance could not be

withheld using univariate logistic regression (p=0,076).

Analysis of age at the moment of catheter insertion showed a range from 0-12 days in the

pretest period and a range of 0-98 days in the posttest period. It could not be identified as a

significant risk factor for CLABSI both in pretest and posttest period (p=0,875/p=0,533).

4.3.2 P value <0,05 (LR or Mann Whitney U test)

NICU temperature ranges from 25,1°C tot 29,7°C in pretest period with a median temperature

of 27°C and ranges from 26,2°C to 28,3°C in posttest period with a median temperature of

27,1°C. First analysis of the data showed significance for temperature of NICU as a risk factor

in pretest period (p=0,025/p=0,076). Using univariate logistic regression, this significance is

confirmed (p=0,033 OR=3,364 95% CI (1,102;10,267)).

PICC connection piece sterility showed to be significant as a risk factor during pretest period

(p=0,01/-). During posttest period sterility was always achieved, so calculation of the LR was

impossible. Significance in the pretest period could not be maintained using univariate logistic

regression (p=1). However, analysis of PICC connection sterility as a risk factor showed a

significant difference when comparing pretest versus posttest period (p=0,006). This

significant result was also visible in univariate logistic regression (p=0,023 OR=0,079 95% CI

(0,009;0,706)). Analysis of PICC connection sterility as a risk factor showed a significant

difference

Mechanism of umbilical disinfection in the pretest period showed to be a significant risk factor

(p= 0,044/p=0,271). This result was rejected by univariate logistic regression (p=0,998). When

comparing pretest with posttest period, a significant result is noted in case of disinfection of

insertion place by doctor (p=0,017) and disinfection of insertion place by nurse, without

disinfection by doctor when he or she proceeds (p=0,045). These results are not confirmed in

univariate logistic regression (p=0,999). (table 2)

Use of a medical hat by doctor 2 shows significance as a predictor in the pretest period

(p=0,030/-). In the posttest period doctor 2 always wears a medical hat so no comparison is

possible. This result is not confirmed by univariate logistic regression (p=0,998).

The presence of the baby in a bag shows to be significant in posttest period

(p=0,216/p=0,022). Again this result is not confirmed by univariate logistic regression

(p=0,999).


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4.3.3 Checklist

A comparison of pretest period with posttest period was executed based on the checklist.

Data are summarized in table 2. None of the observed variables showed significance in

univariate logistic regression analysis.


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TABLE 2: Procedure placement of central venous catheter based on the checklist and proven

catheter infection compared in pre (N=43) and post period (N=27), comparison pretest

period with posttest period

PRE PERIOD (N/N(%))

POST PERIOD (N/N(%))

P-value

P-value Log Regression

Moment of the day (N=70) Morning 1/12 (8,3%) 2/11 (18,2%) 0,481

Afternoon 1/22 (4,5%) 4/13 (30,8%) 0,033 0,06

Evenning 1/9 (11,1%) 0/2 (0%) 0,515

Catheter type (N=70) PICC 1/18 (5,6%) 4/14 (28,6%) 0,071

UVC 2/25 (8%) 2/13 (15,4%) 0,592

Use of 2nd pair of sterile gloves (n=64) No 1/23 (4,3%) 6/27 (22,2%) 0,535

Yes 2/14 (66,7%)

Desinfection region mechanism (N=62) Only doctor 0/6 (0%) 2/3 (66,7%) 0,017 0,999

Nurse 0/12 (0%) 2/8 (25%) 0,045 0,999

Nurse and doctor 2/21 (9,5%) 1/9 (11,1%) 0,95

Nurse hold umbilical or arm or leg 1/1 (100%) 1/2 (50%)

0,306

Drying time 30 sec. (N=57) Yes 2/32 (6,3%) 5/24 (20,8%) 0,102

Sterile enviremont (N=61) Yes 2/35 (5,7%) 6/25 (24%) NA

Massage when moving catheter (N=50) No 2/21 (9,5%) 4/18 (22,2%) 0,270

Yes 0/7 (0%) 2/4 (50%) 0,027 0,999

Bandage according to regulations (N=64) Yes 3/40 (7,5%) 6/23 (26,1%) 0,047

Type of bandage for UVC (N=31) Bridging 0/8 (0%) 0/3 (0%) NA

Bridging & Steristrip 2/12 (16,7%) 2/7 (28,6%) 0,544

Steristrip 0/1 (0%) 0/0 (0%) NA

Bloody bandage (N=56) No 1/25 (4%) 4/20 (20%) 0,084

Yes 1/8 (12,5%) 2/3 (66,7%) 0,081

Who placed the CVC (N=67) Neonatologist 1/13 (7,7%) 5/17 (29,4% 0,123

Student doctor 2/22 (9,1%) 4 /15 (26,7%) 0,157

Catheter repositioning (N=67) No 2/18 (11,1%) 5/14 (35,7%) 0,093

Yes 1/24 (4,2%) 1/11 (9,1%) 0,574

Catheter repositioning mechanism (N=29)

Doctor still sterile 0/11 (0%) 0/3 (0%) NA

HH & steril gloves 1/7 (14,3%) 0/5 (0%) 0,285

Sterile gloves & no HH 0/2 (0%) 1/1 (0%) 0,051


Pagina 18 van 49

4.4 BANDAGE

All manipulations of the CVC were documented in an observation form. Table 3

(manipulations of CVC in pre and posttest period and catheter infection) was based on this

data.



OR=8,039 95% CI (1,187;54,436)).

Of the other variables, a significance is present in some cases; number of times rinsing clave

in posttest period (p=0,015), number of times administration medication in posttest period

(p=0,028), number of times disinfection clave in posttest period (p=0,015) and number of

times connecting the line (p=0,012). These results are not confirmed by univariate logistic

analysis regression.

TABLE 3: Manipulations of CVC in pre and postest period and catheter infection

No CLABSI

Yes: CLABSI P

P log Reg OR 95% BI

N

Median Min Max

N

Median Min Max

Valid Valid

N Rinsing clave Prestest 37 6 0 123 3 10 3 60 0,461

Posttest 21 8 0 195 5 53 23 254 0,015 0,071

N Administration of medication

Pretest 37 4 0 31 3 4 2 17

0,401 Posttest 21 2 0 58 5 22 3 63

0,028 0,076

N Disinfection clave

Prestest 37 7 0 93 3 6 3 66 0,847

Posttest 21 13 3 165 5 54 35 272 0,015 0,090

N Connecting line

Pretest 37 4 0 61 3 2 2 46 0,809

Posttest 21 10 4 160 5 35 29 228 0,012 0,110

N deconnecting line

Prestest 37 1 0 57 2 22 2 42

0,243 Posttest 21 9 1 161 4 28 18 223

0,057

Duration catheter period (days)

Pretest 40 6 1 42 3 8 8 31

0,028 0,093

Posttest 21 7 2 29 6 18 10 65 0,003 0,045

1,127 1,003-1,266

Reattaching bandage

Pretest 3 (9,4%) _ _ _

2 (6,25%) _ _ _ 0,013 0,033 8,039

1,187-54,436

posttest

0 _ _ _ 0 _ _ _ _


Pagina 19 van 49

5. DISCUSSION

In literature, the use of respiratory support was found to be a risk factor for CLABSI determined

by univariate logistic regression (p=0,02). (8) Although no significance could be proven in this

study, data nevertheless show that all CLABSI occurred in the population receiving respiratory

support, both in pretest as well as in posttest period.

Indication for placement of the CVC and more specifically indication for TPN , is in literature

described as a factor independently associated with CLABSI; duration of parenteral nutrition

(OR=1.04, 95 % CI (1.0;1.08)). (7) In this study, TPN as a risk factor shows no significance.

(p=0,816/p=0,696). All CLABSI do occur in the population with TPN, however, this is the main

indication so no conclusions can be made.

Literature indicates that dwell time is a significant predictor. The risk of catheter related

infections increases during the 2 weeks after central line insertion and remains elevated for

the catheter duration, with a predicted CLABSI rate over catheter dwell time of about 4/1000

central line days. (6) In this study, a significant result is visible only in posttest period (p=0,045

OR= 1,27 95% CI (1,003;1,266)). This can possibly be explained by the large number of patients

with very low birth weight (VLBW) <1000 grams in the posttest population. These patients are

more often in need of intravenous access.

Weight at the time of catheter insertion is proven to be a significant risk factor for CLABSI in

literature; extremely low weight (<1000g) at time of catheter insertion (OR=5.13 95% CI (2.1

;12.5)). (7) No significance could be withheld in this study.

There is evidence in literature that age at moment of insertion is a determining risk factor;

catheter insertion after first week of life (OR=2.7 95% CI (1.1;6.7)).(7) However, no significance

for age at moment at insertion catheter can be proven in this study.

Catheter hub colonization (OR=44.1 95% CI14.5;134.4)) (7), exit site colonization (OR=14.4 95

% CI (4.8;42.6)) (7), and luminal care are also important predictors for CLABSI. In this study,

PICC connection sterility showed a significant difference (p=0,006) in pretest with posttest

period comparison. This significant result was also visible in univariate logistic regression

(p=0,023 OR=0,079 95% CI (0,009;0,706)). When using a sterile PICC connection the risk of

infection is lower in the posttest period with a factor 0,079 compared to pretest period risk.

This difference can possibly be attributed to implementation of the care bundle in which

manipulation of the PICC catheter is extendedly documented.



OR=8,039 95% CI (1,187;54,436)). A comparison of pretest period with posttest period is not

possible since the implementation of the care bundle documented only to change dressings

in case of loosening, moist or visibly soiled dressing. (dry bloody dressing excluded). Hence

this was almost never executed in the posttest period. The elevated risk of developing

infection caused by reattaching the dressing is thus no longer present in the posttest period.


