The document summarizes a study evaluating the central line maintenance protocol at Baylor Scott & White Health. The protocol provides guidelines for cleaning, flushing, and dressing central lines. The study analyzes evidence from other research to determine if the protocol follows best practices. Several studies support aspects of the protocol like checklists, hub disinfection, and flushing guidelines. Overall, the evidence validates that the protocol is evidence-based. The recommendation is that Baylor Scott & White Health should continue adhering to their existing protocol to reduce central line infections.
1) The document evaluates integrating HIV care (ART clinics) with regular outpatient care (OPD) in a clinic in Zambia. Data was collected before and after integration on waiting times.
2) Preliminary results found ART patient processing times were longer, and waiting times increased for both patient types after integration. However, more analysis was needed to account for other changing factors.
3) Simulation results also initially found ART waiting times increased after integration, even when controlling for staffing levels. Further simulation informed how and when best to integrate clinics based on patient mix and other factors.
The document examines the implementation of patient safety and patient-centeredness strategies in 84 Iranian hospitals based on a survey completed by hospital and nursing managers in 2009-2010. It finds that the majority of hospitals reported implementing 84% of patient safety strategies and 72% of patient-centeredness strategies. Implementation of most strategies was generally unrelated to hospital characteristics like type, ownership, teaching status, or annual evaluation grade, with some exceptions. Overall implementation of strategies was substantial but there is still room for improvement, including enforcing standards, increasing organizational responsiveness, and partnering with patients.
Ht ai 2015 poster 238 - Efficiency of the Artificial Urinary SphincterREBRATSoficial
The document summarizes research on the artificial urinary sphincter (AS) for treating urinary incontinence following prostatectomy. It finds that while AS has success rates of around 79% and patient satisfaction, the evidence is limited as only one randomized controlled trial exists. Systematic reviews call for more studies directly comparing AS to other surgical therapies. Health technology assessments in Brazil did not recommend AS for public insurance due to low evidence, but private insurance does cover it. More high-quality research is needed to determine the effectiveness and costs of AS versus other options.
Hydroxyurea for the treatment of sickle cell disease2alsaeedhh
This document reports on a study conducted by the Johns Hopkins University Evidence-based Practice Center to evaluate the efficacy, effectiveness, harms, and barriers to use of hydroxyurea for treatment of sickle cell disease. The study was commissioned by the Agency for Healthcare Research and Quality and the National Institutes of Health to clarify the role of hydroxyurea in treating sickle cell disease and to improve physician adherence to treatment guidelines. The report summarizes evidence on key questions related to hydroxyurea and sickle cell disease treatment gathered from a review of scientific literature.
This document summarizes a research study on the knowledge and practices of tuberculosis (TB) clients, healthcare providers, and local government units regarding pulmonary TB and the TB Directly Observed Treatment Short Course (TB-DOTS) strategy in Albay Province, Philippines. The study found that while knowledge of TB and TB-DOTS was generally high, compliance with TB-DOTS practices was low. Key challenges included inadequate staffing and lack of medications. Overall, the study suggests raising further awareness among stakeholders to address issues in implementing TB-DOTS and reducing the TB burden in the region.
The editorial discusses the publication of results from the REVIVE clinical trials that tested the drug levosimendan for acute decompensated heart failure. The trials were completed over 7 years ago but results were only recently published. The editorial argues that this late publication fulfills critical obligations to study participants who consented to the trials, and to clinical colleagues who need complete trial results to inform decisions. While levosimendan provided some benefits like reduced need for rescue interventions, it also increased risks like hypotension and arrhythmias. The editorial maintains researchers and sponsors have a duty to publish full trial results in a timely manner.
1) The document evaluates integrating HIV care (ART clinics) with regular outpatient care (OPD) in a clinic in Zambia. Data was collected before and after integration on waiting times.
2) Preliminary results found ART patient processing times were longer, and waiting times increased for both patient types after integration. However, more analysis was needed to account for other changing factors.
3) Simulation results also initially found ART waiting times increased after integration, even when controlling for staffing levels. Further simulation informed how and when best to integrate clinics based on patient mix and other factors.
The document examines the implementation of patient safety and patient-centeredness strategies in 84 Iranian hospitals based on a survey completed by hospital and nursing managers in 2009-2010. It finds that the majority of hospitals reported implementing 84% of patient safety strategies and 72% of patient-centeredness strategies. Implementation of most strategies was generally unrelated to hospital characteristics like type, ownership, teaching status, or annual evaluation grade, with some exceptions. Overall implementation of strategies was substantial but there is still room for improvement, including enforcing standards, increasing organizational responsiveness, and partnering with patients.
Ht ai 2015 poster 238 - Efficiency of the Artificial Urinary SphincterREBRATSoficial
The document summarizes research on the artificial urinary sphincter (AS) for treating urinary incontinence following prostatectomy. It finds that while AS has success rates of around 79% and patient satisfaction, the evidence is limited as only one randomized controlled trial exists. Systematic reviews call for more studies directly comparing AS to other surgical therapies. Health technology assessments in Brazil did not recommend AS for public insurance due to low evidence, but private insurance does cover it. More high-quality research is needed to determine the effectiveness and costs of AS versus other options.
Hydroxyurea for the treatment of sickle cell disease2alsaeedhh
This document reports on a study conducted by the Johns Hopkins University Evidence-based Practice Center to evaluate the efficacy, effectiveness, harms, and barriers to use of hydroxyurea for treatment of sickle cell disease. The study was commissioned by the Agency for Healthcare Research and Quality and the National Institutes of Health to clarify the role of hydroxyurea in treating sickle cell disease and to improve physician adherence to treatment guidelines. The report summarizes evidence on key questions related to hydroxyurea and sickle cell disease treatment gathered from a review of scientific literature.
This document summarizes a research study on the knowledge and practices of tuberculosis (TB) clients, healthcare providers, and local government units regarding pulmonary TB and the TB Directly Observed Treatment Short Course (TB-DOTS) strategy in Albay Province, Philippines. The study found that while knowledge of TB and TB-DOTS was generally high, compliance with TB-DOTS practices was low. Key challenges included inadequate staffing and lack of medications. Overall, the study suggests raising further awareness among stakeholders to address issues in implementing TB-DOTS and reducing the TB burden in the region.
The editorial discusses the publication of results from the REVIVE clinical trials that tested the drug levosimendan for acute decompensated heart failure. The trials were completed over 7 years ago but results were only recently published. The editorial argues that this late publication fulfills critical obligations to study participants who consented to the trials, and to clinical colleagues who need complete trial results to inform decisions. While levosimendan provided some benefits like reduced need for rescue interventions, it also increased risks like hypotension and arrhythmias. The editorial maintains researchers and sponsors have a duty to publish full trial results in a timely manner.
