A mobile application-based post-stroke care strategy for survivors and their caregivers for prevention and management of post-stroke complications - "Stroke Home Care:" Development and feasibility.

Objectives: In developing nations such as India, a disparity exists between the available resources for stroke rehabilitation and the substantial burden of stroke cases. Consequently, the provision of cost-effective and multidisciplinary post-stroke rehabilitation care to stroke survivors becomes of paramount importance. The utilization of mobile applications (apps) for stroke care has been on the rise, offering a personalized and pragmatic solution with the potential for wider reach in settings constrained by limited resources. To address the unmet needs in the prevention and management of post-stroke complications, we conceptualized a strategy known as a mobile application-based post-stroke care strategy for both survivors and their caregivers. Materials and Methods: The scope of the app's focus was determined based on the incidence of post-stroke complications within a prospective cohort of stroke patients, in conjunction with existing literature. An initial "web-based mobile app" prototype was crafted to align with the identified focus area. Before the development of the final app version, a feasibility study was conducted involving 30 participant dyads (comprising a patient and a caregiver). Content validity was evaluated by a panel of 20 stroke experts encompassing neurologists, nurses, physiotherapists, and psychologists. Results: The "Stroke Home Care" (SHC) mobile app was conceived as a web-based educational tool aimed at preventing and managing post-stroke complications. It seeks to train caregivers of immobile stroke patients in the administration of preventive and therapeutic care procedures, thereby potentially enhancing survivors' quality of life and alleviating caregivers' burden. The feasibility and validity studies indicated "high satisfaction" levels among most caregivers and experts (>75%), with the remainder expressing "satisfaction" and no "dissatisfaction" regarding app utilities. Stroke experts unanimously deemed the app "appropriate", with consensus on contents, video quality, video length, and voice clarity. Caregivers reported "satisfactory" user experiences, encountering no issues during app installation or operation. Suggestions from both caregivers and experts were integrated into the final app version. Conclusion: The "SHC" app represents a feasible and well-received innovation tailored for the use by caregivers of stroke survivors. Consequently, the initial feasibility of the developed app serves as a precursor to a randomized controlled clinical trial aimed at substantiating its effectiveness within the post-stroke survivor and caregiver population. Notably, within resource-constrained contexts, this app has the potential to be a pivotal tool for post-stroke care.

Perception and Attitude of Health Care Personnel Regarding Integration of Nursing Education and Nursing Services for Patient Care at a Tertiary Care Center of Northern India.

This study aims to assess the perception and attitude of health care personnel regarding integration of nursing education and nursing services. Using purposive and stratified random sampling technique, 92 medical faculty, 32 nursing faculty and 346 nursing officers were enrolled. A three-point Likert scale consisting of 15 items and six open ended questions was used to collect the data. Overall, the concept of integration of nursing education and nursing services at their institute was welcomed by 74.4% of health care personnel. Medical faculty (47.8%), nursing faculty (37.5%) and nursing officers (57.5%) scored the concept of integration as very good.

Task shifting of cardiovascular disease risk assessment to Anganwadi Worker in Northern India.

Background: Cardiovascular diseases (CVDs) cause significant morbidity and mortality worldwide. Task shifting in various forms has been adopted extensively around the world in an effort to increase access to CVD risk assessment for early identification of high-risk individuals. Present study explored the feasibility of task shifting of CVD risk assessment by anganwadi workers (AWWs). Method: An operational study was carried out with the objective to develop the knowledge and skill of AWWs in CVD risk assessment. The study was carried out in the anganwadi centres of Northern India. A total of 40 AWWs were enrolled by using purposive sampling technique. They were trained in CVD risk assessment till they fully developed the skill. These trained AWW carried out CVD risk assessment among subjects aged ≥40 years. Cohen Kappa was used to determine the reliability of risk assessment by AWWs. Communication skills of AWWs were measured by using a standardized communication checklist. Result: Result revealed high interrater reliability of risk scores generated by AWWs and researcher (k = 0.91). Majority of the AWWs (87%) demonstrated good communication skills. Conclusion: Study concludes that AWWs can be trained in CVD risk assessment using WHO/ISH risk prediction charts. With proper training and supervision, the task of the CVD risk assessment can be shifted to AWWs.

Randomized Controlled Trial on the Promotion of Sexual Health Using "Self-Care Interventional Package" in Men Who have Sex with Men.

