Why is it that internists do not follow guidelines for preventing intravascular catheter infections?
Why is it that internists do not follow guidelines for preventing intravascular catheter infections?
复制标题
为什么内科医生不遵循预防血管内导管感染的指南？
DOI：
10.1086/502579
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Diette,GregoryB
中科院分区：
文献类型：
--
作者：
Rubinson,Lewis;Wu,AlbertW;Haponik,EdwardE;Diette,GregoryB
Background and ObjectiveHigh morbidity of CVC-related infections has led to national guidelines for their prevention. Despite recommendations for the use of maximal barrier precautions (mask, sterile gloves, gown, and large drape) and skin antisepsis with 2% Chlorhexidine gluconate during CVC insertion, internists in the United States are not implementing these practices frequently. This study sought to identify and characterize the obstacles to and potential opportunities for improving adherence.DesignCross-sectional survey.ParticipantsOne thousand randomly selected physician-members of the American College of Physicians-American Society of Internal Medicine.MethodsSeveral potential determinants of adherence to maximal barrier precautions were assessed, including awareness of, agreement with, and ability to implement the recommendation, as well as the practice and training characteristics of the respondents. Factors influencing antiseptic selection were also recorded.ResultsOf 526 respondents, 178 (34%) had recently inserted CVCs. Clinician experience and subspecialty, awareness of CDC guidelines, and external influences (eg, time to collect equipment) did not affect maximal barrier precautions adherence. The only independent predictor of adherence was high outcome expectancy for the use of large sterile drapes (OR, 5.3; CI95, 2.2-12.6). Availability had the greatest influence on internists' selection of specific antiseptic agents, whereas cost was the least important determinant.ConclusionsDespite established efficacy, use of maximal barrier precautions and Chlorhexidine gluconate is low among internists. Because improved adherence to these practices will require increased outcome expectancy for maximal barrier precautions and availability of Chlorhexidine gluconate, targeting these areas through focused education and systems modifications is essential (Infect Control Hosp Epidemiol 2005;26:525-533).