Advance Research By Working Directly with PatientsQuintiles
This document discusses using direct-to-patient methods in research to increase efficiency and reduce costs. It provides examples of case studies where direct-to-patient approaches were used to collect patient-reported outcomes and medical data. Direct recruitment of patients can speed up enrollment, lower costs by reducing the need for clinical sites, and provide insights from the patient perspective. However, questions remain about data quality without physician involvement and regulatory requirements are still being defined. Overall, direct-to-patient innovation holds potential to drive greater efficiencies in research.
This randomized clinical trial compared medication administration error rates between dedicated medication nurses and general nurses across two hospitals. The main findings were:
1) Overall error rates were similar between medication nurses (15.7%) and general nurses (14.9%).
2) At one hospital, medication nurses had a significantly lower error rate than general nurses in surgical units but not medical units.
3) Differences in medication processes and settings highlighted the role of systems design in errors. The study suggests simple interventions may not reduce errors without broader system changes.
The document summarizes the use of electronic health records (EHRs) for syndromic surveillance, using the example of Zika virus. It discusses how EHRs can help improve reporting of outbreaks by recording patient information. While EHRs provide advantages like improved reporting efficiency and criterion validity of data, they also have limitations like the need for diagnostic and demographic accuracy. The document reviews literature on different surveillance systems and their use in various healthcare settings. It concludes by discussing opportunities for further research, such as including new diseases in surveillance systems and improving collaboration between public and private health sectors.
This document discusses using direct-to-patient research methods to improve clinical trials. It notes that direct engagement of patients can lead to faster enrollment, increased retention, and decreased costs compared to traditional physician-centric models. However, it also notes limitations such as potential questions about data quality without physician involvement. The document presents several case studies showing how direct-to-patient approaches have been used successfully in multiple sclerosis, gout, and other disease areas to collect patient-reported outcomes and validate diagnoses while engaging patients.
Operartions research in US Healthcare IndustryPrasant Patro
1. This document describes how operations research (OR) models can help reduce delays in healthcare. It identifies three major sources of delays: emergency department delays, delays for medical appointments, and delays for nursing care.
2. Within emergency department delays, it notes long wait times to see physicians and delays in getting inpatient beds once admitted. For medical appointments, it describes waits of several weeks on average to see primary care physicians. Delays for nursing care can compromise patient safety due to insufficient staffing levels.
3. It argues that healthcare delays remain prevalent because they have not been well measured or reported, hospitals face cost pressures to maximize occupancy, and national shortages of healthcare professionals exacerbate delays. OR models have
Presentation describes survey results on patient and public attitudes to use of patient data for research and related purposes. Presented by Cicely Marston at the Data Management in Practice workshop, which took place at the London School of Hygiene and Tropical Medicine on Nov 14th 2013
Outcomes research examines the end results of health services on individuals and considers patient values and preferences. Patient-centered outcomes research (PCOR) compares the impact of different preventative, diagnostic, treatment, or healthcare delivery approaches on health outcomes that are meaningful to patients. The Agency for Healthcare Research and Quality accepts nominations for PCOR studies and disseminates findings to help close the 17-year gap for evidence adoption into practice. Funding also supports infrastructure development and evidence synthesis to accelerate research translation into tools and guidelines to improve patient care.
This document discusses maximizing patient outcomes in respiratory care. It outlines the founding principles of the Respiratory Effectiveness Group (REG), which aims to better integrate real-world evidence from sources like observational studies and pragmatic trials into clinical practice guidelines. Currently, guidelines are often based primarily on randomized controlled trials, which have limitations and may not generalize to most patients. The document calls for considering a diversity of evidence and tailoring care to individual patient needs and characteristics. It also discusses how databases could help achieve more personalized care by providing real-world data on topics like disease prevalence, treatments, and outcomes across different healthcare systems.
JMCP 2016 Access to new meds for hep C in Medicaid membersKimberly Lenz
This document summarizes a study that evaluated access to new hepatitis C virus (HCV) treatment medications among Medicaid patients in Massachusetts. The study found that only 5.1% of MassHealth members with HCV had their healthcare provider submit a prior authorization request for treatment with sofosbuvir or simeprevir. Patients who had a treatment request were more likely to be older, have advanced liver disease or have been recently treated for HCV, and less likely to have a substance use disorder. Nearly all (90%) of treatment requests were approved. The results suggest that while the Medicaid program did not restrict access, other factors like provider prioritization and patient barriers influenced who received treatment.
This document discusses biobanks and registries, their value for research, and opportunities for patient involvement. It describes how biobanks store biological samples and associated data to support research. Registries collect standardized clinical data on patient populations over time. Both require governance and quality management. The document presents two cases where patient organizations were involved in biobank and registry co-creation and governance to help advance research.
This study examined the relationship between long-term systemic corticosteroid use and related health complications in patients with severe asthma using claims data. The study found:
1) Patients with severe asthma who were exposed to systemic corticosteroids had a significantly higher risk of developing corticosteroid-related complications compared to those not exposed, and this risk increased with higher corticosteroid doses in a dose-dependent manner.
2) Health care resource utilization, such as inpatient visits, emergency room visits and costs, increased significantly with higher levels of systemic corticosteroid exposure among severe asthma patients.
3) There was a significant dose-response relationship between long-term systemic corticosteroid
1) The speaker discusses the evidence and guidelines for treating sepsis put forth by the Surviving Sepsis Campaign (SSC), noting that while some elements like antibiotics are strongly evidenced, other physiological targets like CVP are weakly evidenced and may not be suitable for all patients.
2) Compliance with SSC bundles is low even in committed institutions, suggesting the guidelines are difficult to follow or clinicians disagree with some aspects.
3) Attempts to protocolize care need to allow clinical judgment based on the individual patient's full clinical picture rather than strict adherence to bundles.
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
This document discusses a quality improvement initiative to reduce hospital acquired venous thromboembolism (VTE). VTE includes deep vein thrombosis and pulmonary embolism, which can be fatal. The document outlines Donabedian's framework for assessing healthcare quality using structure, process, and outcomes measures. It then applies this framework to assess the structure, processes, and intended outcomes of a VTE prevention strategy implemented at a healthcare organization. This included compulsory VTE risk assessment, appropriate prophylaxis ordering and administration, staff education, and ongoing performance monitoring to continuously improve outcomes of reducing hospital acquired VTE events.
