Evidence Based Guidelines

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 literature review confirms that the CDC has noted that there was reduction by 50% Central Line-Associated Bloodstream Infection (CLABSI). The changes were witnessed between 2008 and 2014. Additionally, there was 13 percent reduction in incidences of MRSA bacteremia witnessed in 2011, and later in the year 2014. The implementation of the strategies and efforts from the ACA to reduce the incidence of HAIs has delivered a strong definitive prevention method or effort indicated by the ACA to lower the overall occurrence of HAIs (CDC, 2016).

Healthcare-associated infections from invasive medical devices are linked to high morbidity, mortality, and costs worldwide. Especially in central line–associated bloodstream infection (CLABSI) or catheter-related bloodstream infection (CRBSI) and

Central line bundle is a group of evidence-based practice strategy for patient with central catheters, when implemented together, produce better outcomes than implemented individually (Institute of health care improvement, 2010.). The main elements of central line bundle are hand hygiene, maximal barrier precaution upon insertion, Chlorhexidine skin antisepsis, optimal catheter selection, and daily review of line necessity with prompt removal of unnecessary lines Aseptic technique when using and caring for a central line catheter can decrease the chance of contamination in this critically ill infants. Staff education on adherence to aseptic technique and strict central line care guidelines are essential to decreasing bloodstream infections.

CLABSI prevention research shows overlap in these five areas of evidence-based prevention: appropriate hand hygiene, skin preparation, use of full barrier preparations, avoidance of femoral site for central line placement when possible, and removal of unnecessary lines (Latif et al., 2015). This is the “bundle” approach (Dumont & Nesselrodt, 2012). The Institute for Healthcare Improvement (IHI) and the 2011 CDC Guidelines for Prevention of CLABSIs introduced and currently supports this approach in order to prevent CLABSIs and other healthcare-associated infections (HAIs)

The purpose of the research study was to determine if registered nurses are using evidence-based practice standards for assessing pain in special populations such as different cultural backgrounds and those with chronic pain syndromes. The research hypothesis states that registered nurses utilized evidence-based practice standards when assessing pain in special populations such as those with different cultural backgrounds and those with chronic pain syndromes. The null hypothesis states that registered nurses do not use evidence-based practice standards when assessing pain in special populations such as those with different cultural backgrounds and those with chronic pain syndromes. A survey study was completed to determine if registered nurses (RNs) are utilizing

Upon completion of this project I learned that many times patients were unaware of the compilations such as infection that may occur with central lines. This has taught me the importance of proving education to our patients in addition to staff members. Patients can help decrease central line associated blood stream infections by being aware of their surroundings and ensuring that nurses, physicians, and visitors take proper steps in decreasing infections rate. Implementing a policy to place alcohol infused caps on all central line that are not currently infusing is best practice back by evidence based practice to significantly decrease infection rates. This project as helped me identify evidence based practice and incorporate these practice in our daily care to help improve patient outcomes. The first couple of days there was not any patients within the intensive care unit with central line.

Central lines are a common device used world wide in acute care settings for eligible patient populations such as those receiving chemotherapy, patients with poor venous access, or for those that require prolonged treatment of intravenous medications. Although central lines provide many advantages, they place patients at high risk for acquiring central line associated blood stream infections (CLABSI). CLABSI's are a serious complication associated with central lines and in some cases can be life threatening. There are many evidence based approaches that are used in acute care settings to reduce the incidence of CLABSI's such as meticulous skin care, daily bathing with chlorehexadine surgical scrub, and strict sterile technique when changing central line dressings. These prevention measures are a standard of care nationwide for patients with central lines since they are cost effective and evidence based. Unfortunately, even with proper implementation and compliance with these interventions, CLABSI's are still prevalent amongst vulnerable patient populations.

Nursing is a practice that keeps evolving. A policy, according to Yoder-Wise (2014), “is just a plan for action related to an issue that affect a group’s well-being” (p.179). Nurse Managers and coordinator find ways to keep up to date with the standard of practice or evidence-Based practice. In my current work area, nurses are kept up to date with the use of online classes that are compiled by the company. The online class is a short power point with voice with a test at the end. This is required by all nurses. This online system allows nurses to learn at location of their convenience. If the nurses have any questions, they are able to refer to the power point and consult their administrator. This strategy allows nurses to review and understand

In 2006, $200 million and an estimated 2,000 lives were saved by using a comprehensive safety program called the Keystone Project, which presented a checklist of five crucial steps for central-line catheter placement; as a result, a dramatic reduction in central-line associated bloodstream infections (CLABSIs) was observed. The agency also developed 19 simulation grants to establish a safe environment in which clinicians can obtain proficiency in various clinical settings and procedures such as treating acute myocardial infarction, ultrasound-guided central venous catheter placement, and the disclosure of medical errors (AHRQ, 2012, pp. 7 – 8).

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

Berenholtz, S. M., Lubomski, L. H., Weeks, K., Goeschel, C. A., Marsteller, J. A., Pham, J. C., . . . Hines, S. C. (2014). Eliminating central line-associated bloodstream infections: A national patient safety imperative. Infection Control & Hospital Epidemiology, 35(1), 56-62. doi:10.1086/674384

In my opinion and my experience, I have found that what gets the attention of management and/or leadership is saving money and improving Press Ganey scores. I also believe that management is more likely to listen to a new idea that is well put together in a presentation style than something that is just written on a piece of paper or spoken to them. I also believe that being able to show the facts and research being the proposal makes a huge difference in getting the attention of management. I am very fortunate to work in two places that respond openly to new evidence-based practice recommendations; however, if that was not the case then it would be my responsibility to put something together in order to catch their attention. I think

To simplify central line care, the Joint Commission released their five easy and proven interventions to keep CLABSIs at bay, essentially streamlining the IHI’s recommendations. The five interventions include: thoroughly utilizing appropriate hand hygiene, chlorhexidine skin preparation, and full barriers during insertion, avoidance when possible of utilizing the femoral approach, and a primary focus on removing unnecessary central lines. This last intervention is crucial with central lines as each day that a patient has a central line in place, the higher risk they have of developing a CLABSI. When looking at this intervention it is critical to have a team that can make daily or weekly at the minimum, line rounds to assess the line and determine if the line is still medically necessary. It is imperative that this team is able to have an open communication with the doctor in order to recommend and request the line be removed. Central line teams found in hospitals have proven to be yet another effective measure at controlling CLABSIs. However, still nothing has been effective enough to reach the zero event goal set forth. (The