Pagina 20 van 49

In the comparison of pretest to posttest period, a significant result was achieved in the

category of birthweight <1500 grams (p=0,09). Univariate logistic regression confirmed this

(p=0,028 OR=0,78 95% CI (0,08;0,765)). The risk of developing a CLABSI was higher in posttest

than pretest period. Pretest population contained less patients with a VLBW. Literature shows

that infants admitted to NICU are at increased risk to developing CLABSI. In particular, very

low birth weight infants (<1500g) are at risk due to their compromised immunological defense

system and multiple invasive procedures. (5)

Temperature of NICU in pretest period shows to be a significant predictor (p=0,025/p=0,076).

Using univariate logistic regression, this significance is confirmed (p=0,033 OR=3,364 95% CI

(1,102;10,267)). This result is not confirmed in literature and can be explained by the period.

Pretest study took place in summer and temperature ranged from 25,1°C To 29,7°C.

Temperatures raising so high are not favorable.

There are several limitations regarding this study. Data of 43 cases in the pretest period and

27 cases in the posttest period are used to perform tests on 135 variables. The risk of

producing a type 1 error (false positive result) cannot be ignored.

Given the introduction of a checklist and observation form in the pretest period, it is possible

that some health care workers already gave more attention to these points and that a bias

was created.

Multivariate logistic analysis could not be executed because there were not enough patients

included in the study to test the variables in a model. Independent significance cannot be

reported.

During pretest period, a total of 37 cases was not included in the study. 361 catheterdays were

not monitored. During posttest period, a total of 27 cases was not included in the study. 291

catheterdays were not monitored.


Pagina 21 van 49

6. CONCLUSION

Given the fact that the studied sample size was too small, no significant results can be

displayed here. To evaluate this properly, a new study involving a bigger sample size and

extending over a longer period of time should be instated. However, it might be appropriate

to take some points into consideration. Although not significant, the fact that infection risk

decreases in posttest period when PICC connection is sterile shows that there might be a

positive effect of the implementation of the care bundle. This result in combination with

numerous significant results reported in literature should be an encouragement to keep using

the checklist and care bundle. The same conclusion can be made regarding the reattachment

of the dressing. Although not significant, there was an elevated risk to develop CLABSI in the

pretest period associated with the number of times a dressing was replaced. Due to

implementation of the care bundle, this action became almost obsolete in the posttest period,

thereby reducing the risk factor to develop CLABSI. In literature, catheter manipulation has

shown to be a main predictor for developing CLABSI. It is therefore worthwhile to maintain

the efforts to use the checklist and care bundle.


Pagina 22 van 49

ACKNOWLEDGMENT

I I’m very grateful to my promoter Prof.Dr. Filip Cools, Diensthoofd Neonatology UZ Brussels, for providing me with this subject and for guiding me through the preparation of my master’s thesis. I would also like to thank Mrs. Van Delft, Adjunct Head Nurse Neonatology UZ Brussels, for collecting all the data, development of the care bundle in collaboration with VIKA task force and for answering all of my numerous questions, even in her spare time. My special thanks also goes to my stepfather, François De Vos, for his advice on data processing. Further, I would like to thank my family and children for their patience and understanding.


Pagina 23 van 49

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https://www.ncbi.nlm.nih.gov/pubmed/?term=Helder%20OK%5BAuthor%5D&cauthor=true&cauthor_uid=20381804

https://www.ncbi.nlm.nih.gov/pubmed/?term=Brug%20J%5BAuthor%5D&cauthor=true&cauthor_uid=20381804

https://www.ncbi.nlm.nih.gov/pubmed/?term=Looman%20CW%5BAuthor%5D&cauthor=true&cauthor_uid=20381804

https://www.ncbi.nlm.nih.gov/pubmed/?term=van%20Goudoever%20JB%5BAuthor%5D&cauthor=true&cauthor_uid=20381804

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kornelisse%20RF%5BAuthor%5D&cauthor=true&cauthor_uid=20381804


https://www.ncbi.nlm.nih.gov/pubmed/?term=Smulders%20CA%5BAuthor%5D&cauthor=true&cauthor_uid=23615702

https://www.ncbi.nlm.nih.gov/pubmed/?term=van%20Gestel%20JP%5BAuthor%5D&cauthor=true&cauthor_uid=23615702

https://www.ncbi.nlm.nih.gov/pubmed/?term=Bos%20AP%5BAuthor%5D&cauthor=true&cauthor_uid=23615702



Pagina 26 van 49

25 Borghesi A1, Stronati M. Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit. J Hosp Infect. 2008 Apr;68(4):293-300. doi: 10.1016/j.jhin.2008.01.011. Epub 2008 Mar 7.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Borghesi%20A%5BAuthor%5D&cauthor=true&cauthor_uid=18329134

https://www.ncbi.nlm.nih.gov/pubmed/?term=Stronati%20M%5BAuthor%5D&cauthor=true&cauthor_uid=18329134



Pagina 27 van 49

APPENDIX 1: LIST OF ABBREVIATIONS

CLABSI Central line associated bloodstream infection NICU Neonatal intensive care unit VIKA Vragen incidenten klachten aanbevelingen task force (questions, incidents,

complaints recommendations) CVC Central venous catheter CDC Centers of diseases and prevention NHS National health service IHI Institute for healthcare improvement IV Intravenous UVC Umbilical venous catheter PICC Peripherally inserted central venous catheter TPN Total parenteral nutrition EOS Early onset infection SPSS 25 Statistical package for the social sciences version 25 CNS Coagulase negative Staphylococcus PROM Premature rupture of membranes VLBW Very low birth weight


Pagina 28 van 49

APPENDIX 2: APPROVAL MEDICAL ETHICAL COMMITTEE


Pagina 29 van 49


Pagina 30 van 49

APPENDIX 3: CHECKLIST


Pagina 31 van 49

APPENDIX 4: STATISTICAL DATA ANALYSIS CATEGORICAL VARIABLES

Seq Variable description Test type Variable value CLABSI Total n missing

values

% missing

values

Mode Total P

No Yes

N Row % Column % N Row % Column % N %

CHECKLIST

1 Gender Pretest Female 23 95,8 57,7 1 4,2 33,3 24 55,8% 0 0,0 Female 0,416

Male 17 89,5 42,3 2 10,5 66,7 19 44,2%

Posttest Female 10 90,9 47,6 1 9,1 16,7 11 40,7% 0 0,0 Male 0,154

Male 11 68,8 52,4 5 31,2 83,3 16 59,3%

2 Catheter type Pretest PICC single lumen 13 92,9 32,5 1 7,1 33,3 14 32,6% 0 0,0 UVC Umbilical venous catheter 0,734

PICC double lumen 4 100 10 0 0 0 4 9,3%

UVC Umbilical venous

catheter

23 92 57,5 2 8 66,7 25 58,1%

Posttest PICC single lumen 7 77,8 33,3 2 22,2 33,3 9 33,3% 0 0,0 UVC Umbilical venous catheter 0,555

