Bloodstream Infections: A Case Study

As a visionary researcher, the researcher viewed the discrepancy between the central-line-bundle guidelines and their actual implementation as a cause of the current numbers of central-line bloodstream infections (CLABSI). CLABSIs affect approximately thirty thousand and one hundred patients in intensive care units (ICUs) annually and cost thousands of dollars per episode (Health Research & Educational Trust, 2017). But most of the patients in ICUs need a central line which is a tube placed in a large vein to give medications or fluids. The researcher reviewed many qualitative and quantitative studies to examine the impact of adherence to central-line-bundles on the number of CLABSIs among adult patients in ICU. All studies presented central-line

Healthcare-associated infections are infections that affect the patients when they are in the hospitals or other healthcare setting, such as a care home or hospice, or due to health care interventions or procedures.

First, the article provides a short explanation regarding central line associated bloodstream infections (CLABSI) and CLABSI related deaths that occur annually in the US. A national campaign, ‘On the CUSP,’ is briefly discussed. This was a collaborative cohort study of 1,071 adult intensive care units (ICUs) in 44 states, Puerto Rico, and Washington D.C. Their goal was to evaluate the impact of the ‘On the CUSP’ campaign in relation to CLASI reduction. Extensive education and training was provided prior and during the intervention. The multi-level Poisson regression model showed CLABSIs dropped from 1.96 to 1.15 per 1,000 line-days, a 43% decrease. Limitations included: this was not a randomized controlled trial (RCT), lack of resources to validate CLABSI data or collect intervention compliance data. However, the study indicates CLABSIs are preventable with standardized nursing interventions, which improves patient outcomes.

Central lines are often used or put in place in patients to prevent multiple IV access, administer fluids, medications, parenteral nutrition, blood products, and also for long term therapy treatments. Although, central lines are very useful for long term therapies, it can also result in infection if not properly cared for by healthcare providers and patients. According to the Centers for Disease Control and Prevention [(CDC)] (2012), central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and lead to increase costs to the U.S. healthcare system. Some of these bloodstream infections occur because central line catheters are not flushed properly, cleanse correctly, or dressed appropriately. The

IOM developed six aims of improving to provide safe, effective, patient-centered, timely, efficient, and equitable patient care (Institute of Medicine, 2001). The most common pediatric health care-associated infection is bloodstream infections and CLABSI are a widespread quality concern in the pediatric population (Sandora et al., 2014). Injuries to patients frequently occur due to system problems that allow for errors; therefore, health care systems must take accountability for designing a system that provides reliable, safe, and appropriate care (Institute of Medicine, 2001). MCWHLB chief quality concern is their rate of central line associated blood stream infections (CLABSI), which is impacting patient safety. California has decrease CLABSI rate by 49% between 2008 and 2014; however, there was no significant change between 2013 and 2014 (CDC, 2016). The purpose of this paper is to develop a quality improvement plan, discuss the current situation, describe the measures and indicators, present data and create evidenced-based targets related to CLABSIs.

The US Centers for Disease Control and Prevention’s (CDC’s) and National Healthcare Safety Network (NHSN) associate this term with a bloodstream infection that occurs within 48 hours of a centrally placed catheter that cannot be attributed to infection from another source (Joint Commission, 2012, p. v). There are approximately 80,000 cases if CLASBI reported in intensive care units in the United States each year (Joint Commission, 2012, p. viii). These statistics include infants in the NICU. In one study conducted from January 2007 to September 2012, there were 2615 reported CLABSI events in NICU’s (Patrick, Kawai, Kleinman, Vaz, Gay, & Lee, 2014, p.

CLABSI is the acronym for central line associated blood stream infection. CLABSI are the third leading cause of hospital acquired infection (HAI). Central line associated infections are life threatening and is a common risk factor associated with central venous catheters (CVC). Peripherally inserted central catheters are a common type of CVC used. Research is conducted to determine whether there is a benefit to reducing CLABSI with use of PICC lines that are coated with antimicrobials. This research compares the impact of chlorhexidine impregnated verses non- chlorhexidine PICC with the risk of CLABSI and VTE development in patients that are immune suppressed, critical care or trauma patients.

Controlling infections in the hospital setting has been a major issue for hundreds of years. Patients have largely been effected by pathogens transferred from those appointed to care for them. Florence Nightingale became famous for changing the way we practice patient care. Her idea was simple yet powerful and it is still considered the standard worldwide. She promoted hand washing in order to reduce healthcare infections. Flash-forward a hundred years and we are now seeing infections increase through a different route. The CDC estimated about 31,100 central line associated blood stream infections occur each year (Control, 2015). According to the Centers for Disease Control and Prevention, the most commonly reported pathogens include coagulase-negative staphylococci, Staphylococcus aureus, enterococci, and Candida. (Tavianini, Deacon, Negrete, & Salapka, 2014). Although central lines was not yet a technology created in healthcare, implementing the fundamental skills as emphasized by Nightingale

The prevention and elimination of CLABSI in hospitals, specially in critical care units, have being a problem for many years. New research and strategies have been performed, however, CLABSI rates have remained at unacceptable levels. The purpose of this research is to demonstrate that the use of an antimicrobial PICC will decrease the incidence of PICC-associated CLABSI rate for the acute and critical care environments of hospitals. On 2014, “The Influence of an Antimicrobial Peripherally Inserted Central Catheter on Central Line-Associated Bloodstream Infections in a Hospital Environment” by Glenell S. Rutkoff, MSN, RN, CGRN, was published on JAVA on 2014.

When a patient is admitted to the hospital an initial assessment is done. During that assessment we are already thinking of what kind of care and treatment this patient will need in order to dis-charge him as soon as possible. The longer a patient remains in the hospital, the more at risk he is for Hospital Acquired Infections. “Hospital-acquired pneumonia is the second most common nosocomial infection, but carries the highest mortality rate of 30-50 percent. Ventilator-associated pneumonia is a type of HAP that is associated with endotracheal intubation and me-chanical ventilation” (Pellico, 2012). “It is reported that HAP accounts for 25% of intensive care unit infections, and 90% of those occur during mechanical ventilation” (ATS & IDSA,

Clinical problem: Catheter-related infections pose a detrimental threat to adult patients in intensive care units with a central line. Effects of an infection include: an increase in the patients’ length of hospital stay, morbidity and mortality rates, and hospital readmission rates.

“Infections were identified using previously validated computerized algorithms” (Cohen et al., 2013). Cases of bloodstream infections were patients who had a positive blood culture in the presence of a negative culture for the same organism in another body site within the previous 2 weeks (Cohen et al., 2013). Cases of surgical site infections were patients who had a surgical procedure as demonstrated by an ICD-9 code and a positive surgical wound culture within 30 days after surgery (Cohen et al., 2013). For community-associated infections, data including age, gender, diagnoses, health history, and hospital admissions were identified. For hospital-associated infection, data including hospital admissions, ICD-9 codes, EMRs, MARs, and pre- and

Signs of infection. Three days post-surgery, she developed an infection in her left knee as evidenced by a noticeable inflammation and purulent oozing. If this is not immediately addressed, she might develop some serious complications, considering that her diabetes also slows her healing process.

cases a combination of small and large lesions may be found on the leaves. Fruit can also be infected by bacteria and show symptoms similar to those exhibited by leaves. The appearance of the symptoms on leaves and fruit is influenced by several factors, including the cultivars, strain of the causal bacterium and environmental conditions.