Homework Lance
Rough Draft Qualitative Research Critique and Ethical Considerations
Grand Canyon University
NRS 433V
Background of Study
Central line- associated bloodstream infection (CLABSI) is an ongoing issue in healthcare setting, causing increased mortality and billions in dollars in healthcare costs (White & Lowe, 2013). In an investigation conducted by the Centers for Disease Control and Prevention better known as the CDC in 2011, they found that CLABSI’s have a high mortality rate of 12 to 25 percent. Central line – associated infections are preventable through proper care and most importantly proper insertion technique. Other methods in the prevention and reduction of CLABSIs include specific bundles, staff education and development programs, improved culture of safety and adhering to guidelines for best insertion practices.Such practices have significantly reduced CLABSIs in the intensive care unit (ICU) settings but thousands of patients with central lines outside of ICU continue to acquire central line infections. It was estimated that 37,000 outpatient hemodialysis patients and 23,000 hospitalized patients hospitalized patients in non-ICUs developed CLABIs in 2008 and 2009 (CDC, 2011). That numbers suggested that at least 60,00 had a higher mortality rate and an increase in healthcare costs. As there are trends suggesting that CLABSIs are not only limited to ICU patients, this paper is to explore current literature or data on CLABSIs and emphasize that more investigation is needed in patients with central lines outside of the ICU setting.
Method of Study
Literature review was selected as the primary method to obtain data on current research studies involving CLABSIs. One of the first CLABSI studies included all adult patients in ICU in Michigan(White & Lowe, 2013). These ICUs implemented five evidence based practices recommended by CDC, handwashing, the use of personal protective devices during insertion of any central line catheter, sterile skin preparation with the use of chlorohexidine, avoiding femoraland sites, and removing medically unnecessary catheter devices. The data collected suggested that there was daily communication on whether the central line was a medical necessity and a checklist was set in place to make certain there was a policy compliance. Each month a record was kept on the occurrences of CLABSIs and reported each quarter. Improvements were observed within the first three months and the reported decrease was zero compared to a baseline of 2.7 per 1,000 catheter days. Well after the study, there was a 66%decline in CLABSI demonstrating that changes in daily practices can yield lasting results. Another similar study in Rhode Island that included all 23 ICUs, produced similar results when evidence based practice behaviors were applied. The study in Rhode Island steadily resulted in lower cases of CLABSIs in January until it reached to zero cases in June 2008 (White & Lowe, 2013). Studies also concluded that the largest percentage of CLABSIs occurred in peripherally inserted central catheters and nontunneled hemodialysis catheters. The study also found that the most prevalent bacteria that contributed to CLABSIs was vancomycin resistant enterococci and also the bacteria that was associated with contaminated samples. Another participating ICU location implemented central line insertion bundles and added a post insertion bundle that included nursing interventions such as, daily inspection of site, dressing change every seven days or when visibly soiled using chlorhexidine gluconate, cleaning the hubs prior to using the line and handwashing. The introduction and implementation of a post insertion bundle and the further decrease of CLABSIs supported the need for both an insertion and post insertion bundle.
Educational programs to reduce CLABSIs were also reviewed. Each educational program had a pre-and post-test to assess the educational need and the outcome of the teaching and create measurable data. These educational programs consisted of short length lectures conducted by infection control experts. Fact sheets and CLABSI rate data was shared. Another educational module based on compliance included fact sheets and posters illustrating steps to reduce CLABSI. The last educational method was using the CDC guidelines on the prevention of CLABSIs to all ICU staff. The study concluded that educational programs in place significantly reduced the CLABSI rate. The educational programs also proved increased staff compliance specially when it included proper dressing change, access and use of closed medication system, assessing for the need of a central line and prompt removal along with sharing fact sheets on CLABSIs.
Another population studied was those patients that were in non-ICU settings. Although the usage of central lines was higher in the ICU units, the overall number of patients with central lines was higher on the medical floors at 70% (White & Lowe, 2013). The larger volume of central lines found outside the ICU setting calls for further research on CLABSIs in general wards particularly pediatric and cancer patients
Result of Study
Results of the study showed decreased CLABSIs in ICU when CDC guidelines were followed and institutions were proactive and set their own policies to follow. When educational programs were available to healthcare staff, there was a notable decline in CLABSIs in the ICUs. CLABSIs contribute to an additional hospital cost of more than $36,000 per infection, extending hospital stays and raising mortality rates (White & Lowe, 2013). With cost-effective measures such as following best practice, lectured led by infection control personnel, easily visible CLABSI prevention posters and fact sheets nurses can prevent and/or reduce the incident rate of CLABSIs and save hospital money.Care bundles need to be individualized for each setting. Until further research is conducted on the general medical floors, nurses are recommended to follow the same ICU CLABSI guidelines set by their institution. Often times, central lines are maintained on the medical floors, in such cases, the staff nurses can follow the CDC guidelines for best practices.
Ethical Considerations
Confidentiality was kept throughout the study without revealing the name of the institutions in which the studies were conducted. Each study was conducted in their institution and approved by the institution’s review board.
Conclusion
It is evident that most of the research was conducted in ICU settings, until further investigation is done on the general floor, nurses should follow CDC guidelines in the prevention of CLABSIs. Another option for nurses is to follow their institution’s guidelines until further studies are conducted and new guidelines are inplace. CLABSI guidelines should be appropriate for each hospital setting in order to achieve a higher compliance rate and reduced central line infections. Overall, there was a significant improvement in the care of patients with central lines when best nursing practice was used and policies were set in place along with staff development lectures on how to deliver safer and more efficient care.
Vital Signs: Central Line- Associated Blood Stream Infections- United States, 2001,2008 and 2009. (2011, March 04). Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm
Whited, A., & Lowe, M. J., (2013). Central Line- Associated Bloodstream Infection: Not Just an
Intensive Care Unit Problem. Clinical Journal of Oncology Nursing, 17(1), 21-24.
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