PICC double lumen 3 60 14,3 2 40 33,3 5 18,5%

UVC Umbilical venous

catheter

11 84,6 52,4 2 15,4 33,3 13 48,1%

3 Use of sterile gloves by doctor Pretest Yes 39 92,9 100 3 7,1 100 42 100,0% 1 2,3 Yes

Posttest Yes 21 77,8 100 6 22,2 100 27 100,0% 0 0,0 Yes

4 Use of 2nd pair of sterile

gloves by doctor

Pretest No 22 95,7 64,7 1 4,3 33,3 23 62,2% 6 14,0 No 0,291

Yes 12 85,7 35,3 2 14,3 66,7 14 37,8%

Posttest Yes 21 77,8 100 6 22,2 100 27 100,0% 0 0,0 Yes

5 Drying time 30 sec Pretest Yes 30 93,8 100 2 6,3 100 32 100,0% 11 25,6 Yes

Posttest No 1 100 5 0 0 0 1 4,0% 2 7,4 Yes 0,499

Yes 19 79,2 95 5 20,8 100 24 96,0%

6 Sterile environment during

procedure

Pretest Yes 33 94,3 100 2 5,7 100 35 100,0% 8 18,6 Yes

Posttest No 1 100 5 0 0 0 1 3,8% 1 3,7 Yes 0,464

Yes 19 76 95 6 24 100 25 96,2%

7 Massage when moving katheter Pretest No 19 90,5 73,1 2 9,5 100 21 75,0% 15 34,9 No 0,273

Yes 7 100 26,9 0 0 0 7 25,0%

Posttest No 14 77,8 87,5 4 22,2 66,7 18 81,8% 5 18,5 No 0,280

Yes 2 50 12,5 2 50 33,3 4 18,2%

8 Bandage according to regulations Pretest Yes 37 92,5 100 3 7,5 100 40 100,0% 3 7,0 Yes

Posttest No 1 100 5,6 0 0 0 1 4,2% 3 11,1 Yes 0,443

Yes 17 73,9 94,4 6 26,1 100 23 95,8%

9 Bloody bandage Pretest No 24 96 77,4 1 4 50 25 75,8% 10 23,3 No 0,415

Yes 7 12,5 22,6 1 87,5 50 8 24,2%

Posttest No 16 80 94,1 4 20 66,7 20 87,0% 4 14,8 No 0,109

Yes 1 33,3 5,9 2 66,7 33,3 3 13,0%


Pagina 32 van 49


values

% missing

values

Mode Total P

No Yes


DATA BABY

10 Reason of admission to NICU Prestest PROM 5 100 12,5 0 0 0 5 11,6% 0 0 Prematurity 0,945

Prematurity 19 90,5 47,5 2 9,5 66,7 21 48,8%

Bad start 2 100 5 0 0 0 2 4,7%

IRDS 3 75 7,5 1 25 33,3 4 9,3%

Maternal herpes

infection

3 100 7,5 0 0 0 3 7,0%

Asphyxia 2 100 5 0 0 0 2 4,7%

IUGR 1 100 2,5 0 0 0 1 2,3%

Unstoppable labour 1 100 2,5 0 0 0 1 2,3%

Hyperbilirubinemia 2 100 5 0 0 0 2 4,7%

Suspicion colitis 1 100 2,5 0 0 0 1 2,3%

Chorio-amnionitis 1 100 2,5 0 0 0 1 2,3%

Posttest PROM 4 66,7 19 2 33,3 33,3 6 22,2% 0 0,0 Prematurity 0,583

Prematurity 9 75 42,9 3 25 50 12 44,4%

IRDS 2 100 9,5 0 0 0 2 7,4%

Asphyxia 2 100 9,5 0 0 0 2 7,4%

HELLP 1 50 4,8 1 50 17,7 2 7,4%

Esophageal fistula 2 9,5 7,4 0 0 0 2 7,4%

Hypoglycemia 1 100 4,8 0 0 0 1 3,7%

11 Respiratory support Pretest No 9 100 22,5 0 0 0 9 20,9% 0 0,0 Yes 0,226

Yes 31 91,2 77,5 3 8,8 100 34 79,1%

Posttest No 3 100 15 0 0 0 3 11,5% 1 3,7 Yes 0,194

Yes 17 26,1 85 6 73,9 100 23 88,5%

12 Respiratory support type Pretest Optiflow 5 100 16,1 0 0 0 5 14,7% 9 20,9 BCPAP 0,738

BCPAP 18 90 58,1 2 10 66,7 20 58,8%

NIV-NAVA 7 87,5 22,6 1 12,5 33,3 8 23,5%

VDR 1 100 3,2 0 0 0 1 2,9%

Posttest Optiflow 3 100 17,6 0 0 0 3 13,0% 4 14,8 BCPAP 0,620

BCPAP 7 77,8 41,2 2 22,2 33,3 9 39,1%

NIV-NAVA 2 66,7 11,8 1 33,3 16,7 3 13,0%

Invasive NAVA 4 66,7 23,5 2 33,3 33,3 6 26,1%

VDR 1 50 5,9 1 50 16,7 2 8,7%


Pagina 33 van 49


values

% missing

values

Mode Total P

No Yes


DATA NICU

13 Number of patiënts A side Pretest 4 4 100 10,3 0 0 0 4 9,5% 1 2,3 6 0,153

5 3 75 7,7 1 25 33,3 4 9,5%

6 15 100 38,5 0 0 0 15 35,7%

7 9 81,8 23,1 2 18,2 66,7 11 26,2%

8 8 100 20,5 0 0 0 8 19,0%

Posttest 5 1 50 5,9 1 50 25 2 9,5% 6 22,2 8 0,316

6 4 66,7 23,5 2 33,3 50 6 28,6%

7 3 100 17,6 0 0 0 3 14,3%

8 9 90 52,9 1 10 25 10 47,6%

14 Number of patiënts B side Pretest 2 3 100 7,7 0 0 0 3 7,1% 1 2,3 7 0,729

3 1 100 2,6 0 0 0 1 2,4%

4 3 100 2,6 0 0 0 3 7,1%

5 5 83,3 12,8 1 16,7 33,3 6 14,3%

6 11 100 28,2 0 0 0 11 26,2%

7 13 86,7 33,3 2 13,3 66,7 15 35,7%

8 2 100 5,1 0 0 0 2 4,8%

9 1 100 2,6 0 0 0 1 2,4%

Posttest 3 1 100 5,9 0 0 0 1 4,5% 5 18,5 6 0,457

5 4 66,7 23,5 2 33,3 40 6 27,3%

6 7 77,8 41,2 2 22,2 40 9 40,9%

7 1 50 5,9 1 50 22 2 9,1%

8 4 100 23,5 0 0 0 4 18,2%

15 Number of nurses Pretest 2 1 100 2,6 0 0 0 1 2,4% 1 2,3 5 0,861

4 3 100 7,7 0 0 0 3 7,1%

5 14 93,3 35,9 1 6,7 33,3 15 35,7%

6 14 93,3 35,9 1 6,7 33,3 15 35,7%

7 4 80 10,3 1 20 33,3 5 11,9%

8 3 100 7,7 0 0 0 3 7,1%

Posttest 3 2 66,7 12,5 1 33,3 20 3 14,3% 6 22,2 5 0,583

4 1 100 6,3 0 0 0 1 4,8%

5 7 77,8 43,8 2 22,2 40 9 42,9%

6 4 80 25 1 20 10 5 23,8%

7 0 0 0 1 100 20 1 4,8%

8 1 100 6,3 0 0 0 1 4,8%

9 1 100 6,3 0 0 0 1 4,8%


Pagina 34 van 49


values

% missing

values

Mode Total P

No Yes


16 Moment of the day Pretest 07:00-11:59 11 91,7 27,5 1 8,3 33,3 12 27,9% 0 0,0 14:00-16:59 0,466

12:00-13:59 6 100 15 0 0 0 6 14,0%

14:00-16:59 15 93,8 37,5 1 6,3 33,3 16 37,2%

17:00-20:59 2 66,7 5 1 33,3 33,3 3 37,2%

21:00-06:59 6 100 15 0 0 0 6 14,0%

Posttest 07:00-11:59 9 81,8 45 2 18,2 33,3 11 42,3% 1 3,7 07:00-11:59 0,587

12:00-13:59 3 60 15 2 40 33,3 5 19,2%

14:00-16:59 6 75 30 2 25 33,3 8 30,8%

17:00-20:59 2 100 10 0 0 0 2 7,7%

17 Number of Neonatologists present Pretest 0 11 100 27,5 0 0 0 11 25,6% 0 0,0 1 0,557

1 17 94,4 42,5 1 5,6 33,3 18 41,9%

2 7 87,5 17,5 1 12,5 33,3 8 18,6%

3 4 80 10 1 20 33,3 5 11,6%

4 1 100 2,5 0 0 0 1 2,3%

Posttest 0 1 100 5,6 0 0 0 1 4,2% 3 11,1 1 0,114

1 12 85,7 66,7 2 14,3 33,3 14 58,3%

2 3 42,9 16,7 4 57,1 66,7 7 29,2%

3 2 100 11,1 0 0 0 2 8,3%

18 Number of fellows present Pretest 0 20 90,9 50 2 9,1 66,7 22 51,2% 0 0,0 0 0,574

1 20 95,2 50 1 4,8 33,3 21 48,8%

Posttest 0 18 75 100 6 25 100 24 100,0% 3 11,1 0

19 Number of residents present Pretest 0 5 100 12,5 0 0 0 5 11,6% 0 0,0 2 0,735

1 15 93,8 37,5 1 6,3 33,3 16 37,2%

2 18 90 45 2 10 66,7 20 46,5%

3 2 100 5 0 0 0 2 4,7%

Posttest 0 1 100 5,6 0 0 0 1 4,2% 3 11,1 2 0,343

1 5 83,3 27,8 1 16,7 16,7 6 25,0%

2 9 64,3 50 5 35,7 83,3 14 58,3%

3 3 100 16,7 0 0 0 3 12,5%


Pagina 35 van 49


values

% missing

values

Mode Total P

No Yes


CATHETER PLACEMENT

20 Reason placement CVC Pretest First catheter 3 100 17,6 0 0 0 3 16,7% 25 58,1 Elective replacement 0,771

Elective replacement 13 92,9 76,5 1 7,1 100 14 77,8%

Bad position UVC 17 94,4 5,6 1 0 0 18 5,6%

Posttest First catheter 2 100 28,6 0 0 0 2 18,2% 16 59,3 Elective replacement 0,227