Evidence based practice for dvt prophylaxis - power pointRafie1Davidov
The document discusses evidence-based research on DVT prophylaxis for hospitalized patients. It reviews 4 sources that found Lovenox to be more effective than compression stockings alone in preventing DVTs. The suggested innovation is developing individualized DVT prophylaxis plans for patients based on their risk factors. The implementation process outlines using Kotter's change model to get buy-in from nurses and doctors and establish the new protocol.
SNIIRAM: PRIMARY AND SECONDARY CARE RESOURCE USE IN FRANCEZoe Mitchell
This document summarizes information from the SNIIRAM database in France. It discusses:
- SNIIRAM is a national database containing medical claims data from primary, secondary, and tertiary care.
- It allows linkage of data between different levels of care to study patient pathways.
- Examples of studies using SNIIRAM data include analyzing inhaled corticosteroid use patterns in asthma patients, comparing effectiveness of allergen immunotherapy in children with rhinitis, and assessing montelukast's impact on asthma control in infants.
This document summarizes research on risk assessment of patients presenting to the emergency department (ED) with acute heart failure (AHF). Nearly 700,000 ED visits each year are due to AHF, with over 80% resulting in hospital admission. Existing risk prediction tools for AHF have not impacted admission rates. The authors hypothesize that evaluating both physiological risk factors and barriers to self-care, along with strategies to overcome barriers and shared decision making between providers and patients, could allow more patients to be safely discharged from the ED or observation units rather than admitted. This approach may help reduce hospital admissions, readmissions, and costs while improving long-term management of heart failure.
The current UK regulatory system for health research is overly complex and bureaucratic, undermining the country's status as a leader in medical science. A working group reviewed the system and identified key problems, including delays in obtaining NHS permissions, complexity across the pathway, lack of proportionality in clinical trials regulation, and constraints on access to patient data. The group recommends streamlining regulation through a new Health Research Agency to coordinate approvals and establish national standards. Other recommendations include improving the culture within the NHS to better support research, revising EU clinical trials rules to reduce burdens, and enabling safe and effective access to patient data for approved research. The proposed changes aim to facilitate high-quality research for public benefit while continuing to safeguard participants
This document summarizes a critique of a pneumonia prevention policy at The University of Texas Medical Branch. The policy aims to prevent nosocomial pneumonia through measures such as preventing person-to-person transmission, aspiration prevention, postoperative pneumonia prevention, and equipment sterilization. However, the evidence review found that the policy was missing key elements like a comprehensive oral care plan, requirements for continuous endotracheal cuff pressure maintenance, and fully implementing ventilator bundle practices. The critique makes recommendations to update the policy based on current evidence, such as including an in-depth oral care regimen, specifying ventilator bundle elements, and providing more education resources to reduce non-compliance.
The document discusses a PICOT statement regarding use of a CAUTI bundle to reduce catheter-associated urinary tract infections (CAUTI) in hospital patients. It then summarizes two research articles that support the PICOT statement. Krein et al. (2013) found that while CAUTI bundles reduced infections, barriers like lack of buy-in from nurses and doctors limited their effectiveness. Oman et al. (2012) found that a nurse-led intervention including CAUTI bundles did not reduce infection rates but did reduce catheter duration, thus lowering CAUTI risk. Both studies support the use of CAUTI bundles and guidelines to reduce CAUTI incidence.
This document discusses an evidence-based quality improvement project aimed at evaluating the effectiveness of an educational intervention for nurses on reducing catheter-associated urinary tract infection (CAUTI) rates. The project would employ a pretest-posttest design to assess the impact of education on nurses' knowledge and facility CAUTI rates. Permission is being requested to conduct the project at a hospital where CAUTI rates are currently higher than the national benchmark according to published data. Potential benefits include cost savings from a reduction in CAUTI treatment and reimbursement risks, while there are no anticipated risks to patients. Nurses may have to work longer hours to care for patients with CAUTIs.
Advance Research By Working Directly with PatientsQuintiles
This document discusses using direct-to-patient methods in research to increase efficiency and reduce costs. It provides examples of case studies where direct-to-patient approaches were used to collect patient-reported outcomes and medical data. Direct recruitment of patients can speed up enrollment, lower costs by reducing the need for clinical sites, and provide insights from the patient perspective. However, questions remain about data quality without physician involvement and regulatory requirements are still being defined. Overall, direct-to-patient innovation holds potential to drive greater efficiencies in research.
This randomized clinical trial compared medication administration error rates between dedicated medication nurses and general nurses across two hospitals. The main findings were:
1) Overall error rates were similar between medication nurses (15.7%) and general nurses (14.9%).
2) At one hospital, medication nurses had a significantly lower error rate than general nurses in surgical units but not medical units.
3) Differences in medication processes and settings highlighted the role of systems design in errors. The study suggests simple interventions may not reduce errors without broader system changes.
The document summarizes the use of electronic health records (EHRs) for syndromic surveillance, using the example of Zika virus. It discusses how EHRs can help improve reporting of outbreaks by recording patient information. While EHRs provide advantages like improved reporting efficiency and criterion validity of data, they also have limitations like the need for diagnostic and demographic accuracy. The document reviews literature on different surveillance systems and their use in various healthcare settings. It concludes by discussing opportunities for further research, such as including new diseases in surveillance systems and improving collaboration between public and private health sectors.
This document discusses using direct-to-patient research methods to improve clinical trials. It notes that direct engagement of patients can lead to faster enrollment, increased retention, and decreased costs compared to traditional physician-centric models. However, it also notes limitations such as potential questions about data quality without physician involvement. The document presents several case studies showing how direct-to-patient approaches have been used successfully in multiple sclerosis, gout, and other disease areas to collect patient-reported outcomes and validate diagnoses while engaging patients.
Operartions research in US Healthcare IndustryPrasant Patro
1. This document describes how operations research (OR) models can help reduce delays in healthcare. It identifies three major sources of delays: emergency department delays, delays for medical appointments, and delays for nursing care.
2. Within emergency department delays, it notes long wait times to see physicians and delays in getting inpatient beds once admitted. For medical appointments, it describes waits of several weeks on average to see primary care physicians. Delays for nursing care can compromise patient safety due to insufficient staffing levels.
3. It argues that healthcare delays remain prevalent because they have not been well measured or reported, hospitals face cost pressures to maximize occupancy, and national shortages of healthcare professionals exacerbate delays. OR models have
Presentation describes survey results on patient and public attitudes to use of patient data for research and related purposes. Presented by Cicely Marston at the Data Management in Practice workshop, which took place at the London School of Hygiene and Tropical Medicine on Nov 14th 2013
Outcomes research examines the end results of health services on individuals and considers patient values and preferences. Patient-centered outcomes research (PCOR) compares the impact of different preventative, diagnostic, treatment, or healthcare delivery approaches on health outcomes that are meaningful to patients. The Agency for Healthcare Research and Quality accepts nominations for PCOR studies and disseminates findings to help close the 17-year gap for evidence adoption into practice. Funding also supports infrastructure development and evidence synthesis to accelerate research translation into tools and guidelines to improve patient care.
