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Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

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Open Access   Full Text Article                                                                                                                                                                                            Research Article 

How is the practice of nurses in preventing infection of central venous catheters in hospitalized patients?-Nurse knowledge and attitudes

Santa Manurung¹*, Yupita Dewi²

¹ Department of Nursing, Health Polytechnic of Jakarta III, Jakarta, Indonesia

² Nursing, Dharmais Cancer Hospital, Jakarta, Indonesia

INTRODUCTION

Hospitals can be a repository of various diseases that occur in patients and visitors with career status. The success of a hospital in fulfilling its responsibilities is marked by an increase in the quality of hospital services.^1,2

Infection control is a parameter for high-quality health care, infections that occur as a result of the process of disseminating health services to their source, either by all patient staff or from other sources. Hospital inpatient rooms as one of the hospital facilities are closely related as a source of infection. This is because patient care involves many parties, such as doctors, nurses, medical devices and public officials who work in the field of inpatients. Hospital health service quality standards always depend on the structure, processes and outcomes of the hospital service system. Quality standards for hospital health services can also be assessed based on the level of use of service facilities by the community, service quality and hospital efficiency.^3–5

Central venous catheter (CVC) placement is a routine procedure performed in intensive and perioperative therapy. In the United States, more than 150 million intravenous catheters are used each year, of which 5 million are placed in central veins.^6,7 Based on observations at Dharmais Cancer Hospital there were 54 insertion of central venous catheters in the intensive care unit, 325 insertion of central venous catheters in the elective operating room and a total of 306 insertion of central venous catheters in the diagnostic treatment room from July to December 2019.

Insertion of a central venous catheter has many benefits, including the measurement of hemodynamic variables that cannot be measured accurately by non-invasive methods and which can be used to administer drugs and nutritional supplements that cannot be safely administered via a peripheral venous catheter. Unfortunately, 15% of central venous catheter use is associated with unforeseen complications. Mechanical complications are reported in 5-19% of patients, infection in 5-26% of patients and thrombosis in 2-26%.^8–10

Nurses have a duty to help clients achieve optimal health and independent living through the recovery process with minimal cost, time and energy. Therefore, in this case, nurses must be able to treat central venous catheter wounds in accordance with the development of science and technology so that infection does not occur. Wound care is the daily care of nurses in the ward, especially in the medical-surgical treatment room. Nurses must have sufficient practical knowledge and skills related to the nursing process based on global assessments, plan appropriate interventions, take action and evaluate the results found during care and document the results systematically.^11–13

Knowledge is the most important and most important basis for health professionals when implementing health services. Nurses as health professionals who are primarily responsible for care services and for the implementation of holistic and global care must have a high level of knowledge and skills in the nursing profession, including the prevention of central venous catheter wound infections. The attitude of the nurse is an inner reaction that arises and is obtained based on her knowledge. Knowledge and attitude greatly influence a person's behavior. Knowledge, attitude, and practice of a nurse must be considered in an effort to prevent infection of central venous catheter wounds. Increased efforts to prevent and control wound infections in central venous catheters require supportive attitudes towards change for the better, especially for nurses.^14–16

MATERIALS AND METHODS

The research design was descriptive correlational, aiming to analyze the relationship between knowledge and attitudes with the practice skills of nurses who treat wounds to prevent infection of central venous catheter wounds at Dharmais Cancer Hospital. The data were taken using the cross sectional method, where the data were obtained by observing the independent variable and the dependent variable simultaneously. The population and sample were 69 nurses with a Diploma III education level in the Teratai and Cempaka inpatient rooms at Dharmais Cancer Hospital, with a total sampling technique.

The instrument used in the form of a questionnaire, namely for nurses knowledge about central venous catheter wound care, nurses attitudes towards infection prevention and for nurses' practice in central venous catheter wound care. Data analysis using chi-square.

RESULT

Table 1. Frequency distribution of respondents based on their characteristics

Table 1 shows that all respondents in this study had a Diploma III education level. Most of them have a working period of 1 – 5 years as many as 36 people (52%). Of the 69 respondents, most of them were female, as many as 48 nurses (69.6%) and most of them were in the age range of 25-40 years, namely 49 nurses (71%).