PURPOSE: Men who have sex with men (MSM) is a vulnerable group, who have been neglected and discriminated. Such discrimination decreases their access to health care and increases the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). AIMS AND OBJECTIVE: The objective is to evaluate the effectiveness of "self-care interventional package" on the promotion of sexual health, among MSM. MATERIALS AND METHODS: A randomized controlled trial was conducted on MSM from two nongovernmental organization centers of Chandigarh, which were randomized by simple random sampling into a control and experimental group. Over a period of 1 month, a total of 115 MSM were found eligible; 55 in control group and 60 in experimental group. Data were collected by a personal interview, after taking consent, in a comfortable and private environment. The Self-Care Interventional Package on the promotion of sexual health was developed in the form of flash book and booklet, and delivered by one-to-one interaction. Three follow-ups were done weekly for motivation in both the groups. Postintervention assessment was conducted after 1 month. RESULTS: There was a statistically significant (P < 0.01) improvement in knowledge about prevention and management of STIs and HIV, getting vaccinated for Hepatitis B and regular self check-up. Statistically significant reduction in unsafe sexual practices was noted among the MSM of experimental group. CONCLUSION: The self-care interventional package for the promotion of sexual health was effective in improving the sexual heath of the MSM population.

Effect of Earmuffs on Physiological Parameters of Preterm Neonates Nursed in Incubators: A Before-and-After Study.

OBJECTIVE: To determine the effect of earmuffs on stability of physiological parameters i.e. heart rate, respiratory rate, and oximeter saturation (SpO2) in preterm neonates. METHODS: Non-randomized, cross-over study. 60 stable preterm neonates observed without and with earmuffs for 2 hours each (control and intervention periods, respectively). The above parameters were recorded every 60 seconds. Spikes of parameters and fluctuation [by coefficient of variation (CoV)] were compared between periods. RESULTS: Spikes of all parameters, as a proportion of observations, were significantly less in intervention period. Median (IQR) spikes per subject were lower in intervention vs control: tachycardia [2.5 (2.5, 18) vs. 20.5 (2.2, 37.7); P<0.01]; tachypnea [11.5 (11.5, 25) vs. 18 (2, 40) vs; P=0.01] and hypoxia [0 (0, 0) vs. 0 (0, 1.75); P<0.01]. There was significantly less fluctuation of heart rate and SpO2 with earmuffs. CONCLUSIONS: Earmuffs improve physiological stability of preterms.

Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room.

AIM AND OBJECTIVE: To reduce the incidence of infiltration and phlebitis by 50% over 2 months among children admitted to the emergency room (ER) of a tertiary care hospital. MATERIALS AND METHODS: The study was conducted in the pediatric ER of a tertiary care hospital in North India. All children aged >28 days, receiving intravenous (IV) medication and/or fluids, were enrolled between June (2017) and September (2017). Existing practices of IV line insertion and maintenance were observed and recorded. The visual infusion phlebitis score and infiltration assessment scale were to grade the extent of two. The intervention classified as "IV line insertion and maintenance bundle" included the introduction of low-cost mobile sterile compartment trays, audit and feedback, organizational change, introduction of infection control nurse and quality improvement (QI) team formations were implement in different Plan-Do-Study-Act (PDSA) cycles. Reduction in the "incidence of phlebitis and infiltration" was outcome measures while "scores on checklist of IV line insertion and IV line maintenance and administration of drugs" were process measures. RESULT: The process measures, for IV line insertion, maintenance and administration of drugs through IV line, revealed an increase in scores on the checklist. There was a significant decrease in the incidence of infiltration and phlebitis from 82.9 and 96.1% to 45 and 55%, respectively, postimplementation of all PDSA cycles. CONCLUSION: Multifaceted QI IV line insertion and maintenance bundle reduced the incidence of infiltration and phlebitis. These interventions when integrated into daily work bundles along with continuous education and motivation help in sustaining the goal and attaining long-term success. HOW TO CITE THIS ARTICLE: Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021;25(5):557-565.

Effectiveness of a Breathing Training Program on Quality of Life in Patients with Predialysis Chronic Kidney Disease: A Randomized Controlled Trial.

