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Final presentation research week 6[1]
- 1. Central Line Associated Blood Stream Infection Prevention in non-ICU Settings Erica Badillo, Natalie Farquharson, DeAngel Jones, Heather Smith NUR/518 March 3, 2014 Cindy Boyer
- 2. Central Line Blood Stream Infections • 250,000 CLABSIs occur annually • Lead to higher mortality and morbidity rates • Increase lengths of stay
- 3. Recommendations for CLABSI prevention in any setting • Continuing education • Quality Assurance Intravenous tubing protocols Sterile technique
- 4. Recommendations for CLABSI prevention in any setting • Nurse-Patient Ratios • Care Bundles Hand Hygiene Chlorhexadine dressings Catheter hub disinfection Removal of lines when medically permitted
- 5. TRUSTWORTHINESS & VALIDITY • Credibility • Transferability • Dependability
- 6. TRUSTWORTHINESS & VALIDITY • Validity
- 7. Conflict in research findings • Gaps exists in the area of CLABSI’s in:: 1. specificity of research 2. dedicated educational department 3. educational process
- 8. Confusion • Confusion exists in the area of: 1.responsibility for central line maintenance 2. documentation of central line care
- 9. Research Utilization Process Identification of the problem In-depth literature review Evaluation of previous studies to determine applicability of findings
- 10. Applicability of Findings • Professional nurses share an obligation to review current literature • Allows for clarification of the problem • Evidenced-based standardized care • Prevention initiatives, protocols, guidelines • Goal- to improve patient care and patient outcomes
- 11. Assessing Applicability of the Findings • The interventions and prevention strategies are applicable to multiple clinical settings Findings were consistent in multiple studies • It is expected that these interventions will be just as effective at preventing infections in other settings • A strong leadership team is vital to ensure staff compliance • Many facilities have adapted a CLASBI prevention checklist. Bundle interventions have been shown to significantly decrease infection rates
- 12. Applying the research findings Education Support Compliance Procedure carts Hand hygiene Aseptic technique Checklists Guidelines IV team Daily need assessments Avoid femoral site Chlorhexadine Line maintenance Culture of safety Accountability Quick removal
- 13. References: • Centers for Disease Control and Prevention. (2014). Central Line-Associated Bloodstream Infection: Resource of Patients and Healthcare Providers. Retrieved February 2, 2014 from: http://www.cdc.gov/HAI/bsi/CLABSI-resources.html • Kallen, A., Patel, P., O’Grady, N. (2010). Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society; 51 (3), 335-41. • Morrison, T. (2012). Qualitative analysis of central and midline care in the medical/surgical setting. Clinical Nurse Specialist; 26(6):323-8. doi:10.1097/NUR.0b013e31826e3f2a • The Joint Commission. (2010). Preventing Central Line-Associated Infections. A Global Challenge, A Global Perspective. Retrieved from http://www.jointcommission.org/assets/1/18/CLABSI_Monograph.pdf
- 14. References:
Editor's Notes
- According to the Joint Commission (2012), an estimated 80,000 CLABSIs occur in intensive care units every year in the United States. When including the amount of CLABSIs that occur outside of the intensive care unit the estimate increases to 250,000 CLABSIs annually (Joint Commission, 2012). CLABSIs are directly associated with increased patient mortality and morbidity, an increase in the length of stay, and excessive health care costs (Whited & Lowe, 2013). Although there has been much research in the intensive care unit (ICU) settings, there is little published on the recommendations for other settings in which central lines are utilized.
- Continuing Education plays a major role in CLABSI prevention. According to Morrison (2012) one area identified as a barrier to prevention of CLABSIs in a non ICU setting is the lack of experience a nurse has related to caring for a central line. With education, nurses were able to have a better understanding of the key components to CLABSI prevention. By providing continuing education, nurses can remain abreast on current recommendations for how to care for central lines in turn decreasing CLABSIs. During the education in-services, are taught to inspect the site on a frequent basis to allow for identification and treatment of infections sooner.Quality assurance methods help decrease central line associated blood stream infections in any setting (The Joint Commission, 2010). Quality assurance methods implemented by hospitals and home care settings include changing IV lines that contain antibiotics every 72 hours and those containing routine fluids at 96 hours (Liang, 2012). This helps to decrease the amount of bacteria present in the IV tubing thus decreasing the risk of an infected central line. Another quality assurance method in decreasing CLABSIs is to ensure there is sterile technique when inserting the central line as well as when doing dressing changes (CDC, 2002).
- Nurse to patient ratios were also identified as a barrier to providing the necessary central line care (Morrison, 2012). When nurses had higher patient ratios they were less likely to perform dressing changes as required. If the dressings were performed on time, nurses felt rushed and did not clean the insertion site as long as they should have, increasing the risk for infection. Care Bundles are a set of interventions implemented to decrease CLABSIs.Hand hygiene, aseptic technique, catheter type, inline filters, dressing regimens, antimicrobial impregnated catheters, catheter hub disinfection, catheter securement devices, and catheter removal as soon as possible also have proven to be useful in preventing central line infections (CDC, 2002). Hand hygiene is the most basic infection prevention method. The use of chlorhexadine dressings were also found to decrease central line infections (Kallen, Patel, and O’Grady, 2010). Prior to accessing central lines for blood draws, it is essential to “scrub the hub” for at least 15 seconds (Kallen, Patel, and O’Grady, 2010). This prevents any further introduction of bacteria into the bloodstream. Adherence to these recommendations leads to a decrease in central line infections which shows the effectiveness of following these recommendations. In addition to the implementation of these guidelines, medical professionals should always assess the need for a central line. The longer a central line is in place, the greater the risk for infection. The medical team should look at removing the central line as soon as medically possible.