Replacement for the

sake of malfunction

1 33,3 14,3 2 66,7 50 3 27,3%

Elective replacement 4 66,7 57,1 2 33,3 50 6 54,4%

21 Indication Pretest TPN 34 91,9 85 3 8,1 100 37 86,0% 0 0,0 TPN 0,816

Long-term medication 2 100 5 0 0 0 2 4,7%

Peripheral infusion

impossible 1 100 2,5 0 0 0 1 2,3%

TPN + medication 3 100 7,5 0 0 0 3 7,0%

Posttest TPN 17 77,3 89,5 5 22,7 83,3 22 88,0% 2 7,4 TPN 0,696

TPN + medication 2 66,7 10,5 1 33,3 16,7 3 12,0%

22 Blood culture Pretest No 25 96,2 64,1 1 3,8 33,3 26 61,9% 1 2,3 No 0,298

Yes 14 87,5 35,9 2 12,5 66,7 16 38,1%

Posttest No 9 81,8 47,4 2 18,2 33,3 11 44,0% 2 7,4 Yes 0,542

Yes 10 71,4 52,6 4 28,6 66,7 14 56,0%

23 Blood culture result Pretest Negative 13 86,7 100 2 13,3 100 15 100,0% 28 65,1 Negative

Posttest Negative 10 71,4 100 4 28,6 100 14 100,0% 13 48,1 Negative

24 Lumbar punction performed Pretest No 38 92,7 97,4 3 7,3 100 41 97,6% 1 2,3 No 0,698

Yes 1 100 2,6 0 0 0 1 2,4%

Posttest No 19 76 100 6 24 100 25 100,0% 2 7,4 No

25 Lumbar punction result Pretest Negative 1 100 100 1 100,0% 42 97,7 Negative

Posttest

26 Catheter placement by a

neonatologist

Pretest No 27 93,1 69,2 2 6,9 66,7 29 69,0% 1 2,3 No 0,927

Yes 12 7,7 30,8 1 92,3 33,3 13 31,0%

Posttest No 7 87,5 36,8 1 12,5 16,7 8 32,0% 2 7,4 Yes 0,335

Yes 12 70,6 63,2 5 29,4 83,3 17 68,0%

27 Catheter placement by a fellow Pretest No 28 90,3 71,8 3 9,7 100 31 73,8% 1 2,3 No 0,168

Yes 11 100 28,2 0 0 0 11 26,2%

Posttest No 19 76 100 6 24 100 25 100,0% 2 7,4

28 Catheter placement by a resident Pretest No 19 95 48,7 1 5 33,3 20 47,6% 1 2,3 Yes 0,603

Yes 20 90,9 51,3 2 9,1 66,7 22 52,4%

Posttest No 8 80 42,1 2 20 33,3 10 40,0% 2 7,4 Yes 0,700

Yes 11 73,3 57,9 4 26,7 66,7 15 60,0%

29 Number of attempts neonatologist Pretest 0 18 90 60 2 10 66,7 20 60,6% 10 23,3 0 0,896

1 11 91,7 36,7 1 8,3 33,3 12 36,4%

4 1 100 3,3 0 0 0 1 3,0%

Posttest 0 7 77,8 36,8 2 22,2 33,3 9 36,0% 2 7,4 1 0,578

1 9 69,2 47,4 4 30,8 66,7 13 52,0%

2 2 100 10,5 0 0 0 2 8,0%

3 1 100 5,3 0 0 0 1 4,0%


Pagina 36 van 49


values

% missing

values

Mode Total P

No Yes


30 Number of attempts fellow Pretest 0 15 88,2 57,7 2 11,8 100 17 60,7% 15 34,9 0 0,351

1 8 100 30,8 0 0 0 8 28,6%

2 3 100 11,5 0 0 0 3 10,7%

Posttest 0 19 76 100 6 24 100 25 100,0% 2 7,4

31 Number of attempts resident Pretest 0 11 100 35,5 0 0 0 11 33,3% 10 23,3 1 0,282

1 16 88,9 51,6 2 11,1 100 18 54,5%

2 4 100 12,9 0 0 0 4 12,1%

Posttest 0 8 80 44,4 2 20 33,3 10 41,7% 3 11,1 1 0,322

1 9 75 50 3 25 50 12 50,0%

2 1 100 5,6 0 0 0 1 4,2%

3 0 0 0 1 100 16,7 1 4,2%

32 Total number of attempts Pretest 1 28 90,3 71,8 3 9,7 100 31 73,8% 1 2,3 1 0,593

2 9 100 23,1 0 0 0 9 21,4%

3 1 100 2,6 0 0 0 1 2,4%

4 1 100 2,6 0 0 0 1 2,4%

Posttest 1 12 80 66,7 3 20 50 15 62,5% 3 11,1 1 0,666

2 4 66,7 22,2 2 33,3 33,3 6 25,0%

3 1 50 5,6 1 50 16,7 2 8,3%

4 1 100 5,6 0 0 0 1 4,2%

33 Use of a new needle during second Pretest

attempt

No 5 100 50 5 50,0% 33 76,7 No = Yes

Yes 5 100 50 5 50,0%

Posttest No 18 75 100 6 25 100 24 100,0% 3 11,1 No

34 Reason use of new needle Pretest Not mentionned 1 100 33,3 1 33,3% 40 93,0 Not mentionned = Mandrin

first catheter broken

Mandrin 1st catheter

broken 1 100 33,3

1 33,3%

Guide bent 1 100 33,3 1 33,3%

34 Reason use of new needle Posttest 27 100,0

35 Catheter placement succesfull Pretest Yes 17 94,4 100 1 5,6 100 18 100,0% 25 58,1 Yes

Posttest Yes 8 66,7 100 4 33,3 100 12 100,0% 15 55,6 Yes

36 Place catheter Pretest Vena cephalica hand 1 100 5,9 0 0 0 1 5,6% 25 58,1 Other vena back of hand 0,836

Other vena back of hand 8 88,9 47,1 1 100 5,6 9 50,0%

Vena cephalica lower

arm 4 100 23,5 0 0 0 4 22,2%

Vena dorsalis pedis 2 100 11,8 0 0 0 2 11,1%

Vena saphena leg 2 100 11,8 0 0 0 2 11,1%

Posttest Vena cephalica hand 2 100 25 0 0 0 2 16,7% 15 55,6 Vena saphena leg 0,325

Other vena back of hand 1 100 12,5 0 0 0 1 8,3%

Vena axillaris upper arm 1 50 12,5 1 50 25 2 16,7%

Vena dorsalis pedis 0 0 0 1 100 25 1 8,3%

Vena saphena leg 2 50 25 2 50 50 4 33,3%

Vena temporalis head 1 100 12,5 0 0 0 1 8,3%

Vena cubitalis 1

100 12,5 0 0 0 1 8,3%


Pagina 37 van 49


values

% missing

values

Mode Total P

No Yes


PERIOD BEFORE PLACEMENT CATHETER

37 Number of doctors

assisting placement

Pretest 0 4 80 13,3 1 20 33,3 5 15,2% 10 23,3 1 0,838

1 13 92,9 43,3 1 7,1 33,3 14 42,4%

2 12 92,3 40 1 7,7 33,3 13 39,4%

3 1 100 3,3 0 0 0 1 3,0%

Posttest 0 10 83,3 52,6 2 16,7 33,3 12 48,0% 2 7,4 1 0,405

1 9 69,2 47,4 4 30,8 66,7 13 52,0%

38 Doctor 1 medical hat Pretest Yes 40 93 100 3 7 100 43 100,0% 0 0,0 Yes

Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes 0,453

39 Doctor 2 medical hat Pretest No 1 50 6,7 1 50 100 2 12,5% 27 62,8 Yes 0,030

Yes 14 100 93,3 0 0 0 14 87,5%

Posttest Yes 9 69,2 100 4 30,8 100 13 100,0% 14 51,9 Yes

40 Doctor 3 medical hat Pretest Yes 1 100 100 1 100,0% 42 97,7 Yes

Posttest 0 27 100,0

41 Doctor 1 mouth mask Pretest Yes 40 93 100 3 7 100 43 100,0% 0 0,0 Yes

Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes

42 Doctor 2 mouth mask Pretest Yes 15 93 100 1 6,3 100 16 100,0% 27 62,8 Yes

Posttest Yes 9 69,2 100 4 30,8 100 13 100,0% 27 100,0 Yes

43 Doctor 3 mouth mask Pretest Yes 1 100 100 1 100,0% 42 97,7 Yes

Posttest 0 27 100,0

44 Doctor 1 hand hygiene Pretest Yes 39 92,9 97,5 3 7,1 100 42 97,7% 0 0,0 Yes 0,702

Unknown 1 100 2,5 0 0 0 1 2,3%

Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,7 Yes

45 Doctor 2 hand hygiene Pretest No 1 100 6,3 1 6,3% 27 62,8 Yes

Yes 14 100 87,5 14 87,5%

Unknown 16 100 6,3 16 6,3%

Posttest Yes 9 75 100 3 25 75 12 92,3% 14 51,9 Yes 0,110

Unknown 0 0 0 1 100 25 1 7,7%

46 Doctor 3 hand hygiene Pretest Yes 1 100 100 1 100,0% 42 97,7 Yes

Posttest 0 27 100,0

47 Doctor 1 hand hygiene type Pretest Water and soap 3 100 7,7 0 0 0 3 7,1% 1 2,3 Hand alcohol 0,123

Hand alcohol 21 100 53,8 0 0 0 21 50,0%

Unknown 1 100 2,6 0 0 0 1 2,4%

Water + soap + hand

alcohol

14 82,4 35,9 3 17,6 100 17 40,5%

Posttest Water and soap 0 0 0 1 100 16,7 1 4,0% 2 7,4 Hand alcohol= Water + soap + hand

alcohol

0,197

Hand alcohol 9 75 47,4 3 25 50 12 48,0%

Water + soap + hand

alcohol

10 83,3 52,6 2 16,7 33,3 12 48,0%

48 Doctor 2 hand hygiene type Pretest Water and soap 3 100 20 3 20,0% 28 65,1 Hand alcohol

Hand alcohol 6 100 40 6 40,0%

Unknown 2 100 13,3 2 13,3%

Water + soap + hand

alcohol

4 100 26,7 4 26,7%

Posttest Water and soap 0 0 0 1 100 25 1 7,7% 14 51,9 Hand alcohol 0,053

Hand alcohol 5 71,4 55,6 2 28,6 50 7 53,8%

Unknown 0 0 0 1 100 25 1 7,7%

Water + soap + hand

alcohol

4 100 44,4 0 0 0 4 30,8%


Pagina 38 van 49


values

% missing

values

Mode Total P

No Yes


49 Doctor 3 hand hygiene type Pretest Water + soap + hand

alcohol

1 100 100 1 100,0% 42 97,7 Water + soap + hand alcohol

Posttest 0 27 100,0

50 Duration hand hygiene doctor 1

(min)

