Patient safety: Practice and barriers to adherence to central line care bundle among doctors at a national referral hospital

Abstract

Background: Safety in central line care is crucial to prevent Central Line Associated Blood Stream Infections (CLABSI), a key aspect of 21st-century healthcare and the Sustainable Development Goals (SDGs). Implementing the Central Line Bundle, which includes insertion and maintenance protocols, is essential for reducing CLABSI rates. Adherence to this bundle varies, averaging 62% in middle- and low-income countries, but higher adherence rates of up to 95% are needed to effectively reduce CLABSI. Various personal and institutional factors affect adherence, which can differ by environment, prompting the need for this study in our local setting. 

Objective: This study aimed to assess the current level of adherence to all components of central line insertion bundle among doctors at a national referral hospital in Kenya and determine barriers to adherence to the bundle among doctors.

Methods: This mixed-method study combined quantitative aspects (retrospective chart review, cross-sectional survey) and qualitative aspects (in-depth interviews). Conducted in the adult ICU, renal unit, and specific wards (renal and oncology) at a national referral hospital it reviewed central line insertion records from October 1 to December 31, 2023. The study took place over three months in 2024. Data on central line practices were abstracted from patient files using a checklist. A self-administered questionnaire assessed adherence to the central line bundle challenges, completed by doctors in the identified units. Additionally, 12 doctors (Medical Officers, residents, and consultants) were interviewed using a guide, with responses analyzed thematically. Descriptive data was summarized in frequency tables and percentages, and adherence to each bundle component was calculated. 

Results: Eighty two participants were recruited for the cross-sectional surveys; 85 records were reviewed and 12 in-depth interviews were conducted. The overall self-reported adherence to the central line bundle was 59.3% while that from the retrospective chart review was 4.7%. Specific components of the bundle showed varying levels of adherence, with hand hygiene exhibiting the highest self-reported adherence at 89%, while maximal barrier techniques recorded the lowest adherence in the retrospective chart review at 3.5%. The overall knowledge score was 82.72%. Various factors were identified as barriers to adherence to the bundle such as: lack of training, lack of organizational policies, lack of supplies, work constraints and attitudes towards adherence. 

Conclusion: Adherence to the Central line bundle was low compared to other studies. There were various factors barring adherence to the bundle. This study highlights the need to address the identified barriers in order to increase adherence to the bundle and consequently promote patient safety.