Safety And Prevention Of Central Line Blood Stream Infections

It’s the nurse's duty to advocate for her patient and to make sure that the patient understands and ask questions if necessary.

Nursing is defined as the promotion, protection and the prevention of illness and Injury, the treatment of a patient’s disease or diseases, the patient’s response to a disease, as well as one big thing that nurses are known for, and that is being a patient’s advocate nursing has been one of the fastest growing fields since the 1990’s (Mueller et al.,2012). Advocacy is defined as an action in which a person speaks out, argues a cause, supports and defends on the behalf of others. I believe that the role of being a patient advocate is one of the most important things a nurse can do because there are many patients that cannot speak on their behalf, I believe that it is up to the nurses to be those patients as well as all patient’s voices (Mueller et al., 2012).

It is no secret that communication is key when providing direct patient care in a skilled nursing facility. However, there is a noticeable lapse in the communication between the care team when providing care to the individual or groups of individuals. Two main parts of any care team are the registered nurse and the certified nursing assistant, as these are the two people whom have the most direct and impactful roles with residents in a skilled facility. The Registered Nurse and the Certified Nursing Assistant play similar roles in providing patient care, but have different roles in its entirety. The role of the Registered Nurse (RN) is defined as having the competency and skill to provide direct and indirect health care to individuals, their families, and communities around them. Services are also provided designed to give out medications, to promote comfort or healing, promote healing, and to also provide the dignity of their patients and patient’s families (American College of Rheumatology, 2015).

One of the many roles of the nurse, in caring for their patient, is to advocate for the patient. The nurses in the clip did not exhibit this professional role, the nurses were hesitant in following the physician’s orders, but none of the nurses spoke up on the patient’s behalf. Nurses are often in the best position to communicate with team members and the patient’s family on behalf of the patient, because in most cases, the nurse provides the most interpersonal contact with the patient.

Catheter related bloodstream infections are not only responsible for prolonged hospital stays and increased hospital costs, it is also responsible for increased mortality of the hospitalized patients. According to Centers for Disease Control and Prevention (2017), an estimate of 30,100 central line-associated bloodstream infections (CLABSI) occur in intensive care units and wards of U.S. acute care facilities each year. CLABSI is a serious hospital-acquired infection that occurs when bacteria enters the bloodstream through central venous catheters. CLABSI is preventable as long as health-care personnel practice aseptic techniques when working with the catheter. A blood culture swabbed from the tip of the catheter is needed to confirm the

In Nursing, there will always be instances where the patient's nurse needs to advocate for their patient. There are numerous reasons why a nurse would advocate for their patient ranging from getting the doctor to change the patient’s orders, helping the patient’s treatment team understand what it is the patient is requiring for the day, to expressing the patient’s last wishes before death. In every situation, the nurse should do what is in the patient’s best interest. Tomajan (2012), “Advocacy skills are the ability to successfully support a cause or interest on one’s own behalf or that of another. Advocacy requires a set of skills that include problem solving, communication, influence, and collaboration”(p. 2). With those skills, the

In the article “What Do Nurses Really Do?”, Suzanne Gordon explores what nurses truly do. She concludes that nurses “save lives, prevent complications, prevent suffering, and save money” (Gordon 2006). Nurses provide care for their patients in the physical and emotional sense. Emotionally caring for a patient and being sensitive to his or her needs result from interacting with patients while performing the skills and using the knowledge that nurses learned in school. Nurses grow in their skills, knowledge, and attitudes through practice. Quality and safety education for nursing incorporates competencies that all nurses must use in their practice. These nursing competencies include evidence-based nursing practice, quality improvement, safety, teamwork and collaboration, patient-centered care, and informatics.

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.

Horan, T. C. (2010). Central line-associated bloodstream infection (CLABSI) criteria and case studies. Retrieved from

Was the patient’s best interest at heart? Or was the physician trying to avoid a negative outcome? This is where collaboration among healthcare teams is vital to patient care and upholding patient wishes. Ultimately it is a nurse’s responsibility to advocate for the patient not only in respecting their wishes but communicating all available knowledge so that all parties involved can make and educated decision.

The American Nurses Association (ANA) “Code of Ethics for Nurses” (ANA, 2001) states: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient”. This reflects that advocating for the patient directly correlates with the safety and well-being of the patient. The key part to patient advocacy is effective communication. In recent times, there has been a focus on the connection of effective communication between healthcare workers and patient safety. A number of Institute of Medicine reports has brought focus to the severe matter. The reports have emphasized the concern of the lack of communication in the healthcare setting and the resulting negative patient outcomes. (Hanks, 2012a). This goes back to the notion that while many healthcare professionals consider themselves as a working member of a team, we have the natural tendency to work autonomously. Therefore, it is the nurse’s duty to collaborate patient centered care by practicing good communication skills with the entire healthcare team, the patient, and the patient’s family if consent is given to assure patient safety.

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.

Nurses play many essential roles in the care of their patients, one is being an advocate. Nurse advocates are the liaison between patients and doctors.

While providing safe care, nurses are also taught to be an advocate for their patients. To be an