This document discusses maximizing patient outcomes in respiratory care. It outlines the founding principles of the Respiratory Effectiveness Group (REG), which aims to better integrate real-world evidence from sources like observational studies and pragmatic trials into clinical practice guidelines. Currently, guidelines are often based primarily on randomized controlled trials, which have limitations and may not generalize to most patients. The document calls for considering a diversity of evidence and tailoring care to individual patient needs and characteristics. It also discusses how databases could help achieve more personalized care by providing real-world data on topics like disease prevalence, treatments, and outcomes across different healthcare systems.
JMCP 2016 Access to new meds for hep C in Medicaid membersKimberly Lenz
This document summarizes a study that evaluated access to new hepatitis C virus (HCV) treatment medications among Medicaid patients in Massachusetts. The study found that only 5.1% of MassHealth members with HCV had their healthcare provider submit a prior authorization request for treatment with sofosbuvir or simeprevir. Patients who had a treatment request were more likely to be older, have advanced liver disease or have been recently treated for HCV, and less likely to have a substance use disorder. Nearly all (90%) of treatment requests were approved. The results suggest that while the Medicaid program did not restrict access, other factors like provider prioritization and patient barriers influenced who received treatment.
This document discusses biobanks and registries, their value for research, and opportunities for patient involvement. It describes how biobanks store biological samples and associated data to support research. Registries collect standardized clinical data on patient populations over time. Both require governance and quality management. The document presents two cases where patient organizations were involved in biobank and registry co-creation and governance to help advance research.
This study examined the relationship between long-term systemic corticosteroid use and related health complications in patients with severe asthma using claims data. The study found:
1) Patients with severe asthma who were exposed to systemic corticosteroids had a significantly higher risk of developing corticosteroid-related complications compared to those not exposed, and this risk increased with higher corticosteroid doses in a dose-dependent manner.
2) Health care resource utilization, such as inpatient visits, emergency room visits and costs, increased significantly with higher levels of systemic corticosteroid exposure among severe asthma patients.
3) There was a significant dose-response relationship between long-term systemic corticosteroid
1) The speaker discusses the evidence and guidelines for treating sepsis put forth by the Surviving Sepsis Campaign (SSC), noting that while some elements like antibiotics are strongly evidenced, other physiological targets like CVP are weakly evidenced and may not be suitable for all patients.
2) Compliance with SSC bundles is low even in committed institutions, suggesting the guidelines are difficult to follow or clinicians disagree with some aspects.
3) Attempts to protocolize care need to allow clinical judgment based on the individual patient's full clinical picture rather than strict adherence to bundles.
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
This document discusses a quality improvement initiative to reduce hospital acquired venous thromboembolism (VTE). VTE includes deep vein thrombosis and pulmonary embolism, which can be fatal. The document outlines Donabedian's framework for assessing healthcare quality using structure, process, and outcomes measures. It then applies this framework to assess the structure, processes, and intended outcomes of a VTE prevention strategy implemented at a healthcare organization. This included compulsory VTE risk assessment, appropriate prophylaxis ordering and administration, staff education, and ongoing performance monitoring to continuously improve outcomes of reducing hospital acquired VTE events.
Evidence based practice for dvt prophylaxis - power pointRafie1Davidov
The document discusses evidence-based research on DVT prophylaxis for hospitalized patients. It reviews 4 sources that found Lovenox to be more effective than compression stockings alone in preventing DVTs. The suggested innovation is developing individualized DVT prophylaxis plans for patients based on their risk factors. The implementation process outlines using Kotter's change model to get buy-in from nurses and doctors and establish the new protocol.
SNIIRAM: PRIMARY AND SECONDARY CARE RESOURCE USE IN FRANCEZoe Mitchell
This document summarizes information from the SNIIRAM database in France. It discusses:
- SNIIRAM is a national database containing medical claims data from primary, secondary, and tertiary care.
- It allows linkage of data between different levels of care to study patient pathways.
- Examples of studies using SNIIRAM data include analyzing inhaled corticosteroid use patterns in asthma patients, comparing effectiveness of allergen immunotherapy in children with rhinitis, and assessing montelukast's impact on asthma control in infants.
This document summarizes research on risk assessment of patients presenting to the emergency department (ED) with acute heart failure (AHF). Nearly 700,000 ED visits each year are due to AHF, with over 80% resulting in hospital admission. Existing risk prediction tools for AHF have not impacted admission rates. The authors hypothesize that evaluating both physiological risk factors and barriers to self-care, along with strategies to overcome barriers and shared decision making between providers and patients, could allow more patients to be safely discharged from the ED or observation units rather than admitted. This approach may help reduce hospital admissions, readmissions, and costs while improving long-term management of heart failure.
The current UK regulatory system for health research is overly complex and bureaucratic, undermining the country's status as a leader in medical science. A working group reviewed the system and identified key problems, including delays in obtaining NHS permissions, complexity across the pathway, lack of proportionality in clinical trials regulation, and constraints on access to patient data. The group recommends streamlining regulation through a new Health Research Agency to coordinate approvals and establish national standards. Other recommendations include improving the culture within the NHS to better support research, revising EU clinical trials rules to reduce burdens, and enabling safe and effective access to patient data for approved research. The proposed changes aim to facilitate high-quality research for public benefit while continuing to safeguard participants
This document summarizes a critique of a pneumonia prevention policy at The University of Texas Medical Branch. The policy aims to prevent nosocomial pneumonia through measures such as preventing person-to-person transmission, aspiration prevention, postoperative pneumonia prevention, and equipment sterilization. However, the evidence review found that the policy was missing key elements like a comprehensive oral care plan, requirements for continuous endotracheal cuff pressure maintenance, and fully implementing ventilator bundle practices. The critique makes recommendations to update the policy based on current evidence, such as including an in-depth oral care regimen, specifying ventilator bundle elements, and providing more education resources to reduce non-compliance.
The document discusses a PICOT statement regarding use of a CAUTI bundle to reduce catheter-associated urinary tract infections (CAUTI) in hospital patients. It then summarizes two research articles that support the PICOT statement. Krein et al. (2013) found that while CAUTI bundles reduced infections, barriers like lack of buy-in from nurses and doctors limited their effectiveness. Oman et al. (2012) found that a nurse-led intervention including CAUTI bundles did not reduce infection rates but did reduce catheter duration, thus lowering CAUTI risk. Both studies support the use of CAUTI bundles and guidelines to reduce CAUTI incidence.
