Prevention of Central Line-Associated Bloodstream Infections

Appendix A

Ten Strategic Points

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Broad Topic Area

1. Broad Topic Area:

The topic is the Prevention of Central Line-Associated Bloodstream Infections (CLABSIs).

Literature Review

2. Literature Review:

a. Background of the problem/gap:

· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs (Yaseen, et al., 2016).

· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections (Dick et al., 2015).

· The nurses need to have significant knowledge associated with evidence-based practices for the prevention of central line-associated bloodstream infections (CLABSIs). Their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter in adult Intensive Care (ICU) units with (CVC) patients needs to change for the better (Kadium, 2015).

· Research has shown the existence of variations in the practice of nursing regarding the prevention of CLABSI, thus stressing the need for monitoring and education/training (Elbilgahy et al., 2015).

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· There is a need for implementation of educational interventions to deal with the practice and knowledge gaps about CLABSIs prevention as well as ensuring that nurses apply prevention interventions which are evidence-based (Esposito et al., 2017).

· The Quality Health Outcomes Model (QHOM) Investigating Prophylactic measures to eradicate the incidence of Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich et al., 2014)

b. Carrying out a review of literature topics with a key theme for each one.

c. Prevention of Central Line Associated Blood Stream Infection (CLABSI) (Masse, Edmond, & Diekema, 2018). Comment by Kathryn Flynn: Need more info

· The Quality Health Outcomes Model (QHOM) is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. This model/framework has been used by various researchers to test the effectiveness of infection prevention measures (Gilmartin & Sousa 2016).

· The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed uses Standardized Infection Ratios (SIRs). Clear Lake regional Medical Center (“NHSN | CDC,” 2018) uses SIRs and this study will also utilize SIRs for measuring the effectiveness of preventivive CLABSI maintance bundles (“SIR Report | HAI | CDC,” 2019). Comment by Kathryn Flynn: rephrase Comment by Kathryn Flynn: use APA format

Setting

· Adult ICU (Elbilgahy, et al., 2015). Comment by Kathryn Flynn: in a what? Major metro hospital? Rural ? describe

· The incidence of Catheter-Related Infections (CRIs) in cancer patients at the hospital (Hentrich et al., 2014). Comment by Kathryn Flynn: how is this related to setting? What does the citation refer to? Was that a research study? Need specifics what this means.

Summary

· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention through nursing education (Dombecki, Vercher, Valyko, Mills, & Washer, 2017). Comment by Kathryn Flynn: Was there just one set of authors that did research? You should find more to justify the project.

· Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting. There seems to be a problem regarding the training and education regarding the procedures which should be followed when carrying out catheter-related procedures (Dombecki, Vercher, Valyko, Mills, & Washer, 2017). The objective of this study is to address this issue.

· Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site are necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia (Yaseen, et al., 2016). Prevention of Central Line-Associated Bloodstream Infections

a. Background of the problem/gap:

Even though earlier CVCs were associated with mechanical complications such as leaks, air embolisms, and hub separation, CLABSIs quickly became a serious problem when it came to the use of catheters. A study by Owings et al. (2017) indicates that elementary infection control steps may reduce incidences of CLABSIs significantly.

a. Theoretical Foundations (models and theories to be the foundation for the project). Specifically, the model proposed is the Quality Health Outcomes Model (QHOM), which is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system (Gilmartin & Sousa, 2016).

The theoretical model is associated with the strategies deployed and operational processes linked to the prevention of Central Line Association Bloodstream Infection. This is demonstrated through a meta-analysis review of randomized control and quasi-experimental studies (Moody, 2019). Comment by Kathryn Flynn: I’m pretty sure I asked you to rephrase this. Clarify..

b. Review of literature topic

Rapid Dissemination of Universal Decolonization in Adult Intensive Care Units (ICUs) reduces healthcare-associated (HA) central line-associated bloodstream infections (CLABSI) in over 100 Community Hospitals (Hickok et al., 2015). Comment by Kathryn Flynn: How is this related to your topic? clarify

a. Single Healthcare System

c. Prevention of Central Line Associated Blood Stream Infection (CLABSI).

Problem Statement

There are several safety measures to follow during a procedure involving the insertion of a central line catheter. Despite this, there still exist many cases of infections resulting from such insertions, especially in adult ICUs. For example, a study conducted in an ICU in northern India indicates that in spite of there being several guidelines for CLABSIs prevention, cases of such infections are still high (Mishra et al., 2016). Comment by Kathryn Flynn: Find research that is specific to your population, setting.

Clinical/PICO Questions

3. Clinical/PICOT Questions:

“In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of central line catheter maintain high levels of hygiene after its insertion, along with thorough cleaning of the insertion site, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) compared to standard care over a one-month period?” Many care givers seem to show more consistency in the application of evidence-based practices when inserting the CVC. However, this is not the case after the insertion, explaining the reason why many infections occur postinsertion. This study suggests an intervention measure targeting the post insertion period. Comment by Kathryn Flynn: Move this after staff training, organize sentence. Comment by Kathryn Flynn: Support with citation. All hospitals rely on EBP. Are you saying they don’t In other words, it’s not clear to the reader why this is needed. Are the rates high at your hospital? Has the administration asked for this? Justify the project.

P: Patients > 65 years of age with a central line Comment by Kathryn Flynn: Describe population demographics. Review in text if questions. You mentioned cancer, in hospital? short term? Be specific.Prevention of Central Line-Associated Bloodstream Infections

I: Staff training on proper CVC maintenance, reinforcement of central catheter, and hub hygiene to educate staff on the utilization of the Central Line (CL) Bundle with a target of at least 100% compliance. This intervention has been proposed by (Tomlinson, 2015) but has not been implemented effectively across centers. Successful implementation of CL Bundle can help in reducing the rates of CLABSI and achieving zero CLABSI events for a period of one month (Yaseen et al, 2016). Comment by Kathryn Flynn: Compliance with what? Sattendance for training? Implementing? Be specific. Comment by Kathryn Flynn: This should be in lit review. Make sure its primary research.

C: Compared to standard care. The aim is to identify any discrepancies between the skills gained by trained staff and the standard care procedure.

O: Reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections). Pre and post intervention outcomes will be measured by counting the number of CLABSIs cases before and after the intervention. Using various questionnaire types (true/false, short answers, and fill in the blank. Comment by Kathryn Flynn: It’s time to say what kind of questionnaires. I can’t approve this until you let me know what you are doing…

T: A period of one-month

Sample

4. Sample (and Location):

a. Location: Acute care ICU Clear Lake Regional Medical Center, Webster, Texas

b. Sample: The study seeks to sample 60 total nurses from the adult intensive care unit department. 30 nurse’s utilizing the CLABSI bundle and 30 nurse’s not utilizing the CLABSI bundle (specifically CHG bathing). Patient sample size will be >30. Comment by Kathryn Flynn: Sample should be patient focused. Mention nurses after.