PICOT Statement and Literature Search

Grand Canyon University

NRS 433V

Cent[MR1] ral lines have become an integral part of providing critical care in an Intensive Care Unit. In a time where a patient is critically ill and need [MR2] multiple venous access, central lines can provide an easier way to manage intravenous medications without having to constantly be finding a new IV placement. Central lines not only provide access to infuse medication but also aid in providing an access to draw blood for laboratory exams. Its benefit is does not come without drawbacks. The major complication that can arise from having a central line access is Central Line-associated Bloodstream Infection, better known in healthcare as CLABSI. CLABSI is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line (CDC).

PICOT Statement and Literature Search

P- (population): ICU patients

I- (issue of interest): Central line associated bloodstream infections

C- (comparison group): no comparison group of interests[MR3]

O- (outcome): reducing CLABSI

T- (time frame): while having a central line

References

Central Line-associated Bloodstream Infections: Resources for Patients and Healthcare Providers. (n.d.). Retrieved from https://www.cdc.gov/hai/bsi/clabsi-resources.html [MR4]

Lui, H., Herzig, C. A., Dick, A. W., Furuya, E. Y., Larson, E., Reagan, J., & Stone, P. W. (2017).

Impact of State Reporting Laws on Central Line-Associated Bloodstream Infection Rates

In U.S. Adult Intensive Care Units. Health Service Research, 52(3), 1079-1098. doi: 10.1111/1475-6773.12530

Objective: To examine the effect of mandated state health care-associated infection (HAI) reporting laws on central line-associated bloodstream infection [MR5] (CLABSI) rates in adult intensive care units (ICUs). Data Sources: We analyzed 2006-2012 adult ICU CLABSI and hospital annual survey data from the National Healthcare Safety Network. The final analytic sample included 244 hospitals, 947 hospital years, 475 ICUs, 1,902 ICU years, and 16,996 ICU months. Study Design: We used a quasi-experimental study design to identify the effect of state mandatory reporting laws. Several secondary models were conducted to explore potential explanations for the plausible effects of HAI laws. Principal Findings: Controlling for the overall time trend, ICUs in states with laws had lower CLABSI rates beginning approximately 6 months prior to the law’s effective date (incidence rate ratio = 0.66; p < .001); this effect persisted for more than 6 1/2 years after the law’s effective date. These findings were robust in secondary models and are likely to be attributed to changes in central line usage and/or resources dedicated to infection control. Conclusions: Our results provide valuable evidence that state reporting requirements for HAIs improved care. Additional studies are needed to further explore why and how mandatory HAI reporting laws decreased CLABSI rates.

Whited, A., & Lowe, J. M., (2013). Central Line-Associated Bloodstream Infection: Not Just an

Intensive Care Problem. Clinical Journal of Oncology Nursing, 17(1), 21-24.

Central line-associated bloodstream infection (CLABSI) is an ongoing issue in health care, causing increased mortality and billions of dollars in healthcare costs. The majority of research and implementation has been done in the intensive care unit (ICU) setting. Although thousands of non-ICU patients are known to have CLABSI, adequate research has not been conducted in this population. This article explores the current literature on CLABSI and recommends additional research to focus on the non-ICU population and setting.

Traynor, K. (2011). Central Line Infections Fall in ICUs. American Journal of Health-System

Pharmacy, 68(8), 650-652.

Objective: To examine the effect of mandated state health care-associated infection (HAI) reporting laws on central line-associated bloodstream infection (CLABSI) rates in adult intensive care units (ICUs).Data Sources: We analyzed 2006-2012 adult ICU CLABSI and hospital annual survey data from the National Healthcare Safety Network. The final analytic sample included 244 hospitals, 947 hospital years, 475 ICUs, 1,902 ICU years, and 16,996 ICU months. Study Design: We used a quasi-experimental study design to identify the effect of state mandatory reporting laws. Several secondary models were conducted to explore potential explanations for the plausible effects of HAI laws.Principal Findings: Controlling for the overall time trend, ICUs in states with laws had lower CLABSI rates beginning approximately 6 months prior to the law’s effective date (incidence rate ratio = 0.66; p < .001); this effect persisted for more than 6 1/2 years after the law’s effective date. These findings were robust in secondary models and are likely to be attributed to changes in central line usage and/or resources dedicated to infection control. Conclusions: Our results provide valuable evidence that state reporting requirements for HAIs improved care. Additional studies are needed to further explore why and how mandatory HAI reporting laws decreased CLABSI rates.

Skilton, A., Marx, C., Prewitt, D., & Wheeler, K. Eliminating Central Line-Associated

Bloodstream Infections in the ICU. Critical Care Nurse, 28(2), e7.

[MR6] [MR7]

Patients with central venous catheters are at risk for central line–associated blood stream infections (CLABSIs). Such infections often result in increased ICU and hospital LOS, ICU mortality and cost associated with patient care. Description: Multiple evidenced-based practice changes have been implemented in the ICU in an effort to decrease CLABSI rates. Recent changes include an intensivist model, daily multi- disciplinary rounds, use of a central line cart, pre-insertion cleansing with chloraprep, and silver-impregnated central venous catheters. Evaluation and Outcomes: Baseline data, reported as infections per 1000 patient days, have been extracted from data reported to the National Healthcare Safety Network over the past 7 years. Annual trended rates are: 2000 = 3.76; 2001 = 2.71; 2002 = 2.55; 2003 =0.82; 2004 =1.25; 2005 = 0.99. Peripherally inserted central catheters infections were added to our data collection in 2006 subsequent rate was 1.3.

Ya-Wen, S., Min-Jung, H., Chin-Yi, C., Ching-Tzu, H., Jong-Rung, T., & Sue-Hui, C. (2014).

The Effect of Bundle Care on Central Line Associated Bloodstream Infection Care Unit.

Journal of Nursing, 61(3), 87-96.

Background & Problems: While the central line catheter is a common device used in intensive medical care, it is a frequent source of nosocomial infection. The central line associated bloodstream infection (CLABSI) rate at our medical ICU had increased steadily, with an average rate between January and May 2011 of 4.7‰. We used a cross-team approach to implement bundle care as a strategy to reduce the CLABSI rate. Purpose: We designed a project to reduce the CLABSI rate below 3.0‰ in our ICU. Resolution: This project was conducted between June 2011 and May 2012. Our strategy included providing a sterile towel, implementing maximal barrier precautions (head to toe), designing an illustration explaining how to use 2% CHG, establishing a procedures and care checklist, implementing quality assurance for procedures and care, and providing education on bundle care. Results: The CLABSI rate reduced to 2.4‰ after project implementation. This result was below the target of 3.0‰. Conclusions: We want to share this experience to help other hospitals and units improve critical care quality and to continue working to achieve a zero-tolerance infection rate.

[MR1]Indent here

[MR2]needs

[MR3]the I is actually your intervention or what you are going to do and your C is your comparison of what you are going to do compared to what is currently being done

You need to then provide a fully developed PICOT statement

[MR4]I am not seeing your abstract for this and this is not quantitative or qualitative

[MR5]No sure why you have bolded words here you don’t need them, this looks very copied and pasted

[MR6]Be sure to double space

[MR7]