Pretest 1,5 5 100 14,7 0 0 0 5 13,5% 6 14,0 2,0 0,625

2 25 89,3 73,5 3 10,7 100 28 75,5%

2,5 2 100 5,9 0 0 0 2 5,4%

3 2 100 5,9 0 0 2 5,4%

Posttest 1 1 50 5,9 1 50 20 2 9,1% 5 18,5 2,0 0,421

1,5 2 100 11,8 0 0 0 2 9,1%

2 12 75 70,6 4 25 80 16 72,7% 2,0

3 2 100 11,8 0 0 0 2 9,1%


(min)

Pretest 1 1 100 9,1 1 9,1% 32 74,4 2,0

1,5 3 100 27,3 3 27,3%

2 7 100 63,6 7 63,6%

Posttest 1 0 0 0 1 100 50 1 14,3% 20 74,1 2,0 0,085

2 5 83,3 100 1 16,7 50 6 85,7%


(min)

Pretest 1 1 100 100 1 100,0% 42 97,7 1,0

Posttest 0 27 100,0

53 Sterile apron doctor 1 Pretest Yes 40 93 100 3 7 100 43 100,0% 0 0,0 Yes

Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes

54 Sterile apron doctor 2 Pretest No 2 66,7 14,3 1 33,3 100 3 20,0% 28 65,1 Yes 0,060

Yes 12 100 85,7 0 0 0 12 80,0%

Posttest Yes 9 69,2 100 4 30,8 100 13 100,0% 14 51,9 Yes

55 Sterile apron doctor 3 Pretest Yes 1 100 100 1 100,0% 42 97,7 Yes

Posttest 0 27 100,0

56 Number of people surrounding

patient, except doctors placing

catheter

Pretest 1 15 100 53,6 0 0 0 15 50,0% 13 30,2 1 0,203

2 9 90 32,1 1 10 50 10 33,3%

3 4 80 14,3 1 20 50 5 16,7%

Posttest 1 8 80 44,4 2 20 33,3 10 41,7% 3 11,1 1 0,115

2 3 42,9 16,7 4 57,1 66,7 7 29,2%

3 5 100 27,8 0 0 0 5 20,8%

4 1 100 5,6 0 0 0 1 4,2%

5 1 100 5,6 0 0 1 1 4,2%

57 Mouth mask surrounding people Pretest Yes 30 93,8 100 2 6,3 100 32 100,0% 11 25,6 Yes

Posttest No 1 100 5,6 0 0 0 1 4,2% 3 11,1 Yes 0,443

Yes 17 73,9 94,4 6 26,1 100 23 95,8% Yes

58 Hand hygiene nurse Pretest Yes 38 92,7 100 3 7,3 100 41 100,0% 2 4,7 Yes

Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes

59 Hand hygiene nurse type Pretest Water and soap 2 66,7 5,4 1 33,3 33,3 3 7,5% 3 7,0 Hand alcohol 0,075

Hand alcohol 20 100 54,1 0 0 0 20 50,0%

Water + soap + hand

alcohol

15 88,2 40,5 2 11,8 66,7 17 42,5%

Posttest Water and soap 1 100 5,6 0 0 0 1 4,3% 4 14,8 Water + soap + hand alcohol 0,590

Hand alcohol 7 70 38,9 3 30 60 10 43,5%

Water + soap + hand

alcohol

10 83,3 55,6 2 16,7 40 12 52,2%

60 Mouth mask nurse Pretest Yes 39 92,9 100 3 7,1 100 42 100,0% 1 2,3 Yes

Posttest Yes 18 75 100 6 25 100 24 100,0% 3 11,1 Yes


Pagina 39 van 49


values

% missing

values

Mode Total P

No Yes


61 Cleaning medical table Pretest Yes 38 92,7 100 3 7,3 100 41 100,0% 2 4,7 Yes

Posttest Yes 19 79,2 100 5 20,8 100 24 100,0% 3 11,1 Yes

62 Cleaning medical table: product Pretest Incidin foam 36 92,3 94,7 3 7,7 100 39 95,1% 2 4,7 Incidin foam 0,856

Chlorhexidine 1 100 2,6 0 0 0 1 2,4%

Incidin wipes 1 100 2,6 0 0 0 1 2,4%

Posttest Incidin foam 18 85,7 94,7 3 14,3 60 21 87,5% 3 11,1 Incidin foam 0,102

Chlorhexidine 0 0 0 1 100 20 1 4,2%

Incidin wipes 1 50 5,3 1 50 20 2 8,3%

63 Medical table setup: place Pretest Desk 14 100 35 0 0 0 14 32,6% 0 0,0 Patiënt 0,206

Patiënt 23 88,5 57,5 3 11,5 100 26 60,5%

Bath 3 100 7,5 0 0 0 3 7,0%

Posttest Desk 10 76,9 52,6 3 23,1 60 13 54,2% 3 11,1 Desk 0,467

Patiënt 6 75 31,6 2 25 40 8 33,3%

Bath 3 100 15,8 0 0 0 3 12,5%

64 Medical table desterilisation Pretest No 34 91,9 94,4 3 8,1 100 37 94,9% 4 9,3 No 0,566

Unknown 2

17

100

77,3

5,6 0

100 5

0

22,7

0 2

100 22

5,1%

100,0%

Posttest No 5 18,5 No

65 Medical table desterilisation: type Pretest 0 43 100,0

Posttest 0 27 100,0

66 Medical table desterilisation:

mechanism

Pretest

0 43 100,0

Posttest 0 27 100,0

67 Disturbance during medical table

setup

Pretest No 34 94,4 89,5 2 5,6 66,7 36 87,8% 2 4,7 No 0,333

Yes 2 66,7 5,3 1 33,3 33,3 3 7,3%

Unknown 2 100 5,3 0 0 0 2 4,9%

Posttest No 16 76,2 88,9 5 23,8 100 21 91,3% 4 14,8 No 0,310

Yes 2 100 11,1 0 0 0 2 8,7%

68 Disturbance during medical table

setup: type

Pretest Microclave missing 1 100 50 0 0 0 1 33,3% 40 93,0 Conversation colleague 0,306

Conversation colleague 1 50 50 1 50 100 2 66,7%

Posttest Material missing 1 100 50 1 50,0% 25 92,6 Material missing = Passage

transportshuttle

Pasage transportshuttle 2 100 50 2 100,0%

69 Hand hygiene after interruption Pretest No 1 50 25 1 50 100 2 40,0% 38 88,4 No= Unknown 0,328

Yes 1 100 25 0 0 0 1 20,0%

Unknown 2 100 50 0 0 0 2 40,0%

Posttest Yes 2 100 100 2 100,0% 25 92,6 Yes

70 Hand hygiene after interruption:

type

Pretest Hand alcohol 1 100 100 1 42 97,7 Hand alcohol

Posttest Hand alcohol 2 100 100 2 25 92,6 Hand alcohol


Pagina 40 van 49


values

% missing

values

Mode Total P

No Yes


PERIOD DURING CATHETER PLACEMENT

71 Baby in bag Pretest No 14 87,5 66,7 2 12,5 100 16 69,6% 20 46,5 No 0,216

Yes 7 100 33,3 0 0 0 7 30,4%

Posttest No 8 100 80 0 0 0 8 66,7% 15 55,5 No 0,022

Yes 2 50 20 2 50 100 4 33,3%

72 Umbilical opening widened Pretest No 1 100 14,3 1 14,3% 36 83,7 Yes

Yes 5 100 41,4 5 41,4%

Unknown 1 100 14,3 1 14,3%

Posttest Yes 1 33,3 100 2 66,7 100 3 100,0% 24 88,9 Yes

73 Disinfection umbilical region:

product

Pretest Chlorhexidine 0,5% 30 90,9 78,9 3 9,1 100 33 80,5% 2 4,7 Chlorhexidine 0,5% 0,244

Hibidil 8 100 21,1 0 0 0 8 19,5%

Posttest Chlorhexidine 0,5% 16 80 88,9 4 20 66,7 20 83,3% 3 11,1 Chlorhexidine 0,5% 0,232