This document discusses an evidence-based quality improvement project aimed at evaluating the effectiveness of an educational intervention for nurses on reducing catheter-associated urinary tract infection (CAUTI) rates. The project would employ a pretest-posttest design to assess the impact of education on nurses' knowledge and facility CAUTI rates. Permission is being requested to conduct the project at a hospital where CAUTI rates are currently higher than the national benchmark according to published data. Potential benefits include cost savings from a reduction in CAUTI treatment and reimbursement risks, while there are no anticipated risks to patients. Nurses may have to work longer hours to care for patients with CAUTIs.
1
Quantitative Synopsis and Appraisal
Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
February 14, 2020
2
Quantitative Appraisal and Synopsis
The purpose of this paper is to summarize and appraise a research study testing the use of
disinfectant caps on intravenous (IV lines) to reduce the rate of hospital associated bloodstream
infections (BSI). The Centers for Disease Control and Prevention (CDC, 2019) reports that
central line associated bloodstream infections (CLABSI) remain a major concern in hospital
settings causing fatalities, increased length of stay, and increased costs. The CDC (2019)
recommends proper maintenance of intravenous lines to reduce the risk of infection. Current
research is still looking to define what proper maintenance should be, including whether
disinfectant caps influence rates of infection for intravenous (IV) lines.
Summary of the Study
The CDC recommends that healthcare workers disinfect all needleless connectors for
peripheral and central IVs prior to connection to reduce the risk of CLABSIs without further
recommendation on the type or length of disinfections. The authors of this study note other
studies have tested disinfecting caps and sought to confirm those results.
Merrill et al. (2014) conducted a quasi-experimental study to identify if disinfectant caps
reduce CLABSI incidence and the relationship between nursing compliance with the caps and
CLABSI rates. This study was held in a single Trauma 1 hospital with 430 beds in the United
States.
The researchers obtained their sample through nonrandom convenience sampling by
including all patients meeting inclusion criteria at the hospital starting January 2012. Participants
were included if they had a central or peripheral intravenous line, of any age, and were admitted
to 13 specific hospital floors. Subjects were excluded if they were on the following floors:
emergency department; labor, delivery or post-partum; ambulatory care, surgical services; and
Commented [CP1]: This answers “Why is this important
to study?” It’s not just ensuring our patients do not get
CLABSIs…it goes beyond that to fatalities, length of stay in
hospitals, and healthcare costs.
The CDC and other healthcare related organizations are great
sources of information on the importance of topics.
Commented [CP2]: What is known (recommendation to
disinfect ports), not known (what specifically should be
used), and gap in knowledge (confirmation of other study
results).
This information is found in the introduction to every
research article. DO NOT use the discussion/conclusions
section of an article for this information! It will be
WRONG.
Commented [CP3]: Study being summarized/appraised is
correctly cited.
Specific research design stated.
Setting of study stated.
3
well-baby nursery. The study did ...
1 Quantitative Synopsis and Appraisal StudentfAbbyWhyte974
1
Quantitative Synopsis and Appraisal
Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
February 14, 2020
2
Quantitative Appraisal and Synopsis
The purpose of this paper is to summarize and appraise a research study testing the use of
disinfectant caps on intravenous (IV lines) to reduce the rate of hospital associated bloodstream
infections (BSI). The Centers for Disease Control and Prevention (CDC, 2019) reports that
central line associated bloodstream infections (CLABSI) remain a major concern in hospital
settings causing fatalities, increased length of stay, and increased costs. The CDC (2019)
recommends proper maintenance of intravenous lines to reduce the risk of infection. Current
research is still looking to define what proper maintenance should be, including whether
disinfectant caps influence rates of infection for intravenous (IV) lines.
Summary of the Study
The CDC recommends that healthcare workers disinfect all needleless connectors for
peripheral and central IVs prior to connection to reduce the risk of CLABSIs without further
recommendation on the type or length of disinfections. The authors of this study note other
studies have tested disinfecting caps and sought to confirm those results.
Merrill et al. (2014) conducted a quasi-experimental study to identify if disinfectant caps
reduce CLABSI incidence and the relationship between nursing compliance with the caps and
CLABSI rates. This study was held in a single Trauma 1 hospital with 430 beds in the United
States.
The researchers obtained their sample through nonrandom convenience sampling by
including all patients meeting inclusion criteria at the hospital starting January 2012. Participants
were included if they had a central or peripheral intravenous line, of any age, and were admitted
to 13 specific hospital floors. Subjects were excluded if they were on the following floors:
emergency department; labor, delivery or post-partum; ambulatory care, surgical services; and
Commented [CP1]: This answers “Why is this important
to study?” It’s not just ensuring our patients do not get
CLABSIs…it goes beyond that to fatalities, length of stay in
hospitals, and healthcare costs.
The CDC and other healthcare related organizations are great
sources of information on the importance of topics.
Commented [CP2]: What is known (recommendation to
disinfect ports), not known (what specifically should be
used), and gap in knowledge (confirmation of other study
results).
This information is found in the introduction to every
research article. DO NOT use the discussion/conclusions
section of an article for this information! It will be
WRONG.
Commented [CP3]: Study being summarized/appraised is
correctly cited.
Specific research design stated.
Setting of study stated.
3
well-baby nursery. The study did ...
1
Quantitative Synopsis and Appraisal
Studentfirstname Studentlastname, Studentfirstname Studentlastname, Studentfirstname
Studentlastname, Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
February 14, 2020
2
Quantitative Appraisal and Synopsis
The purpose of this paper is to summarize and appraise a research study testing the use of
disinfectant caps on intravenous (IV lines) to reduce the rate of hospital associated bloodstream
infections (BSI). The Centers for Disease Control and Prevention (CDC, 2019) reports that
central line associated bloodstream infections (CLABSI) remain a major concern in hospital
settings causing fatalities, increased length of stay, and increased costs. The CDC (2019)
recommends proper maintenance of intravenous lines to reduce the risk of infection. Current
research is still looking to define what proper maintenance should be, including whether
disinfectant caps influence rates of infection for intravenous (IV) lines.
Summary of the Study
The CDC recommends that healthcare workers disinfect all needleless connectors for
peripheral and central IVs prior to connection to reduce the risk of CLABSIs without further
recommendation on the type or length of disinfections. The authors of this study note other
studies have tested disinfecting caps and sought to confirm those results.
Merrill et al. (2014) conducted a quasi-experimental study to identify if disinfectant caps
reduce CLABSI incidence and the relationship between nursing compliance with the caps and
CLABSI rates. This study was held in a single Trauma 1 hospital with 430 beds in the United
States.
