Scatliffe And Davis Study Summary

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

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.

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 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’s, or Central Line Associated Bloodstream Infections, are a worldwide problem of bloodstream infections from the unsterile insertion or unclean maintenance of a central line catheter, which are inserted in large veins and are in place for weeks or months (CDC, n.d.). CLABSIs have a high morbidity and mortality rate, increases cost of medical treatment and extends the length of hospitalization (Poderman & Girbes, 2002). Implementing evidence based practices have significantly reduced these CLABSI rates (Latif et al., 2015). 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

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.

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

The study determined the most common factors among those sampled to be: an overwhelming majority of male patients (98%), most seeking long-term use for antibiotic treatment (52%) or for venous access (21%), 85% were placed by vascular access nurses within the basilic vein of the right arm (Chopra et al., 2014). Single-lumen PICC devices (48%) were the most commonly used, many placed within medical or surgical units (18%) and remained for a median length of time of 21 days (Chopra et al., 2014). Over a total of 1156 catheter days, 966 PICCs were analyzed, 58 PICCs (6%) acquired CLABSIs. The most common infectious organism was determined to

Within the intensive care unit (ICU), one of the most important items or equipment utilized in management of patients is the central venous catheters (CVCs). These are typically devices that can allow intravascular access while terminating at any site close in proximity of the heart or in the neck around the great vessels. CVCs are vital for the management of critically ill and hospitalized patients as they provide or facilitate the procedures such as the medication infusion, blood sampling as well as hemodynamic measurement. Despite their importance, the CVCs are associated with increased cases of central line associated blood-stream infections (CLABSIs) in the healthcare facilities. These CLABSI are among the noted cases of hospital acquired infections for which Medicare cannot reimburse; and apart from the issues of reimbursement, these CLABSI are associated with lengthened hospital stay for patients, increased direct and indirect costs of treatment as well as significant compromise on health and wellness of the patient.

Chlorhexidine has been used for over 60 years for multiple purposes, first being used as a disinfectant in the 1950’s to being introduced in 1988 for the first skin preparation combination launched in the United States and then finally approved by the FDA in 2005 for peri-operative preparation. In 2010 the first chlorhexidine needless connectors were introduced, as well as the first impregnated peripheral inserted central catheter was cleared as an antimicrobial catheter. Over that period it has proven its broad-spectrum efficacy and safety. It has been used in preoperative patient for prevention of nosocomial infections during

Great job you nurses are doing at your unity. Central line associated blood stream infection (CLABSI) is one of the major problems most hospitals are experiencing. As explained by Boubekri, (2013) health care associated infections are a measure problem in most hospital and about 70% are from centrals lines. An effort put in place at my hospital was the use of chlorhexidine (CHG) wipes, we use them daily with patients that have a central line, wiping the daily around the central line side to reduce infection. Boubekri went further to explain in the article that the use of CHG wipe daily reduce the CLABSI. We use the CHG wipes on patients going for surgery, patients on Foley catheter, and any invasive procedure. It has really helped to reduce

The use of central venous catheters (CVCs) are integral to modern healthcare and have become an increasingly common means of administering treatments that vary from intravenous fluids to blood products to life-saving medications (Sacks et al., 2014; Oto, Imanaka, Konno, Nakataki, & Nishimura, 2011; The Joint Commission, 2012). The use of CVCs allows for immediate vascular access and improved patient comfort as a result of the decreased need for multiple needle sticks. However, their use is associated with an increased risk of blood stream infections. These infections called central-line associated bloodstream infections (CLABSIs) cause significant morbidity, mortality, and increased health care costs (Ramirez, Lee, & Welch, 2012; Sacks et al., 2014; Sandora et al., 2014 Wright et al., 2013; The Joint Commission, 2012).

Article reference (in APA style): Sofroniadou, S., Revela, I., Smirloglou, D., Makriniotou, I., Zerbala, S., Kouloubinis, A., & ... Iatrou, C. (2012). Linezolid versus Vancomycin Antibiotic Lock Solution for the Prevention of Nontunneled Catheter-related Blood Stream Infections in Hemodialysis Patients: A Prospective Randomized Study. Seminars In Dialysis, 25(9), 344-350. doi:10.1111/j.1525-139X.2011.00965.x

Central Lines are inserted for a number of clinical reasons including measurement of CVP, Administration of IV drugs, IV fluids, Blood Draw for difficult to stick patients and some times for nutritional reason (Administration of TPN). The main benefit of central line is for extremely sick people multiple drugs/treatments can be administered simultaneously. The major disadvantages of central lines, it can increase the risk of infection, pneumothorax, hemothorax, subclavian artery puncture, Catheter misplacement, air embolism, thrombosis and malfunctioning. The aim of this study is to discuss the methods adopted by hospitals to minimize