CONTEXT: Chronic kidney disease (CKD) patients have suboptimal quality of life (QOL). Various studies/researches have revealed that breathing exercises have a positive and favorable impact on different systems of the body. AIMS: This study aims to assess the effect of a breathing training program on QOL in patients with predialysis CKD. SETTINGS: The study was a single-center study conducted at PGIMER, Chandigarh. DESIGN: Randomized controlled trial. METHODS: Sixty individuals were enrolled and randomized using lottery method. QOL was assessed or evaluated by Kidney Disease and QOL questionnaire (KDQOL™-36). Breathing exercises were taught to the intervention group. Patients included in control group continued with the routine care. Assessment of QOL was done after 4 weeks in both the groups. RESULTS: Change in KDQOL™-36 scores showed significant difference between control and the intervention group. The mean scores of control group in the subscale effects of kidney disease, SF-12 Physical functioning (Physical Health Composite) and SF-12 Mental functioning (Mental Health Composite) were 84.79, 39.16 and 37.40, respectively, whereas in intervention group, the respective mean scores were 91.88, 43.92, and 44.16. The difference was statistically significant (P = 0.04, P = 0.01, and P = 0.003, respectively). CONCLUSIONS: Breathing training program improves QOL in patients with predialysis CKD.

Cognitive, Behavioral, and Functional Impairments among Traumatic Brain Injury Survivors: Impact on Caregiver Burden.

Background The burden of cognitive, behavioral, and functional impairments after traumatic brain injury (TBI) is still not highlighted much, but its impact on caregivers is socio-economically relevant. The objectives of the study were to assess cognitive, behavioral, and functional impairments in patients of TBI and its impact on caregiver burden. Materials and Methods A descriptive cross-sectional study was conducted using a total enumeration sampling technique. Mini-mental status examination, neuropsychiatric inventory and Rappaport's disability rating scale were used to assess patients' cognitive, behavioral, and functional impairments, respectively. Zarit Caregiver Burden Scale was executed to quantify the caregiver burden. Results Fifty patients of TBI and their caregivers were enrolled. Among these, 24% had moderate cognitive impairments. Among behavioral symptoms, 40% had agitation, 24% had depression, 18% had anxiety, and 16% had irritability. Moderate functional disability was reported by 18% of the patients, while 2% reported severe functional disability. Moderate to severe caregiver burden was reported by 8% of caregivers. Patients' behavioral ( r = 0.507, p < 0.001), functional ( r = 0.473, p = 0.001), and cognitive ( r = -0.438, p = 0.001) impairments had significant correlations with caregiver burden. Conclusion Patients develop cognitive, behavioral, and functional disability after TBI. The caregiver burden increases significantly with cognitive dysfunction, behavioral symptoms, and impaired functional status of patients. Therefore, appropriate support is to be provided to caregivers as well as patients.

Perception about Marriage among Caregivers of Patients with Schizophrenia and Bipolar Disorder.

BACKGROUND: Marriage has a complex relationship with mental illness. The marriage of a person with mental illness (PMI) is a controversial issue with varied opinions. There is a dearth of studies exploring perception about marriage among caregivers of patients with severe mental disorders. MATERIALS AND METHODS: Thirty caregivers were interviewed in depth using a semi-structured interview schedule. Quantitative data were analyzed using MS Excel, while qualitative data were interpreted based on Colaizzi's framework. RESULTS: About half (53%) of the caregivers believed that PMI should marry, and 46% of caregivers believed that marriage could worsen the mental illness of their patient. The qualitative analysis showed that factors that affect the decision among caregivers to get their mentally ill wards married include shovelling off the stigma of keeping the unmarried ward at home and to have somebody to take care of the unmarried ward after their death. Many caregivers believe that marriage and/or sexual intercourse can be a cure/treatment for various mental disorders. CONCLUSION: Caregivers of patients with severe mental illness have many misconceptions about the association of marriage and outcome of mental illnesses.

The Effectiveness of Personal Hygiene Practices on Non-Cuffed Central Vein Catheter-Related Infection in Patients Undergoing Hemodialysis: A Randomized Controlled Trial.