The researchers obtained their sample through nonrandom convenience sampling by
including all patients meeting inclusion criteria at the hospital starting January 2012. Participants
were included if they had a central or peripheral intravenous line, of any age, and were admitted
to 13 specific hospital floors. Subjects were excluded if they were on the following floors:
emergency department; labor, delivery or post-partum; ambulatory care, surgical services; and
3
well-baby nursery. The study did not report any demographic information about participants, the
number of participants, or attrition or loss to follow up.
The intervention involved applying a Curos brand disinfectant cap to all ports on
peripheral lines, central lines, and IV tubing when not in use on patients. The nurses on the
involved units were trained on the use of the disinfectant caps with a 1:1 follow up by the
researchers. Nurses were then responsible for placing caps. The researchers intermittently
observing nurses for compliance to the intervention and reporting compliance to nursing
departments twice a week.
CLABSIs were defined as a positive blood culture drawn within 48 hours symptom onset,
and C ...
The document summarizes a study that tested the use of disinfectant caps on intravenous (IV) lines to reduce the rate of hospital-associated bloodstream infections (BSIs). The study found that using disinfectant caps on IV ports decreased the mean rate of central line-associated BSIs from 1.5 infections per month before the intervention to 0.88 infections after. However, the study had limitations such as lack of statistical significance testing for the pre-post infection rates and not accounting for other infection prevention practices. Therefore, more research is needed to fully understand the impact of disinfectant caps on reducing BSIs.
EVALUATION EMPIRICAL RESEARCH 2EVALUATION EMPIRICAL RESEARCH .docxturveycharlyn
EVALUATION: EMPIRICAL RESEARCH 2
EVALUATION: EMPIRICAL RESEARCH 7
Running head: EVALUATION: EMPIRICAL RESEARCH 1
Evaluation: Empirical Research
Introduction
The primary purpose of the research study has been to evaluate if, in adult patients with Central Venous Catheters (CVC), interventional staff education about hub hygiene provided to RN’s who access the CVC impact Central Line-Associated Bloodstream Infections (CLABSI) rates compared to pre and post-intervention assessments over a two-month period. CLABSI rates will be compared to the Patient Safety Component from the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network’s (NHSN) that includes identifying the causation and surveillance methods to track device-associated infections (Centers for Disease Control and Prevention, 2016). In addressing the issue and providing the answer the to the research question, this researcher will examine the literature available on the stated topic. Some of the research articles on the subject show similarities regarding research approaches and themes and some have differences. The researcher also looked for evidence that suggests that the data supported the conclusion, and, in some studies, the findings answered the research question.
Evaluation of Research
Regarding similarity in the theme, the researcher did find some regularity in the articles by O’Neil et al. and Salma et al. In the research study, “A Central Line Care Maintenance Bundle for the Prevention of Central Line-Associated Bloodstream Infection in Non-Intensive Care Unit Setting,” O’Neil et al. (2016) have suggested that there is a higher rate of compliance with optimal dressing care practices in the control group against the expectations. The primary theme of the research study has been the degree of hygiene maintained by nursing professionals in the context of caregiving in a central line care maintenance setting. In the research study a 12-month study was conducted by Caroline and associates to establish the effectiveness of a central line care maintenance bundle in the reduction of Central Line–Associated Bloodstream Infection (CLABSIs) in general medicine wards. They substantiated their research by disseminating educative guidelines and proper hands-on training for catheter insertion and care for nurses of the experimental group against those of a control group, along with asepsis (hygiene and evaluation of microbiological data). The trained nurses were instructed to examine the central line dressings twice a week for secureness or any purulent discharge. The results of the study revealed higher rates of compliance in optimal dressing care practices in the control group against the expectations. They exemplified a marginal reduction in the incidence of CLABSIs in the intervention group over the control group. The study lacks documentation of dating the dressing changes-a key factor in CLABSI prevention. Moreover, the research is restricted.
The Role Bacteria Biofilm Have in Identifying, Classifying and Defining UTI in Laboratory and Clinical Screenings of NB Patients That Use CIC in Clinical Settings
Running head ANALYSIS OF LITERATURE REVIEW 1ANALYSIS OF LITERA.docxhealdkathaleen
Running head: ANALYSIS OF LITERATURE REVIEW 1
ANALYSIS OF LITERATURE REVIEW 7
Literature Review
Atsede Iyasu
NRS-490- 0500- Professional Capstone and Practicum
Grand Canyon University
08/11/2019
Analysis of Literature Review
Introduction
Catheter-associated urinary tract infection (CAUTI) more so in the ICU seems to be an issue that is challenging hospitals and health care centers. Nurses are the healthcare staffs who are responsible for ensuring that patients do not acquire CAUTI in their stay in the ICU (Mody et al., 2015). There are proven techniques and methods identified to be effective at preventing the catheter associated urinary tract infection. One technique that is highly mentioned in the prevention of CAUTI is strict aseptic technique and hand hygiene. The technique can significantly help nurses reduce CAUTI in intensive care units and lessen the health burden of patients in the intensive care unit (Bradley et al., 2018).
In order to confirm whether the above-mentioned technique is effective at preventing CAUTI, a literature review was carried out. The review touched on these method as well as other known methods or techniques for preventing CAUTI. A total of eight studies were reviewed. All the reviewed studies were on publications made between 2014 and 2018. It is important that the studies reviewed are not over five years old. The above was important as it ensured only relevant and up-to-date information established from the review. Comment by Shanna Foley: Great introduction. Be sure your thesis discusses the purpose of the current paper, not the purpose of your change proposal.
A comparison of the research questions
There were three main research questions that were identified in the studies reviewed. The first main research question identified was whether there was an effective scientific method of preventing CAUTI (Purvis et al., 2014). Five of the studies reviewed were interested in answering whether there is a well-known and established medical interventions or scientific interventions that can effectively prevent CAUTI. All the five studies are driven by the hypothesis that CAUTI can be prevented and treated by given medication and it is for the above reason that all the five studies were seeking to confirm whether medical interventions can effectively prevent the infection.
The second main research question was what is the role of hospitals or health centers in the acquiring of CAUTI? According to a publication done in 2017 by Theobald and his colleagues, Hospital conditions are the primary reasons that patients acquire CAUTI. The conditions being mentioned above include; general hospital cleanliness practices and the handling of patients. The third main research question identified was whether the method of administering and removing the catheter was the main reason that patients were acquiring CAUTI. Three of the studies reviewed seemed to run on the hypothesis that the main reason that CAUTIs are acquir ...
