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.
To complete this study the author used a quasiexperimental design, consisting of 1 intervention group and 1 historical control group. The setting was
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PICC-related bloodstream infections were found less frequently in patients with the antimicrobial PICC. The nonintervention group had a total of 8 CLABSIs (rate ¼ 4.18/1,000 catheter days). There was 1 CLABSI (rate ¼ 0.47/1,000 catheter days) in the intervention group. Along the course of the study there were limitations affecting its applicability. For example, the 2 study groups were not fully comparable with respect to underlying conditions or admitting diagnosis that might have predisposed the patients to CLABSI. The variables collected on each diagnosis varied greatly between patients and did not offer a pattern to code effectively for known CLABSI risk factors. The quasiexperimental design could only provide evidence of probability. The retrospective data for the nonintervention group was another limitation. In addition, the inability of the researcher to determine the significance of nursing compliance with maintenance practices could have introduced bias into this
Getting an infection from improper care during or after insertion of a central line is the last thing you want to get while in the hospital. This paper will discuss Kaiser Permanente’s policy on central venous catheter, also known as a central line, care and dressing change, and whether it follows the current evidence-based practice on preventing bloodstream infection in patients who have them inserted. I will explain about what a central line is, why evidence-based practice is important in the clinical setting, what Kaiser Permanente’s policy about central line care and dressing change is, if Kaiser is currently following evidence-based practice based on current articles about preventing central line associated bloodstream infections (CLABSIs), and what my role in using evidence-based practice is as a future registered nurse.
Article by Clancy (2009) explained central lines were a result of an estimated 250,000 blood stream infections and accounted for 30,000 to 62,000 patient deaths, then adding that each infection cost upwards of $36,000 and cumulatively add up to at least $9 billion in preventable costs annually. The article also explains how the mindset has changed from the cost of having a central line in place and expecting complications to lowering infection rates by an intentional interventional process/s. The article speaks of 5 basic steps to reduce CLABSI, hand washing, insertion techniques, skin cleansing, avoidance of certain sites and earlier removal of the CVC. Studies showed that these guidelines were only followed 62% of the time. The system was changed to ascertain that all the clinicians were in compliance. This prompted 5 interventions, education, a CVC insertion cart with all necessary equipment, physicians having to validate central line necessity, a concise checklist for bedside clinicians and the empower of nurses to stop procedures if guidelines were not followed. These low cost interventions from 11.3/1000 in catheter days in 1998 to zero in the fourth quarter of 2002.
The purpose of this initiative is to decrease and/or eliminate central line-associated bloodstream infections (CLABSI) in the neonatal intensive care unit (NICU) at Aurora Bay Care Medical Center. Hospital acquired infections, including CLABSI, is a major cause of mortality, prolonged hospitalization, and extra costs for NICU patients (Stevens & Schulman, 2012). The goal of this initiative is to decrease CLABSI by 75% by reducing the number of days lines are in and standardizing the insertion process and line maintenance.
A two-year program called On the CUSP: Stop BSI was formulated in 2008 to prevent CLABSIs in hospitals nationwide and was organized as a state or region-level collaborative with centralized education, data collection, and program management functions (AHRQ, 2012). More than 1,000 hospitals and 1,800 hospital units, representing a total of 44 states, the District of Columbia, and Puerto Rico, participated in the program (AHRQ, 2012). The program structure included three main components: (1) a model to translate evidence into practice at the bedside to prevent CLABSIs; (2) the CUSP to improve the safety culture; and (3) a system to measure and report infection data (Sawyer et al., 2010). Results of the program revealed success in reducing CLABSIs nationwide by 41% from a baseline of 1.915 infections per 1,000 line days to a rate of 1.133 infections (AHRQ, 2012). With the nationwide success of the On the CUSP: Stop BSI program (AHRQ, 2012), the state of Hawaii embarked on their own study to determine if a national ICU collaborative to reduce CLABSIs would succeed in the state (Lin et al., 2012). The study, which began in January 2009 and ended in December 2010, included the CUSP, a multifaceted intervention approach to CLABSI prevention, and infection rate monitoring (Lin et al., 2012). Data was collected and reported from 20 ICUs representing 16 hospitals across the state (Lin et al., 2012). The results revealed the overall mean 9statewide CLABSI rates decreased 61% from 1.5 infections per 1,000 catheter days at baseline to 0.6 at 16 to 18 months post-implementation of the project, reinforcing the evidence that the On the CUSP: Stop BSI program can succeed in other states and substantially reduce CLABSI rates in hospitals (Lin et al., 2012). The success of the initial Hawaii study was the catalyst to conduct a second study in the state. This cohort study continued the national On the CUSP: Stop BSI program interventions, extended
Central line associated blood stream infection, better known as CLABSI, are on a continual rise in critical patients. CLABSI are implemented to help improve vascular access in patients where venous access is minimal or reduced. They help to maintain intraveneous access to deliver medications to the body and in case of emergency. Central lines are not given to every patient admitted into the hospital, only those who are critical. The purpose of this paper is to provide reasoning and evidence behind my research strategy for this particular topic. In the critical populations, how does not using chlorhexidine containing dressing compare to using the dressings influence the central line associated blood stream infection rates over two years.
