Barrier analysis of evidence-based practice for the prevention and management of central line-associated bloodstream infections (CLABSI) in pediatric non-ICU patients
儿科非ICU患者中心静脉导管相关性血流感染预防与管理循证实践的障碍因素分析

摘要

目的 了解儿科非ICU患者中心静脉导管相关性血流感染（CLABSI）预防与管理的临床现状，分析循证实践过程中的障碍因素，探讨应对策略。方法 检索汇总证据后确立审查指标，基线审查后根据i-PARIHS模型分析障碍因素。结果 基线审查结果显示，24项指标中有19项依从性低于90%，其中3项为0%。基于i-PARIHS框架分析揭示，主要障碍因素分布于：（1）变革层面：如抗生素封管等证据未充分本土化，缺乏标准化流程与工具（如置管核查表）；（2）变革接受者层面：医护人员相关知识更新不足、对流程认知存在偏差、患者教育成效有限；（3）组织环境层面：部分关键流程（如造口护理与导管操作隔离、每日导管评估）未纳入常规，物资支持与多学科评估机制不完善。结论 儿科非ICU患者CLABSI防控管理循证实践障碍因素多种，制定以变革接受者为中心的改进策略并建立有效的激励反馈机制，推动最佳证据应用临床。

Abstract

Objective To assess the current clinical status of prevention and management of Central line-associated bloodstream infection (CLABSI) in pediatric non-ICU patients, analyze the barriers in the evidence-based practice process, and explore corresponding strategies.
Methods Evidence was reviewed and summarized to establish audit criteria. Following a baseline audit, barriers were analyzed using the i-PARIHS model.
Results The baseline audit revealed that compliance for 19 out of 24 indicators was below 90%, with 3 indicators showing 0% compliance. Analysis using the i-PARIHS model identified key barriers across three domains: (1) Innovation : Insufficient localization of evidence (e.g., antibiotic lock therapy) and a lack of standardized procedures and tools (e.g., catheterization checklists); (2) Recipients : Inadequate knowledge updates among healthcare workers, perceptual biases regarding procedures, and limited effectiveness of patient education; (3) Organizational environment : Failure to routinely integrate critical procedures (e.g., isolating stoma care from catheter manipulation, daily catheter assessment), coupled with insufficient material support and inadequate multidisciplinary evaluation mechanisms.
Conclusion   Multiple barriers hinder evidence-based practice in CLABSI prevention and management in pediatric non-ICU patients. Developing strategies focused on the recipients of change and establishing effective incentive and feedback mechanisms are essential to promote the translation of best evidence into clinical practice.