Hibidil 2 50 11,1 2 50 33,3 4 16,7%

74 Disinfection umbilical region:

mechanism

Pretest Doctor disinfects

insertion place

6 100 16,2 0 0 0 6 15,0% 3 7,0 Nurse disinfects insertion

place, doctor proceeds and

disinfects again

0,044

Nurse disinfects insertion

place, doctor proceeds

12 100 32,4 0 0 0 12 30,0%



and disinfects again

19 90,5 51,4 2 9,5 66,7 21 52,5%

Nurs holds limb, doctor

disinfects and proceeds

0 0 0 1 100 33,3 1 2,5%

Posttest Doctor disinfects

insertion place

1 33,3 6,3 2 66,7 33,3 3 13,6% 5 18,5 Nurse disinfects insertion

place, doctor proceeds and

disinfects again

0,271



6 75 37,5 2 25 33,3 8 36,4%



and disinfects again

8 88,9 50 1 11,1 16,7 9 40,9%

Nurs holds limb, doctor

disinfects and proceeds

1 50 6,3 1 50 16,7 2

75 New pair of sterile gloves

after disinfection insertion place

Pretest No 23 95,8 62,2 1 4,2 33,3 24 60,0% 3 7,0 No 0,332

Yes 14 87,5 37,8 2 12,5 66,7 16 40,0%

Posttest No 3 75 18,8 1 25 16,7 4 18,2% 5 18,5 Yes 0,255

Yes 13 76,5 81,3 4 23,5 66,7 17 77,3%

Unknown 0 0 0 1 100 16,7 1 4,5%

76 Sterile field: size Pretest Completely sealed,

attached to skin

4 100 11,1 0 0 0 4 10,3% 4 9,3 Completely sealed, not

attached to skin

0,394

Completely sealed, not

attached to skin

26 89,7 72,2 3 100 7,7 29 74,4%

Not sealed around limb,

non sterile surface

underneath not visible

6 100 16,7 0 0 0 6 15,4%

Posttest Completely sealed,

attached to skin

4 100 23,5 0 0 0 4 17,4% 4 14,8 Completely sealed, not

attached to skin

0,077

Completely sealed, not

attached to skin

13 72,2 76,5 5 27,8 83,3 18 78,3%

Not sealed around limb,

non sterile surface

underneath not visible

0 0 0 1 100 16,7 1 4,3%


Pagina 41 van 49


values

% missing

values

Mode Total P

No Yes


77 Number of catheter reinstatements Pretest 0 18 94,7 58,1 1 5,3 33,3 19 55,9% 9 20,9 0 0,731

1 9 81,8 29 2 18,2 66,7 11 32,4%

2 1 100 3,2 0 0 0 1 2,9%

3 2 100 6,5 0 0 0 2 5,9%

5 1 100 3,2 0 0 0 1 2,9%

Posttest 0 7 77,8 50 2 22,2 40 9 47,4% 8 29,6 0 0,410

1 5 62,5 35,7 3 37,5 60 8 42,1%

2 2 100 14,3 0 0 0 2 10,5%

78 Number of catheter purging Pretest 0 1 100 7,7 0 0 0 1 7,1% 29 67,4 1 0,759

1 7 87,5 53,8 1 12,5 100 8 57,1%

2 3 100 23,1 0 0 0 3 21,4%

4 2 100 15,4 0 0 0 2 14,3%

Posttest 0 3 60 37,5 2 40 50 5 41,7% 15 55,6 0 0,391

1 1 100 12,5 0 0 0 1 8,3%

2 2 50 25 2 50 50 4 33,3%

4 2 100 25 0 0 0 2 16,7%

79 Catheter movement flawless Pretest No 8 100 25 0 0 0 8 22,9% 8 18,6 Yes 0,391

Yes 23 88,5 71,9 3 11,5 100 26 74,3%

Unknown 1 100 3,1 0 0 0 1 2,9%

Posttest No 4 80 26 1 20 20 5 25,0% 7 25,9 Yes 0,762

Yes 11 73,3 73,3 4 26,7 80 15 75,0%

80 Problems when moving catheter Pretest Bumps against liver 2 100 25 2 25,0% 35 81,4 No reflu = unknown

No reflu 3 100 37,5 3 37,5%

Unknown 3 100 37,5 3 37,5%

Posttest Moved, slipped back 0 0 0 1 100 100 1 25,0% 23 85,2 Difficult to move forward 0,105

Difficult to move forward 2 100 66,7 0 0 0 2 50,0%

Replacement Seldinger 1 100 33,3 0 0 0 1 25,0%

81 Massage during catheter Pretest

movement

No 7 87,5 46,7 1 12,5 100 8 50,0% 27 62,8 No 0,484

Yes 7 100 46,7 0 0 0 7 43,8%

Unknown 1 100 6,7 0 0 0 1 6,3%

Posttest No 7 70 87,5 3 30 75 10 83,3% 15 55,6 No 0,592

Yes 1 50 12,5 1 50 25 2 16,7%


Pagina 42 van 49


values

% missing

values

Mode Total P

No Yes


PREPARATION PERFUSION LINES

82 Preparation perfusion lines: hand

Pretest hygiene

Yes 34 91,9 97,1 3 8,1 100 37 97,4% 5 11,6 0,683

Unknown 1 100 2,9 0 0 0 1 2,6%

Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4

83 Hand hygiene preparation Pretest

perfusion lines: type

Water and soap 1 100 3 0 0 0 1 2,8% 7 16,3 Hand alcohol 0,358

Hand alcohol 23 88,5 69,7 3 11,5 100 26 72,2%

Water + soap + hand

alcohol

9 100 27,3 0 0 0 9 25,0%

Posttest Hand alcohol 15 78,9 78,9 4 21,1 66,7 19 76,0% 2 7,4 Hand alcohol 0,549

Water + soap + hand

alcohol

4 66,7 21,1 2 33,3 33,3 6 24,0%

84 Preparation perfusion lines: Pretest

disinfection medical table proceeding

preparation of perfusion lines

No 4 100 11,1 0 0 0 4 10,3% 4 9,3 Yes 0,651

Yes 31 91,2 86,1 3 8,8 100 34 87,2%

Unknown 1 100 2,8 0 0 0 1 2,6%

Posttest No 1 100 5,3 0 0 0 1 4,0% 2 7,4 Yes 0,453

Yes 18 75 94,7 6 25 100 24 96,0%

85 Preparation perfusion lines: Pretest

disinfection medical table type

Incidin foam 29 90,6 93,5 3 9,4 100 32 94,1% 9 20,9 Incidin foam 0,537

Incidin wipes 2 100 6,5 0 0 0 2 5,9%

Posttest Incidin foam 17 77,3 94,4 5 22,7 83,3 22 91,7% 3 11,1 Incidin foam 0,425

Incidin wipes 1 50 5,6 1 50 16,7 2 8,3%

86 Preparation perfusion lines: mouth

Pretest mask nurse

No 1 100 2,8 0 0 0 1 2,6% 4 9,3 Yes 0,848

Yes 34 91,9 94,4 3 8,1 100 37 94,9%

Unknown 1 100 2,8 0 0 0 1 2,6%

Posttest No 1 100 5,3 0 0 0 1 4,0% 2 7,4 Yes 0,453

Yes 18 75 94,7 6 25 100 24 96,0%

87 Preparation perfusion lines: use of

Pretest sterile field

Yes 36 92,3 100 3 7,7 100 39 100,0% 4 9,3 Yes

Posttest Yes 18 75 100 6 25 100 24 100,0% 3 11,1 Yes

88 Prepartion perfusion lines: use of

Pretest sterile material

No 1 100 2,8 0 0 0 1 2,6% 4 9,3 Yes 0,713

Yes 32 91,4 88,9 3 8,6 100 35 89,7%

Unknown 3 100 8,3 0 0 0 3 7,7%

Posttest Yes 17 73,9 100 6 26,1 100 23 100,0% 4 14,8 Yes

89 Preparation perfusion lines: purging

Pretest according to regulations

No 1 100 2,8 0 0 0 1 2,6% 5 11,6 Yes 0,795

Yes 32 94,1 88,9 2 5,9 100 34 89,5%

Unknown 3 100 8,3 0 0 0 3 7,9%

Posttest No 1 100 5,9 0 0 0 1 4,3% 4 14,8 Yes 0,431

Yes 16 72,7 94,1 6 27,3 100 22 95,7%


Pagina 43 van 49


values

% missing

values

Mode Total P

No Yes


90 Preparation perfusion lines: purging Pretest

product

Physiological serum 12 100 33,3 0 0 0 12 30,8% 4 9,3 TPN + physiological serum 0,445

TPN + physiological

serum

13 86,7 36,1 2 13,3 66,7 15 38,5%

Glucose 10% and

physiological serum

10 90,9 27,8 1 9,1 33,3 11 28,2%

Glucose 10% 1 100 2,8 0 0 0 1 2,6%

Posttest Physiological serum 3 60 18,8 2 40 33,3 5 22,7% 5 18,5 TPN + physiological serum 0,260

TPN 0 0 0 1 100 16,7 1 4,5%

TPN + physiological

serum

9 90 56,3 1 10 16,7 10 45,5%

Glucose 10% and

physiological serum

3 75 18,8 1 25 16,7 4 18,2%

Glucose 10% 1 50 6,3 1 50 16,7 2 9,1%

91 Preparation perfusion lines: nurse

Pretest absent

No 28 93,3 80 2 6,7 100 30 81,1% 6 14,0 No 0,649

Yes 6 100 17,1 0 0 0 6 16,2%

Unknown 1 100 2,9 0 0 0 1 2,7%

Posttest No 15 75 88,2 5 25 83,3 20 87,0% 4 14,8 No 0,764

Yes 2 66,7 11,8 1 33,3 16,7 3 13,0%

92 Preparation perfusion lines: Pretest number of

times nurse absent

1 1 100 33,3 1 33,3% 40 93,0 1=2=3

2 1 100 33,3 1 33,3%

3 1 100 33,3 1 33,3%

Posttest 1 1 100 50 0 0 0 1 33,3% 24 88,9 1=2=3 0,148

2 1 100 50 0 0 0 1 33,3%

3 0 0 0 1 100 100 1 33,3%


Pretest hygiene after

interruption

No 1 100 25 1 25,0% 39 90,7 Yes

Yes 3 100 75 3 75,0%

Posttest Yes 1 50 100 1 50 100 2 100,0% 25 92,6 Yes


Pretest hygiene after

interruption: type

Hand alcohol 3 100 100 3 100,0% 40 93,0 Hand alcohol

Posttest Hand alcohol 1 100 100 0 0 0 1 50,0% 25 92,6 Hand alcohol=Water + soap +

hand alcohol

0,096

Water + soap + hand

alcohol

0 0 0 1 100 100 1 50,0%


Pagina 44 van 49


values

% missing

values

Mode Total P

No Yes


BANDAGE

95 Umbilical cord stomp clean Pretest No 7 87,5 21,9 1 12,5 33,3 8 22,9% 8 18,6 Yes 0,664

Yes 25 92,6 78,1 2 7,4 66,7 27 77,1%

Posttest No 2 100 13,3 0 0 0 2 10,0% 7 25,9 Yes 0,269

Yes 13 72,2 86,7 5 27,8 100 18 90,0%

96 Bandage type Pretest Bridging to secure UVC 8 100 42,1 0 0 0 8 38,1% 22 51,2 Bridging to secure UVC +

steristrip

0,302

Bridging to secure UVC +

steristrip

10 83,3 52,6 2 16,7 100 12 57,1%


steristrip + attached to

skin

1 100 5,3 0 0 0 1 4,8%

Posttest Bridging to secure UVC 3 100 37,5 0 0 0 3 30,0% 17 63,0 Bridging to secure UVC +