For instance, there are many different types of infections that occur in the intensive care unit (ICU), as well as various methods of prevention that patients, visitors, providers, and other hospital staff can practice. Of the many different types of infections that occur in these critically ill patients, catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) are two of the most serious infections, and they also happen to be the most
Hospital acquired infections (HAI) are inflecting a tremendous impact on healthcare safety and medical costs. The purpose of this qualitative analysis is to evaluate current research and evidence based practice on central line acquired blood stream infections (CLABSI) in the neonatal intensive care unit (NICU). Further, this paper will examine how the closed medication line system can help decrease of a CLABSI event. Neonates are a vulnerable population with a low immune suppression where an infection could simply mean life or death. This particular topic is crucial; with the continual rise in pre-term neonates, this topic is crucial to eliminate CLABSI 100% in the NICU environment
P in the PICOT is patients with Foley catheter inserted at admission causing patients catheter-associated urinary tract infections (CAUTI). The aim is to build a nurse-driven protocol to remove Foley catheters early on will help reduce additional days of having the use of an unnecessary indwelling urinary catheter. For every extra day, a Foley catheter increases the risk to develop hospital-acquired catheter-associated infections in our patients ("AACN Competencies and Curricular Expectations for CNL Education & Practice,"
There is an abundance of information identifying central line acquired bloodstream infection (CLABSI) as a serious adverse event during hospitalization resulting in increased morbidity, mortality, and health care cost. Present data from research indicates that CLABSI is the second most avoidable cause of death during hospitalization (Shah, Schwartz, & Cullen, 2016). The above concepts that CLABSI is preventable yet it continues to yield a yearly cost of 2.3 billion dollars and remains a quality metric for national offices such as Joint Commission indicates a foundation for research (Son et al., 2012). Upon the literature review, CLABSI rates were significantly reduced when specific techniques were implemented. Furthermore, all the articles
In the healthcare, evidence-based guidelines are utilized to prevent complications that can be very significant to both the patient and the healthcare in general. Having worked in different health care settings including, home-health, long-term care facilities, rehabilitation hospitals, long-term acute care, and acute care, I have come across various healthcare associated infections (HAIs). For my project, I will focus on prevention of central line-associated bloodstream infections (CLABSIs). I have seen the importance of central lines in management of patient care, be it in nutrition supplementation, hydration, or medication treatments in all the mentioned different settings. I have also encountered infected central lines and the risk they pose to the patients. According to the Centers for Disease Control and Prevention (CDC), CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable (CDC, 2010).
This shows a vast majority of infection cases are likely to be witnessed in the future if appropriate measures are not taken to curb the challenge. While the frequency of CLABSI outside ICU is not known, patients who are outside the intensive care units are equally at risk. However, Baker (2016) found out that the cases of central line infections in patients transitioned from ICUs to step-down units or outside the intensive care units had increased in some areas. The efforts to prevent the infections through research into the problems associated with CLABSI also represent substantial mechanisms in place to curb this health problem (Smith, Mba-Jonas, Tourdjman, Schimek, DeBess, Marsden-Haug & Harris, 2014).
CLABSI prevention is a standard of practice for those who provide care CVCs within an adult ICU and throughout the various units. However, infection rates remain high despite the care that is provided. This provides a clear need for education for those who are in direct care of those with a CVC. Utilizing the ACE Star Model, the discovery of a decrease in CLABSIs due to an education program was observed. In summary, the education program provided proper technique, antisepsis solutions, hand hygiene, and the location of insertion site significantly reduced CLABSI presence within adult ICUs. The creation of an education program as the driving force to change the current practice is to be implemented for those with direct contact of care for
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
The authors studied multiple articles and used a total of 20 articles to validate their results concerning CAUTIs. The author studied how urinary catheter placement was one of the biggest reasons of hospital-acquired infections today. The authors also studied current percentages of catheters placed where no need of one is indicated. They also studies education regarding compliance, appropriate uses, nurse derived initiatives and overall prevention of infections. The citing of references were properly placed and had a sufficient reference page. Majority of the articles were up to date. Fifteen of the twenty articles were written since 2010 and nine in the past three
Principally, quasi-experiments utilize the comparison of two existing set of groups to determine the maximum level of impact caused by an intervention. The design is standard among behavioral researcher in determining the effects of an intervention before and after treatment. The design attempts to eliminate all other unrelated explanations to an outcome