Infection of the internal jugular vein (IJV) catheter continues to be a common cause of death in patients with end-stage renal disease undergoing hemodialysis (HD). The present study aimed to evaluate the effectiveness of personal hygiene on the incidence of IJV catheter-related bloodstream infection (CRBSI). A randomized, controlled, parallel, and non-inferiority trial was conducted on patients initiated on maintenance HD via right IJV catheter. Patients were randomly allocated to control and intervention group via computer-generated random table. Intervention package for the intervention group included hand washing (2-4 hourly and whenever visibly dirty), feet washing (12 hourly), and axillary shave (at any point during the study, no hair growth in axilla). Patients were provided with a pamphlet and reinforced to continue package till IJV catheter was in situ. Patients were followed up twice a week for one month from the date of catheter insertion for the incidence of CRBSI. The primary outcome of the study was percentage of patients free from CRBSI. On intention-to-treat analysis, the percentage of patients without CRBSI was 53.7% and 29.3% in the intervention and control arm, respectively [P = 0.04; 25.12% (1.43-45.28%)]. Positive blood cultures were higher in control (73.3%) as compared to the intervention group (28.6%) (P = 0.19). Personal hygiene interventions are an effective method to reduce the incidence of CRBSIs among population undergoing maintenance HD via non-cuffed IJV catheter.

Risk Factors of Cervical Cancer: A Case-Control Study.

OBJECTIVE: Cervical cancer is one of the most common malignancies among women. The present study aims to assess the risk factors for cervical cancer in women aged 25-80 years. METHODS: The current study was a case-control study. In total, 75 age matched cases and 75 controls were enrolled. In case group sampling technique was total enumeration. Sampling for control group is done by purposive sampling. Women who satisfied the inclusion criteria were included in the study. A questionnaire was developed to assess the risk factors of cervical cancer among the participants. Face to Face interview were conducted with the participants. RESULTS: There was a significant association (P < 0.05) of cervical cancer with education, place of residence, using an old cloth sanitary napkins, young age at marriage, number of husband's partners, washing the genitalia after sexual intercourse, and availability of health services. Bathing daily and during menstruations was found to be preventive factors for cervical cancer. In logistic regression, the utilization of health services and the presence of sexually transmitted infections showed a significant association with the development of cervical cancer. CONCLUSIONS: The present study aimed to assess the risk factors of cervical cancer. With prior knowledge of risk factors, cervical cancer can be identified. Identification of high-risk populations and starting early screening is found to be effective in early recognition of cervical cancer.

Intracranial Tumors: A Nurse-Led Intervention for Educating and Supporting Patients and Their Caregivers

BACKGROUND: Behavioral symptoms among postoperative patients with intracranial tumors and distress among caregivers are common. OBJECTIVES: This article aimed to assess the effectiveness of a brief nurse-led intervention on behavioral symptoms of postoperative patients with intracranial tumors and distress of their caregivers. METHODS: A randomized controlled trial was conducted on 80 patients with intracranial tumors and their family caregivers in a tertiary care institute in India. A brief nurse-led intervention was provided in the form of individual counseling, and a pamphlet was given to patients and caregivers in the experimental group at the time of discharge. Behavioral symptoms of patients and distress of caregivers were assessed. FINDINGS: Patients in the experimental group had significantly fewer behavioral symptoms and less severity of behavioral symptoms as compared to the control group. Caregivers in the experimental group had significantly less severity of distress as compared to the control group.

Effect of Music Therapy on Pain Perception, Anxiety, and Opioid Use During Dressing Change Among Patients With Burns in India: A Quasi-experimental, Cross-over Pilot Study.

The effectiveness of music therapy for relieving pain and anxiety during burn dressing changes has not been reported from India. PURPOSE: This study was conducted to assess the effect of music therapy on pain, anxiety, opioid use, and hemodynamic variables during burn dressing change. METHODS: Patients in a tertiary care burn unit who were >10 years old, conscious, able to respond, and oriented to time, place, and person participated in a 2-month, quasi-experimental, cross-over pilot study. Each served as his/her own control. Dressings were changed every other day alternating between the control (standard pain management) and experimental (control plus patient-selected music) intervention. Pain was assessed using a numerical rating scale, anxiety was scored using the State Trait Anxiety Test (higher scores indicated more pain and anxiety), and hemodynamic parameters and analgesics were recorded. Wilcoxon Test and chi-squared tests were utilized for statistical analysis. RESULTS: Median pain scores (5, interquartile range [IQR] IQR: 3-7; and 6, IQR: 5-8) and median anxiety scores (12, IQR: 8-17; and 14, IQR: 10-19) were significantly lower during the experimental than during the standard dressing change, respectively (P <.001), and opioids were used significantly less frequently during the experimental change (P = .002). CONCLUSION: Music therapy helps reduce anxiety, pain, and opioid use during burn dressing change.