Table 2. Frequency distribution of nurse knowledge

Table 2 shows that, most of the nurses in the criteria of good knowledge are 49 nurses (71%) and enough knowledge is as many as 20 nurses (29%).

Table 3. Frequency distribution of nurse attitude

Table 3 shows that, most of the nurses in the criteria of good attitude were 65 nurses (94%) and 4 nurses had enough attitude (6%).

Table 4. Frequency distribution of nurse practice in central venous catheter wound care

Table 4 shows that, most of the nurses in 2 criteria, namely good practice as many as 49 nurses (71%) and enough practice as many as 20 nurses (29%).

Table 5. Chi-square analysis of the relationship between knowledge and nursing practice

Based on table 5, it can be seen that, the results of the correlation test indicate that the p-value is 0.002 (p<0.05), so there is a significant relationship between knowledge and practice of nurses on efforts to prevent infection of central venous catheter wounds.

Table 6. Chi-square analysis of the relationship between attitude and nursing practice

Based on table 6, it can be seen that, the results of the correlation test indicate that the p-value is 0.001 (p<0.05), so there is a significant relationship between attitude and practice of nurses on efforts to prevent infection of central venous catheter wounds.

DISCUSION

The level of knowledge is closely related to one's education and experience, where a nurse with high education and supported by good work experience will make the nurse understand the cognitive aspects of an object.^17,18

Based on the results of the study, there was a significant relationship between knowledge and practice of nurses on efforts to prevent infection of central venous catheter wounds. This is supported by the results of the study which showed that most of the respondents had good knowledge about prevention of central venous catheter wound infection, namely 49 nurses (71%). Knowledge is very influential on a person's attitudes and actions, in the sense that the better the respondent's knowledge about preventing central venous catheter wound infection, the better the respondent's attitude towards efforts to prevent central venous catheter wound infection.

Knowledge or cognitive is dominant which is very important for the formation of one's actions because from experience and research it turns out that behavior based on knowledge will be more lasting than behavior that is not based on knowledge. Knowledge generally comes from the senses that occur through the human senses, namely the senses of sight, hearing, smell, taste and touch. Knowledge included in the cognitive domain has 6 levels, including knowing (know) is defined as remembering a material that has been studied previously, understanding (comprehension) is defined as an ability to explain correctly about known objects, and can interpret the material correctly, application (application) is the ability to use the material that has been studied in real situations or conditions, analysis (analysis) is a component to describe material or an object into components, but it is still in an organizational structure and is still related to each other, synthesis (synthesis) refers to an ability to create or connect parts in a new whole form, and evaluation (evaluation) is related to the ability to make an assessment of a material or object.¹⁹

Based on the results of the study, there was a significant relationship between the attitude of nurses and the practice of nurses towards efforts to prevent infection of central venous catheter wounds. This is supported by the results of the study which showed that most of the attitudes of nurses towards the prevention of central venous catheter wound infection were in the good attitude category, as many as 65 nurses (94%).

Attitude is an individual's tendency to make a closed response to certain stimuli or objects in the surrounding environment. Attitude is still a readiness or willingness to act, not implementing certain motives or in other words attitude is not yet an action or activity. This can be caused by the education level of the respondents, most of whom have a D3 Nursing educational background, where the higher the education level of a person, the better the level of knowledge and creates a positive attitude towards the application of prevention of central venous catheter wound infection.^20,21 This is also in accordance with Notoatmodjo's theory which suggests that education is a change in human beings so that education is one of the factors that can influence a person's perception to make it easier to make decisions and act.¹⁹

CONCLUSION

Based on the results of the study, it can be concluded that there is a relationship between the level of knowledge and attitudes of nurses in wound care to the practice of nurses in preventing wound infections in patients with central venous catheters in hospitals.

ACKNOWLEDGEMENTS

The authors thank all participants and research assistants who have participated in conducting the research.

CONFLICT OF INTEREST

The author declared that don’t have conflict of interest

ETHICAL CLEARANCE

This research has received ethical approval from the Research Ethics Committee, Dharmais Cancer Hospital No.092/KEPK/VIII/2020.

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