The Use of Health Information Technology to Improve Care and .docxpelise1
The Use of Health Information Technology to Improve Care and
Outcomes for Older Adults
Kathryn H. Bowles, PhD, FAAN, FACMI,
van Ameringen Professor in Nursing Excellence, Director of the Center for Integrative Science in
Aging, University of Pennsylvania School of Nursing, Philadelphia, PA
Patricia Dykes, PhD, FAAN, FACMI, and
Senior Nurse Scientist, Director of the Center for Patient Safety Research and Practice; Director
of the Center for Nursing Excellence, Brigham and Women’s Hospital, Boston, MA
George Demiris, PhD, FACMI
Alumni Endowed Professor in Nursing; Professor in Biomedical and Health Informatics, School of
Medicine; Director, Clinical Informatics and Patient Centered Technologies; Graduate Program
Director, Biomedical and Health Informatics University of Washington, Seattle, Washington
Introduction
Using health information technology (HIT) to improve care and outcomes for older adults is
a growing program of research propelled by recent transformative policies such as the
Health Information Technology for Economic and Clinical Health (HITECH) Act
(Blumenthal, 2010; Institute of Medicine, 2011) and the Institute of Medicine report, "The
Future of Nursing: Leading Change, Advancing Health." (Institute of Medicine, 2010). Both
documents call for the implementation of electronic health records (EHR) and HIT solutions
to improve the safety, quality and efficiency of care. Several nurse scientists are at the
forefront of advancing this work, particularly using electronic health records, decision
support and telehealth. This commentary highlights examples of recent research (2010–
2014) led by nurse scientists using HIT to improve patient safety, and the quality and
efficiency of patient care. We also discuss future opportunities for Gerontological nurse
scientists interested in blending the care of older adults and HIT and suggest strategies to
increase our capacity to engage in such innovative research.
Using the EHR to improve outcomes for older adults
Recent incentives provided by the HITECH Act have resulted in rapid growth in the
development and implementation of the EHR. Nurse led studies are beginning to
demonstrate that effective use of the EHR can improve outcomes of relevance to older
adults such as pressure ulcers and falls. Dowding and colleagues evaluated the impact of an
integrated EHR in 29 Kaiser Permanente hospitals on process and outcome indicators for
patient falls and hospital acquired pressure ulcers (Dowding, Turley, & Garrido, 2012).
They found that the EHR system was associated with improved documentation of both fall
and pressure ulcer risk assessments and statistically significant improvements for pressure
ulcer risk assessment documentation. They demonstrated that improved documentation
using the EHR was associated with a 13% decrease in hospital acquired pressure ulcer rates.
HHS Public Access
Author manuscript
Res Gerontol Nurs. Author manuscript; avai.
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2CENTRAL LINE-ASS.docxsleeperharwell
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
Central Line-Associated Bloodstream Infections Literature Review
Kerry S. Murphy
Grand Canyon University
Translational Research and Evidence-Based Practice
DNP-820-O501
Dr. Kari Lane
September 26, 2018
Running head: CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
Central Line-Associated Bloodstream Infections Literature ReviewComment by Microsoft Office User: The heading of introduction is inferred in APA format
I. Introduction
Central Line-Associated Bloodstream Infection (CLABSIs) in a fatal infection that results from bacteria or viruses entering the bloodstream through the central line. A central line, also known as a central venous catheter, refers to a tube used by doctors to administer medication, fluids or to collect blood from the body of a patient (Deason & Gray, 2018). Central Line-Associated Bloodstream Infection is one of the leading causes of deaths each year in different countries across the globe. Central Line-Associated Bloodstream Infection has been an area of interest for many healthcare researchers representing a diverse body of knowledge about the infection while still expanding on what is already known. The paper is an analysis of articles related to CLABSIs with the major themes of concern to the authors including risk factors, interventions, CLABSIs and Hospital Acquired Infections (HAIs), benefits of the preventive measures and the common symptoms of CLABSIs. Comment by Microsoft Office User: Add a description of how the literature search was completed. Tell the reader how you did your literature search, which databases you searched, how many articles were found, and how you eliminated articles to come to the ones you included here.
II. Questions Posed in the Studies
a. Afonso, Blot, & Blot (2016) seeks to establish how hospital-acquired bloodstream infections can be prevented through the use of chlorhexidine gluconate-impregnated washcloth bathing in intensive care units. In the study by Chidambaram (2015), the question raised is, what associations dental procedure and CVCs have.
b. Kadium, M. (2015) inquired into how the education program for 1 month, based on the
evidence-based guidelines recommended by CDC, will improve registered dialysis nurses’ knowledge regarding CVC maintenance care?
c. CDC and NCBI (2011) raise the research question, how many people have been affected in the USA from 2001-2009?
d. Srinivasan, Wise, Bell, Cardo,Edwards, Fridkin, Jernigan, Kallen, McDonald, & Patel (2011) considers questioning the perception of central line-associated bloodstream infection.
e. Dougherty (2012) questions the potential solutions in reducing incidences of central-line associated bloodstream infections have to be created in line with the clinical setting and careful consideration of the patients and the organizational culture.
f. Lin, Apisarnthanarak, Jaggi, Harrington, Morikane, Thu, Ching, Villanueva.
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A2EVIDENCE- BASED PR.docxSANSKAR20
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:2
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:7
Running head: EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:1
Evidence- Based Practice Proposal- Section A: Organizational Culture and Readiness Assessment
Evidence based practice (EBP) should be fundamental in every healthcare setting in the sense that it ensures decisions based on the best evidence integrated with clinical experience and the various expectations of patients within the healthcare setting (Gale & Schaffer, 2009). The main objective and aim in evidence-based practice protocols are to integrate the clinical expertise with the patient’s perspective and the scientific evidence in a bid to provide efficient and high quality healthcare services which are based on the needs, values, interests and culture of the patients served by the healthcare organization in question. It should be noted that evidence- based practice is essential as it does integrate the perspective of the patient, including values and culture in providing higher quality healthcare supported by research and scientific evidence (Gale & Schaffer, 2009). In essence it ensures the provision of quality and reliability of the healthcare services provided within the healthcare setting.
In regards to the healthcare organization I am currently employed by, and would opt for the implementation of EBP in, the organization is ready for the implementation of EBP in the sense that all stakeholders are in support of implementation of EBP protocols in the various units. Considering the fact that my organization is a very small critical access hospital in rural Georgia, with very limited resources, the organization is ready to fully adopt EBP. All stakeholders believe that such implementation is critical and vital for ensuring quality, and reliable healthcare service that is comprehensive and not only meets but exceeds the needs and expectations of our clients.