- Evaluates whether or not the research findings represent a reliable conceptual interpretation of the data drawn from the participant’s original data. The credibility was met by the truth value and verification by participants. Interview took place by phone and 45 minutes per interview. Transferability representation of the degree to which the findings of this inquiry can apply or transfer beyond the bounds of the project. Transferability was met by defining the participant sample, setting, and sample data. Dependability is an assessment of the quality of the process of data collection, data analysis, and theory generation. Dependability was met by utilizing digital recording to establish rigorous research trail documenting how the study was introduced to the participant and who conducted the interviews.
- The validity of the study was measure by the interventions. In the study they recorded before and after interventions, the epidemiology and the clinical features of CLABSI. Data from prevalence studies were used to calculate a sample device utilization ratio (number of line days divided by the number of patient-days in the sample). Continuous variables were analyses using the t-test and categorical data were analyses using the chi-squared.
- Gaps are present in the research of CLABSI”s because the literature is predominately based on CLABSI’s in intensive care units. CLABSI’s research is lacking in other areas such as outpatient, home care settings, post-surgical departments, and immunocompromised patients. There is a need for the creation of an educational department specifically for central line and CLABSI’s. This department could then focus on the education of nurses responsible for central line care in the area of the impact of CLABSI’s on patients including bleeding, pain, pneumothorax, and death. Another educational topic is the impact of CLABSI’s on facilities including increased cost, increased work-load on nurses, and decreased patient satisfaction.
- Identification of a sole position designated to ensure central line dressing changes and central line administrations sets are changed according to central line protocols are still the primary responsibility of the bedside nurse. The confusion exits because at some facilities IV team nurses will perform the initial dressing change; while at other facilities the bedside nurse is responsible for all dressing changes. This confusion can be eliminated if there is a designated position created specifically for central line dressing changes and administration set changes. At present, there is no alert in computerized charting that prompts nurses when central line dressing changes and/or administrations sets are due to be changed. It is imperative that when these actions are completed that is documented in the patient’s recorded and it should also be communicated the next time these actions are due to be completed.
- The research utilization process involved identification of the problem (CLASBI rates), an in-depth literature review of both qualitative and quantitative studies, and an evaluation of previous research studies to determine the applicability of findings to the clinical setting. There is a strong emphasis placed on research in nursing to improve patient care and patient outcomes. Professional nurses share an obligation to review current literature consistently to provide evidenced-based standardized care. Upon a review of the literature on CLABSI prevention, many of the research studies and reports are applicable to multiple clinical settings.
- Hospitals and health care professionals across the world have recognized the seriousness of CLASBI and the need for prevention interventions to avoid harm and even death to the patient. Many health care organizations have begun to work towards CLASBI prevention, implementing bundle interventions and central-line protocols, particularly in the critical care setting. This allows for the development of evidenced-based standardized care through prevention initiatives, protocol, and guidelines. The common goal revolves around the patient, improving patient care to improve patient outcomes.
- A key challenge for researchers is to determine if the research findings are applicable to the clinical setting and patient population. CLASBIs are a considerable clinical issue with 250,000 occurring annually in the United States, and more specifically 80,000 in intensive care units (The Joint Commission, 2010). While it is true that some patients are at a higher risk for infection then others, the CLASBI is not specific to one patient population over another. The significance of this clinical issue is widespread, not designed to critical patients but consistent with patients in various clinical settings. Research studies showed that bundle interventions, consisting of hand hygiene, daily needs assessment, frequent line inspections, and staff education will drastically reduce CLASBI rates. Studies have discussed the implementation of prevention toolkits, guidelines, checklists, and bundle protocols. State and federal initiatives have also focused on CLASBI prevention.Barriers to compliance and high infection rates have been identified as inadequate resources, staffing shortages, lack of leadership involvement and support, infection prevention policies, time management, focus of responsibility, patient population/unit, and variations in nursing clinical experience. Recommendations to decrease central line infections in non ICU settings include continuing education, quality assurance, and certified IV teams. A strong leadership team is needed to implement infection control policies as well as bundle interventions protocols, to ensure staff are educated, informed, to offer support, and handle barriers such as inadequate resources. The leadership team’s involvement is critical to success, providing teamwork, support, and showing commitment to a common goal which then focuses on a culture of safety throughout the health care organization. Preventing infection does require all staff members to work together, to hold each other accountable, and for staff to be empowered to make the necessary changes at the bedside. Health care administrators can empower staff, provide motivation, and then reward efforts when positive results are made. Support of the managers and leaders in dealing with this issue can be powerful.
- Applying the research findings: EducationSupport from the leadership teamConsistent ComplianceProcedure cartsHand hygieneAseptic technique ChecklistsGuidelines and protocolsIV teamDaily needs assessmentsAvoid the femoral siteChlorhexadineLine maintenanceCulture of safetyAccountability Quick removal