Home-Based Yoga Program for the Patients Suffering from Malignant Lymphoma during Chemotherapy: A Feasibility Study.

BACKGROUND: Yoga is proven beneficial in improving quality of life among breast cancer survivors receiving chemotherapy, but its effectiveness in lymphoma patients needs to be explored. As chemotherapy-induced neutropenia is very common among lymphoma patients, they are much prone to infections from the environment. Furthermore, trained yoga instructors are not available in every setting, so there is a need to develop home-based yoga program modules for lymphoma patients receiving chemotherapy. AIM: The aim of the study was to explore the feasibility and safety of yogic exercises among lymphoma patients during chemotherapy. SUBJECTS AND METHODS: An interventional, single-arm prepost design study was conducted at a tertiary health-care center. Patients suffering from malignant lymphoma (18-65 years) with Eastern Cooperative Oncology Group performance status from 0 to 2, planned to receive chemotherapy were administered a home-based yoga program over a period of 2 months from the start of chemotherapy. The primary outcome variables were retention rate, acceptance rate, safety, and adherence. Health-related quality of life (HRQOL), fatigue level, overall sleep quality, depression, anxiety level, and pain were also assessed. STATISTICAL ANALYSIS: Descriptive statistics was used to see the feasibility and adherence. The paired t-test was used to compare various pre and postintervention outcome measures. RESULTS: Fourteen patients (median age: 36 years, range13-65 years) of malignant lymphoma were enrolled in the study. Male-to-female ratio was 9:5. Non-Hodgkin's lymphoma patients constituted 64%. The recruitment rate was 93%. Favorable retention (100%), acceptability (97%), adherence (78.6%), and no serious adverse events following yoga practice were reported. Improvement was also found in HRQOL, fatigue, sleep, depression, and anxiety. However, it needs further validation in a randomized study. CONCLUSION: Home-based yoga program is safe and feasible among the patients suffering from malignant lymphoma receiving chemotherapy.

Quality of Life Among Children Who Had Undergone Ventriculoperitoneal Shunt Surgery.

BACKGROUND: Ventriculoperitoneal (VP) shunting is the most common neurosurgical treatment for hydrocephalus. In spite of significant developments in the technology and design of shunt systems, shunt surgery is still associated with morbidity. AIM: To identify the problems faced by children on VP shunt and assess their quality of life (QOL). SETTING AND DESIGN: A cross-sectional exploratory study. MATERIALS AND METHODS: A total of 31 children on VP shunt were selected through consecutive sampling technique, and hydrocephalus outcome questionnaire was used to collect the data, with the converted metric score ranging from 0 to 1. Hydrocephalus due to stroke, hemorrhage, and malignant tumors was excluded. RESULTS: The mean age of patients was 11.51 ± 4.26 years. Headache and generalized pain were the common problems experienced (42%). The mean score of QOL was 0.67 ± 0.21. Among the three domains, cognitive domain was the most affected. Among the clinicoradiological factors, multiple surgeries (P = 0.02) had the most significant impact on QOL. CONCLUSION: Children who underwent VP shunt face various health-related problems in different domains and low QOL. Although cognitive domain was the most affected, multiple surgeries had the most significant impact on QOL. Appropriately focused interventions and holistic management are essential to improve the QOL of children undergoing VP shunt.

Effectiveness of an Interventional Package on the Level of Anxiety, Depression, and Fatigue among Patients with Cervical Cancer.

OBJECTIVE: To evaluate the effectiveness of interventional package on the level of anxiety, depression, and fatigue. METHODS: The study was conducted in room no. 5, first floor, B Block, Department of Radiotherapy, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh Quasi experimental pretest-posttest design was used in the study. A total of 60 patients receiving radiotherapy/chemotherapy were assigned in two groups of 30 each, through total enumeration sampling technique. The tools used for the study were Zung Anxiety Scale, Beck Depression inventory, and Fatigue Scale. The protocol used for the study includes the Jacobson's Progressive muscle relaxtion technique, counsling and home care techniques. RESULTS: Sociodemographic variables and clinical profile of participants in both groups were comparable. Interventional package significantly reduces the anxiety, depression, and fatigue (P < 0.001 in 3 variables) in experimental group. CONCLUSIONS: Interventional package for patients with cervical cancer proved to be an effective modality in reducing the anxiety, depression, and fatigue.