steristrip

0,201


steristrip

5 71,4 62,5 2 28,6 100 7 70,0%

97 Tegaderm 5 x 5 cm Pretest No 4 100 25 0 0 0 4 23,5% 26 60,5 Yes 0,456

Yes 12 92,3 75 1 7,7 100 13 76,5%

Posttest Yes 8 66,7 100 4 33,3 100 12 100,0% 15 55,5 Yes

98 Tegarderm oval Pretest No 1 100 6,3 0 0 0 1 5,9% 26 60,5 Yes 0,724

Yes 15 93,8 93,8 1 6,3 100 16 94,1%

Posttest Yes 8 66,7 100 4 33,3 100 12 100,0% 15 55,6 Yes

99 Tegafilm Pretest No 15 93,8 93,8 1 6,3 100 16 94,1% 26 60,5 No 0,724

Yes 1 100 6,3 0 0 0 1 5,9%

Posttest No 7 63,6 100 4 36,4 100 11 100,0% 16 59,3 No

100 Cut tegaderm Pretest No 14 93,3 87,5 1 6,7 100 15 88,2% 26 60,5 No 0,611

Yes 2 100 12,5 0 0 0 2 11,8%

Posttest No 7 63,6 100 4 36,4 100 11 100,0% 16 59,3 No

101 Bandage: protective dressing under Pretest

PICC connection

Yes 16 100 100 16 100,0% 27 62,8 Yes

Posttest No 1 100 12,5 0 0 0 1 8,3% 15 55,6 Yes 0,355

Yes 7 63,6 87,5 4 36,4 100 11 91,7%

102 PICC connection piece sterile Pretest No 0 0 0 1 100 50 1 2,6% 5 11,6 Yes 0,011

Yes 36 97,3 100 1 2,7 50 37 97,4%

Posttest Yes 17 73,9 100 6 26,1 100 23 100,0% 4 14,8 Yes

103 Perfusion instantly ready for Pretest

connection

Yes 35 94,6 100 2 5,4 100 37 100,0% 6 14,0 Yes

Posttest Yes 16 72,7 100 6 27,3 100 22 100,0% 5 18,5 Yes

104 Perfusion: method of connection Pretest Doctor holds catheter

end, nurse makes

connection

30 93,8 93,8 2 6,3 100 32 94,1% 9 20,9 Doctor holds catheter end,

nurse makes connection

0,617

Doctor holds catheter

end, than takes clean

perfusion line and makes

connection

2 100 6,3 0 0 0 2 5,9%

Posttest Doctor holds catheter

end, nurse makes

connection

13 68,4 100 6 31,6 100 19 100,0% 8 29,6 Doctor holds catheter end,

nurse makes connection


Pagina 45 van 49


values

% missing

values

Mode Total P

No Yes


CHECK

105 RX control Pretest Yes 38 92,7 100 3 7,3 100 41 100,0% 2 4,7 Yes

Posttest Yes 19 76 100 6 24 100 25 100,0% 2 7,4 Yes

106 Catheter repositioning Pretest No 16 88,9 41 2 11,1 66,7 18 42,9% 1 2,3 Yes 0,389

Yes 23 95,8 59 1 4,2 33,3 24 57,1%

Posttest No 9 64,3 47,4 5 35,7 83,3 14 56,0% 2 7,4 No 0,107

Yes 10 90,9 52,6 1 9,1 16,7 11 44,0%

107 Catheter repositioning: mechanism Pretest Doctor still sterile 11 100 57,9 0 0 0 11 55,0% 23 53,5 Doctor still sterile 0,333

Hand hygiene and sterile

gloves by doctor

6 85,7 31,6 1 14,3 100 7 35,0%

Use of sterile gloves by

doctor, no hand hygiene

performed

2 100 10,5 0 0 0 2 10,0%

Posttest Doctor still sterile 3 100 33,5 0 0 0 3 30,0% 17 63,0 Hand hygiene and sterile

