Construction Of Evidence-based Protocol For Prevention Of Central Venous Catheter-related Infection In Burns

Objectives:1.To know the general situation of burns and the puncture rate and infection rate of central venous catheter in three years of Yunnan Burn Institute.2.To construct evidence-based practice for prevention central venous catheter-related infection in burns through the methods of evidence-based and Delphi,this provides a reference for clinical continuous quality improvement/implementation research.Methods:1.According to the criteria of inclusion and exclusion,the case data of burns admitted to the Burn Institute of the second affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were selected.The information collected included the burns’ gender,age,burn area,burn cause,outcome,hospitalization days,the number of burns’ CVC puncture,the positive number of culture at the tip of CVC;the number of burns’ CRI,SPSS 22 was used for descriptive analysis.2.An evidence-based practice for prevention of central venous catheter-related infection in burns was preliminarily constructed through five steps,including team building,problem determination,literature retrieval,literature quality evaluation,and evidence extraction.Set up a medical team of 9 people;Develope normative evidence-based questions based on the PIPOST format;Comprehensive computerized retrieval of clinical practice guidelines website,professional society website,evidence-based medicine database,synthesis database;Searching for guidelines,systematic review,evidence summary,expert consensus,original studies on prevention of central venous catheter-related infections in burns,and guidelines in common patients(patients with intact skin and need central venous catheter);Two researchers conducted quality evaluation and evidence extraction of the included literature,the quality evaluation of clinical practice guidelines use AGREE II to evaluate,the quality evaluation of systematic review,randomized controlled trials,quasi-experimental trials,cohort studies,and expert consensus used the evaluation tool for the authenticity of various literatures launched by JBI Evidence-Based Healthcare Center(2016)to evaluate,evidence summary traced its original literature and selected the corresponding JBI evaluation tools for quality evaluation according to the original literature type;Relevant evidence was extracted from the included literature,and the classification of evidence was determined by using the JBI Pre-ranking System(2014 edition).3.Fifteen burn experts inside and outside the province were invited to participate in two rounds of expert letter consultation.In the first round,the importance of each item of the preliminarily constructed evidence-based practice was scored,and then the second round of expert consultation was formed according to experts opinions and group discussion,the second round evaluated the importance of the modified items and increased the judgment of the feasibility of the items.Results:1.The number of burns in Yunnan Burn Institute was large every year,among which hydrothermal burns was the main ones,males were more than females,and most of them were between 0 and 10 years old.Most of the burned area was 0 to 10%,87.3%recovered or improved after treatment,the length of hospital stay was usually 1 to 10 days.The rate of CVC puncture was 3.89%in burns,28.60%in severe burns,and the rate of CRI was 29.33%.2.A total of 16 literatures were included.There were 9 literatures on burn patients,including 1 clinical practice guideline,1 systematic review,2 evidence summary,1 expert consensus,3 quasi-experimental trials,and 1 case series study.There were 7 literatures for common patients,including 6 clinical practice guidelines and 1 industry standard,and an evidence-based practice consisting of 48 items in five aspects,including assessment,puncture,maintenance,extubation,human resources and training and education,was initially formed.3.After two rounds of expert letters,expert opinions tended to be consistent,the recovery rate of the two rounds of expert letters was 100%.In the end,an evidence-based protocol for prevention of central venous catheter-related infection in burns,consisting of 55 items in five aspects,including assessment,puncture,maintenance,extubation,human resources and training and education,was formed,among which 27 items were strongly recommended(A)and 28 items were weakly recommended(B).Conclusions:1.The number of burns is large every year,so we should strengthen the knowledge of burn prevention and first aid,especially to avoid hydrothermal burns in children under 10 years old.2.This study strictly followed evidence-based methodology,and the protocol was constructed through literature retrieval,literature screening,literature quality evaluation,evidence extraction and rating,then improving the protocol by the Delphi method,and finally,an evidence-based protocol for prevention of central venous catheter-related infection in burns was formed,which included 55 evidences from five aspects of assessment,puncture,maintenance,extubation,human resources and training and education,of which 27 were strongly recommended(A)and 28 were weakly recommended(B).This protocol was scientific and feasible,and can provide reference for the clinical prevention of central venous cathter-related infection in burns.