Knowledge and Attitude of Nursing Students toward Electroconvulsive Therapy.

BACKGROUND: Electroconvulsive therapy (ECT) is one of the commonly used treatment modalities for patients with severe mental disorders. However, acceptance of ECT by the patient and relatives often depends on how the health-care professionals themselves present the treatment modality to the patients and their relatives. There is a lack of information about the knowledge and attitude toward ECT among health professionals. AIM: This study aimed to evaluate the knowledge about and attitude toward ECT among nursing students. METHODOLOGY: Knowledge of and attitudes toward ECT among nursing students were assessed using ECT knowledge and attitude questionnaires. RESULTS: The study included 183 nursing students. Majority (n = 62; 60.8%) of the participants obtained information about ECT from media (movies, television, print media, etc.). None of the students had full knowledge about ECT. Although a significant proportion of students had knowledge about the ECT procedure and consent procedure, majority of them had poor knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitudes were also highly prevalent, with more than two-thirds of the participants having negative attitudes toward ECT on more than half of the attitude items of the scale. Total knowledge score positively correlated with total attitude score, suggesting that higher knowledge was associated with more positive attitude. CONCLUSIONS: Although nursing students have knowledge about basic ECT procedure and consent, they lack knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitude toward ECT is also highly prevalent among nursing students. Accordingly, there is a need to improve the knowledge and address the negative attitude of nursing students, which may ultimately lead to better acceptance of the treatment.

Impact of post-meal and one-time daily exercise in patient with type 2 diabetes mellitus: a randomized crossover study.

BACKGROUND: To evaluate the effectiveness of short-timed post-meal and one-time daily exercise on glycemic control in patients with T2DM. METHODS: Sixty-four T2DM patients were randomised into crossover design. Group A (n = 32) underwent post-meal exercise (moderate-intensity brisk walking covering 1500-1600 steps for 15 min, starting 15 min after each meal) from d1 to d60 followed by one-time daily exercise (45 min pre-breakfast brisk walking at stretch covering 4500-4800 steps) from d61 to d120, while it was vice versa for the group B (n = 32). The five-point blood glucose profile was performed on d1, d30, d60, d90 and d120, and HbA1c on d1, d60 and d120. Fitness wrist band was used for step-counting to ensure the intensity of exercise and compliance to exercise protocol. RESULTS: Group A patients showed a significant improvement in five point blood glucose profile and HbA1c after performing post-meal exercise (p < 0.001), which was mitigated after switchover to one-time daily exercise (p < 0.001). While, group B patients showed improvement in glucose profile and HbA1c (p < 0.001) after performing post-meal exercise, as compared to one-time daily exercise. Further, on pooled analysis (post-meal versus one-time daily exercise group) the beneficial effect of post-meal exercise on glucose profile and HbA1c was consistent as compared to one time daily exercise and the significance persisted on comparison between the two groups. No hypoglycemic events were noted between the groups during the study period. CONCLUSION: Post-meal exercise is more effective than routine one-time daily exercise for glycemic control in T2DM patients.

A Methodological Study to Develop a Standard Operational Protocol for Nurses on Central Line Catheter Care of Patients in Selected Intensive Care Units.

AIM: This study aims to develop a standard operational protocol (SOP) for central line catheter care for nurses. MATERIALS AND METHODS: A preliminary draft of protocol based on extensive review of the literature was developed. The current practices of the nurses regarding central line catheter care were observed. Focus group discussions (FGD) were conducted with the nurses to identify the problems encountered by them during care of central line. Four rounds of Delphi were conducted to validate the protocol. The protocol was found to be feasible in terms of understanding, clarity and easy implementation after conducting a pilot study. An observation checklist was developed from the final draft of the protocol. The nurses were taught regarding the central line catheter care as per the protocol. 30 nurses were observed during central line catheter care by the researcher. After implementation of the protocol, feedback of the nurses was taken by conducting FGDs. RESULTS: Content validity index of each item in the protocol was acceptable. The overall Cronbach's alpha value of the checklist was 0.75. It was concluded that the checklist is reliable and each item has a contribution in the checklist. CONCLUSION: This protocol addresses interventions to enable staff to provide proper care of the central line catheter to prevent CLABSI.