gloves by doctor

0,090

Doctor again sterile 1 100 11,1 0 0 0 1 10,0%

Hand hygiene and sterile

gloves by doctor

5 100 55,6 0 0 0 5 50,0%

Use of sterile gloves by

doctor, no hand hygiene

performed

0 0 0 1 100 100 1 10,0%

108 Catheter repositioning: disinfection Pretest

insertion place before catheter repositioning

No 9 90 47,4 1 10 100 10 50,0% 23 53,5 No=Yes 0,230

Yes 10 100 52,6 0 0 0 10 50,0%

Posttest No 1 100 16,7 0 0 0 1 14,3% 20 74,1 Yes 0,563

Yes 5 83,3 83,3 1 16,7 100 6 85,7%

109 Catheter repositioning: new Pretest

bandage

No 8 100 44,4 0 0 0 8 42,1% 24 55,8 Yes 0,287

Yes 10 90,9 55,6 1 9,1 100 11 57,9%

Posttest Yes 5 83,3 100 1 16,7 100 6 100,0% 21 77,8 Yes

MANIPULATIONS

110 Month Manipulations catheter Pretest January 10 100 25,6 0 0 0 10 23,8% 1 2,3 December 0,459

February 4 100 10,3 0 0 0 4 9,5%

March 5 100 12,8 0 0 0 5 11,9%

May 3 75 7,7 1 25 33,3 4 9,5%

June 5 83,3 12,8 1 16,7 33,3 6 14,3%

December 12 92,3 30,8 1 7,7 33,3 13 31,0%

Posttest January 8 100 38,1 0 0 0 8 30,8% 1 3,7 November 0,085

February 4 100 19 0 0 0 4 15,4%

October 2 66,7 9,5 1 33,3 20 3 11,5%

November 6 60 28,6 4 40 80 10 38,5%

December 1 100 4,8 0 0 0 1 3,8%

111 N Reattaching bandage Pretest 0 30 100 90,9 0 0 0 30 85,7% 8 18,6 0 0,013

1 1 50 3 1 50 50 2 5,7%

2 2 66,7 6,1 1 33,3 50 3 8,6%

Posttest 0 27 100,0


Pagina 46 van 49


values

% missing

values

Mode Total P

No Yes


INFECTION

112 Catheter infection: type Pretest S. Capitis 2 100 66,7 2 66,7% 40 93,0 S. Capitis

Clinical 1 100 33,3 1 33,3%

Posttest S. Capitis 2 100 33,3 2 33,3% 21 77,8 S. Epidermis

S. Epidermis 3 100 50 3 50,0%

S. Capitis + S. Epidermis 1 100 16,7 1 16,7%

EXTRA

113 Catheter type Pretest PICC 17 94,4 42,5 1 5,6 33,3 18 41,9% 43 0,0 UVC 0,754

UVC 23 92 57,5 2 8 66,7 25 58,1%

Posttest PICC 10 71,4 47,6 4 28,6 66,7 14 51,9% 27 0,0 UVC 0,406

UVC 11 84,6 52,4 2 15,4 33,3 13 48,1%

114 Reason Admission Pretest PROM 5 100 12,5 0 0 0 5 11,6% 43 0,0 Prematurity 0,650

Prematurity 23 92 57,5 2 8 66,7 25 58,1%

Respiratory 3 75 7,5 1 25 33,3 4 9,3%

Infection 5 100 12,5 0 0 0 5 11,6%

Other 2 100 5 0 0 0 2 4,7%

Asphyxia 2 100 5 0 0 0 2 4,7%

Posttest PROM 4 66,7 19 2 33,3 7,4 6 22,2% 27 0,0 Prematurity 0,378

Prematurity 10 71,4 47,6 4 28,6 66,7 14 51,9%

Respiratory 2 100 9,5 0 0 0 2 7,4%

Other 3 100 14,3 0 0 0 3 11,1%

Asphyxia 2 100 9,5 0 0 0 2 7,4%

115 Moment of the day Pretest Morning 11 91,7 27,5 1 8,3 33,3 12 27,9% 0 0,0 Afternoon 0,794

Afternoon 21 95,5 52,5 1 4,5 33,3 22 51,2%

Evening 8 88,9 20 1 11,1 33,3 9 20,9%

Posttest Morning 9 81,8 45 2 18,2 33,3 11 42,3% 1 3,7 Afternoon 0,447

Afternoon 9 69,2 45 4 30,8 66,7 13 50,0%

Evening 2 100 10 0 0 0 2 7,7%

116 N Disinfection clave Pretest <3 5 100 13,5 0 0 0 5 12,5% 3 7,0 3-46 0,311

3-46 30 93,8 81,1 2 6,3 66,7 32 80,0%

47-90 1 50 2,7 1 50 33,3 2 5,0%

>91 1 100 2,7 0 0 0 1 2,5%

Posttest 3-46 17 94,4 94,4 1 5,6 25 18 81,8% 5 18,5 3-46 0,003

47-90 1 25 5,6 3 75 13,6 4 18,2%

117 N administration medication Pretest <2 17 100 45,9 0 0 0 17 42,5% 3 7,0 2-13 0,195

2-13 17 89,5 45,9 2 10,5 66,7 19 47,5%

14-25 2 66,7 5,4 1 33,3 33,3 3 7,5%

26-37 1 100 2,7 0 0 0 1 2,5%

Posttest <2 7 100 33,3 0 0 0 7 26,9% 1 3,7 2-13 0,200

2-13 8 88,9 38,1 1 11,1 20 9 34,6%

14-25 4 66,7 19 2 33,3 40 6 23,1%

26-37 1 50 4,8 1 50 20 2 7,7

38-63 1 50 4,8 1 50 20 2 7,7

118 Birth weight (gram) Pretest 0-1499 17 94,4 42,5 1 5,6 33,3 18 41,9% 0 0,0 >1500 0,754

>1500 23 92 57,5 2 8 66,7 25 58,1%

Posttest 0-1499 8 57,1 38,1 6 42,9 100 14 51,9% 0 0,0 0-1499 0,002

>1500 13 100 61,9 0 0 0 13 41,8%


Pagina 47 van 49


values

% missing

values

Mode Total P

No Yes


119 Duration catheter period Pretest 0-3 7 100 17,5 0 0 0 7 16,3% 0 0,0 4-9 0,382

4-9 29 93,5 72,5 2 6,5 66,7 31 72,1%

>9 4 80 10 1 20 33,3 5 11,6%

Posttest 0-3 5 100 23,8 0 0 0 5 18,5% 0 0,0 4-9 0,001

4-9 11 100 52,4 0 0 0 11 40,7% >9

>9 5 45,5 23,8 6 54,5 100 11 40,7%

120 Gestational Age (weeks) Pretest 0-24,6 1 100 2,5 0 0 0 1 2,3% 0 0,0 33-36,6 0,664

25-28,6 11 91,7 27,5 1 8,3 33,3 12 27,9%

29-32,6 9 100 22,5 0 0 0 9 20,9%

33-36,6 15 93,8 37,5 1 6,3 33,3 16 37,2%

37-42,6 4 80 10 1 20 33,3 5 11,6%

Posttest 0-24,6 3 75 14,3 1 25 16,7 4 14,8% 0 0,0 25-28,6 0,122

25-28,6 4 50 19 4 50 66,7 8 29,6%

29-32,6 6 85,7 28,6 1 14,3 16,7 7 25,9%

33-36,6 3 100 14,3 0 0 0 3 11,1%

37-42,6 5 100 23,8 0 0 0 5 18,5%

121 N connecting line Pretest <37 36 94,7 97,3 2 5,3 66,7 38 95,0% 3 7,0 <37 0,090

37-73 1 50 50 1 50 33,5 2 5,0%

Posttest <37 17 85 81 3 15 60 20 76,9% 1 3,7 <37 0,634

37-73 2 66,7 9,5 1 33,3 20 3 11,5%

>73 2 66,7 9,5 1 33,3 20 3 11,5%


Pagina 48 van 49

APPENDIX 5: STATISTICAL DATA ANALYSIS QUANTITATIVE

VARIABLES

No: No CLABSI Yes: CLABSI P Mann Withney U test

N

Median Minimum Maximum

Percentiles

N


Valid Missing 25 75 Valid Missing

Duration procedure (min) Prestest

Posttest

35 5

18 3

45,0

32,5

15,0 78,0

15,0 120,0

30,0 50,0

26,5 48,8

2,0

6,0

1,0

0,0

27,5 15,0

35,0 30,0

40,0

65,0 0,192

0,673

Gestational age (weeks, days) Pretest

Posttest

40 0

21 0

32,5

32,3

24,0 40,2

24,0 39,4

28,5 35,1

26,6 37,1

3

6 0

0 33,1 28,5

26,6 24,1

38,0

29,6 0,668

0,057

Birth weight (grams) Prestest

Posttest

40 0

21 0

1753

2035

695 3035

595 4370

1005 2386 845

2725 3

6

0

0

2415 900 838

725 4663

1330 0,396

0,049

Age at moment of cateher insertion (days) Pretest

Posttest 40 0

20 1

0

1

0 12

0 98

0 3

0 7

3

6

0

0

0 0

5 0

6

17 0,875

0,533

Weight at moment of catheter insertion (grams) Prestest

Posttest 39 1

20 1

1770

1942

695 3035

667 4370

872 2328

1006 2513

3

6 0

0

2415 855 924

800 4663

1150 0,371

0,046

Birthweight - weight catheter insertion Pretest

Posttest 39 1

20 1

0

0

-350 107 0

1675 -60 0 0

174 3

6 0

0 0 0

64 0

45

345 0,255

0,533

Temperature NICU (°C) Prestest

Posttest

37 3

14 7

27,0

27,3

25,1 29,7

26,6 28,1

26,6 27,6

26,9 27,8

3

6

0

0

29,2 27,6

26,7 26,2

29,6

28,3 0,025

0,076

Humidity NICU (%) Pretest

Posttest

36 4

12 9

29,8

31,0

22,8 41,6

21,7 42,0

27,5 32,8

27,3 35,7

3

6

0

0

31,0 29,8

33,7 29,3

33,0

35,5 0,464

0,750

Humidity incubator (%) Pretest

Posttest

38 2

19 2

54,5

50,0

0,0 85,0

0,0 75,0

41,8 65,0 0,0

63,0 3

6

0

0

46,0 0,0

60,0 0,0

46,0

70,0 0,120

0,221

Labo CRP (mg/dl) Prestest

Posttest

34 6

18 3

0,5

0,5

0,5 44,0

0,5 23,0

0,5 1,0

0,5 1,4

3

6

0

0

8,1 0,5

1,0 0,5

10,4

193,0 0,165

0,454

Labo WBC (x10³/mm³) Pretest

Posttest

36 4

17 4

9,6

14,0

3,1 64,7

2,6 48,8

5,9 13,6

8,4 26,1

3

5

0

1

11,9 4,9

15,1 4,6

18,2

22,2 0,823

0,820

Hemoglobin (g/dl) Prestest

Posttest

36 4

17 4

16,1

14,9

1,5 22,0

8,8 19,0

13,0 17,6

11,6 15,7

3

5

0

1

14,8 12,2

11,6 8,3

16,2

16,9 0,433

0,704

Depth catheter (cm) Pretest

Posttest

38 2

18 3

10,3

12,3

5,0 23,5

5,5 23,0

8,0 18,5

7,8 15,0

3

6

0

0

12,0 10,0

10,8 7,0

13,0

18,0 0,906

1,000

Start procedure - start table preparation (min) Pretest

Posttest 29 11

15 6

5,0

5,0 0,0 85,0

0,0 30,0

0,5 16,5

0,0 15,0

2

4 1

2 7,5 5,0

7,5 5,0

10,0

20,0 1,000

0,530

Duration medical table setup (min) Prestest

Posttest 34 6

17 4

3,0

2,0 2,0 75,0

2,0 10,0

2,0 5,0

2,0 5,0

3

5 0

1 5,0 5,0

3,0 2,0

7,0

4,0 0,183

0,880

Disinfection umbilical region: diameter (cm) Pretest

Posttest 35 5

12 9

5,0

5,0

1,0 11,0

3,0 15,0

4,0 6,0

4,3 9,0

3

5

0

1 5,0 4,0

5,0 5,0

10,0

10,0 0,959

0,646

Perfusion: Time of preservation before connection (min) Prestest

Posttest 32 8

15 6

20,0

20,0

1,0 180,0 0,0

60,0 10,0 45,0 5,0

30,0 2

6 1

0

21,5 3,0 32,5

10,0 40,0

75,0 0,602

0,267

Time difference catheter placement - RX control (min) Pretest

Posttest 25 15

12 9

10,0

6,0 0,0 70,0

0,0 30,0

9,5 20,0

5,0 13,8

3

6

0

0

15,0 10,0 7,5

5,0 40,0

20,0 0,622

0,750

Catheter repositioning: distance (cm) Prestest

Posttest 36 4

11 10

1,0

0,0 0,0 4,0

0,0 3,0

0,0 1,5

0,0 2,0

3

5

0

1 0,0 0,0

0,0 0,0

0,5

0,0 0,249

0,441

Time difference catheter repositioning - catheter placement

(min) Pretest

Posttest 18 22

7 14 12,5

35,0

0,0 185,0

0,0 240,0

8,8 41,3 5,0 120,0 1

1

2

5 16,0 16,0 1,0

1,0 16,0

1,0 0,737

0,500

Appendix 5 -Page 1 of 2


Pagina 49 van 49

No: No CLABSI Yes: CLABSI P Mann Withney U test

N


Percentiles

N


Valid Missing 25 75 Valid Missing

N Rinsing clave Prestest 37 3 6 0 123 2 14 3 0 10 3 60 0,461

Posttest 21 0 8 0 195 4 30 5 1 53 23 254

0,015 N Administration of medication Pretest 37 3 4 0 31 0 7 3 0 4 2 17

0,401

Posttest 21 0 2 0 58 1 16 5 1 22 3 63

0,028 N Disinfection clave Prestest 37 3 7 0 93 3 14 3 0 6 3 66

0,847

Posttest 21 0 13 3 165 10 32 5 1 54 35 272

0,015 N Connecting line Pretest 37 3 4 0 61 3 10 3 0 2 2 46

0,809

Posttest 21 0 10 4 160 8 19 5 1 35 29 228

0,012 N deconnecting line Prestest 37 3 1 0 57 0 4 2 1 22 2 42

0,243

Posttest 21 0 9 1 161 7 25 4 2 28 18 223

0,057 Duration catheter period (days) Pretest 40 0 6 1 42 4 8 3 0 8 8 31

0,028

Posttest 21 0 7 2 29 4 10 6 0 18 10 65

0,003

Appendix 5 -Page 2 of 2

effe tiveness of the implementation of insertion and ... · effectiveness of the implementation of...

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