According to the survey, some respondents were in full support of the implantation of EBP, while others were not. It should be noted that the category scores for the survey varied due to the fact that respondents had a varied degree of preference when it comes to the implementation of EBP, and changes to practice within the facility. Most respondents responded higher in areas pertaining to changes in providing educational strategies according to EBP guidelines (Melnyk & Fineout-Overholt, 2015). Incorporating EBP within the facility basically requires all the organizational stakeholders to develop a culture of openness and inquiry since such implementation provides very clear parameters for quality and efficient care (Melnyk & Fineout-Overholt, 2015). Some of the notable barriers to the full implementation of EBP include lack of managerial commitment to the full implementation, lack of resources due to the size and financial situation of the facility. Above all lack of interest of upper management to assist staff in ...
BioMed CentralBMC Health Services ResearchssOpen AcceDebChantellPantoja184
BioMed CentralBMC Health Services Research
ss
Open AcceDebate
From theory to practice: improving the impact of health services
research
Kevin Brazil*1, Elizabeth Ozer2, Michelle M Cloutier3, Robert Levine4 and
Daniel Stryer5
Address: 1Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University and St. Joseph's Health System
Research Network, Hamilton, ON, Canada, 2Department of Pediatrics/Adolescent Medicine, University of California, San Francisco, CA, USA,
3Department of Pediatrics, University of Connecticut Health Center and Connecticut. Children's Medical Center, Hartford, CT, USA,
4Occupational and Preventive Medicine, Meharry Medical College, Nashville, TN, USA and 5Center for Outcomes and Effectiveness Research,
Agency for Healthcare Research and Quality, Rockville, MD, USA
Email: Kevin Brazil* - [email protected]; Elizabeth Ozer - [email protected]; Michelle M Cloutier - [email protected];
Robert Levine - [email protected]; Daniel Stryer - [email protected]
* Corresponding author
Abstract
Background: While significant strides have been made in health research, the incorporation of
research evidence into healthcare decision-making has been marginal. The purpose of this paper is
to provide an overview of how the utility of health services research can be improved through the
use of theory. Integrating theory into health services research can improve research methodology
and encourage stronger collaboration with decision-makers.
Discussion: Recognizing the importance of theory calls for new expectations in the practice of
health services research. These include: the formation of interdisciplinary research teams;
broadening the training for those who will practice health services research; and supportive
organizational conditions that promote collaboration between researchers and decision makers.
Further, funding bodies can provide a significant role in guiding and supporting the use of theory in
the practice of health services research.
Summary: Institutions and researchers should incorporate the use of theory if health services
research is to fulfill its potential for improving the delivery of health care.
Background
While significant strides have been made in medical
research over the past several decades, many research
results considered important by researchers and expert
committees are not being used by health care practition-
ers. While the value of health services research must be
judged by its validity, its utility cannot be taken for
granted. There has been an assumption that when
research information is available it will be accessed,
appraised and then applied [1]. However, knowledge of a
research-based recommendation is by itself insufficient to
ensure its adoption. While the value of research evidence
as a basis for decision making in health care is well estab-
lished, the incorporation of such evidence into decision-
making remains inconsistent [2].
The gap betw ...
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2.docxaudeleypearl
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2
Research-Based Literature Support for CAUTI
Kamila Julian
Chamberlain College of Nursing
NR 505: Advanced Research Methods: Evidenced Based Practice
July 2019
Running head: RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 1
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 8
Research-Based Literature Support for CAUTI
Preventing inappropriate use of a urinary catheter and the risk of patient harm associated with the use of indwelling catheters remains a significant challenge for healthcare facilities. The purpose of this paper is to provide research-based literature support from 10 (ten) different research-based references, on the prevention of CAUTI, evaluating interventions that support the use of nurse-driven protocols to reduce the incidence of CAUTI.
The following is the proposed PICO question: “How does the use nurse-driven protocol for evaluating the appropriateness and prevalence of catheter use or removal, compared with no protocol affect the CAUTI rates?”
The literature review from Fakih, Krein, Edson, Watson, Battles, and Saint (2014) aimed to engage healthcare workers to prevent CAUTI and prevent patient harm. A quantitative approach and a quasi-experimental design were used to assess the impact of guidelines for CAUTI prevention and reduce CAUTI rates in the state of Michigan through the use of a bladder bundle, promoting a daily evaluation of catheter indication (Fakih et al., 2014). The ability of the selected design to generate a cause and effect relationship collaborated in spreading educational insights and guidance to various stakeholders. A disadvantage of such design is the lack of control group, as internal validity is not easy to control once a probability of a stakeholder not following all the necessary steps of the protocol to generate true findings, for example nurses not consistent with their rounds to evaluate daily necessity of indwelling catheter, which are important in order to identify gaps and make appropriate and necessary modifications based on new evidence. Target population here are hospitalized patients from 163 units including ER, ICU, Surgical, and operating room from 71 acute care hospitals in the state of Michigan, with an equal probability of being selected resulting in random sampling and confidentiality (Fakih et al., 2014).
The aim of the study by Shehab (2017) is to analyze the impact of the protocol of care, from nurse’s knowledge, of patients that requires a urinary catheter. A quasi-experiment design was used to test assumptions of effective changes in nurse’s knowledge after caring out the protocol of care on patients with the urinary catheter by using a structured interview questionnaire and a nurse’s knowledge assessment tool (Shehab, 2017). An advantage of this study is to evaluate nurse’s readiness to follow protocols and to update their knowledge on how to provide the best EBP care for patients with a Foley catheter. ...
8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L.
8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L ...
Central Line-associated Bloodstream Infections.Walden UniversiMaximaSheffield592
Central Line-associated Bloodstream Infections.
Walden University
Dr. Linda Johanson
Francis Mercado
1
Identification and description of the clinical issue.
The clinical issue or problem identified for my study is the central line bloodstream infections (CLABSI)
Central line bloodstream infections(CLABSI) is a health condition that affects many people.
It occurs when pathogens such as bacteria and other germs invade the patients central line after which they get into the bloodstream.
CLABSI related infections are often serious but they can be successfully managed through appropriate treatment approaches.
Femoral central venous catheters and internal jugular along with subclavian central lines have high risk of getting infected.
As per the survey conducted in 2019 about the central line bloodstream infections, it was found that the infection ratio for the said infections was 0.8 per 1000 central line days. This means that over 250000 people across the world bloodstream infections occur yearly and most of them are associated with the presence of intravascular devices.
2
Identification and description of the clinical issue.
Cont.………
Risk factors for Central Line-associated Bloodstream Infections (CLABSI)
presence of gastrostomy tube.
ICU placement of central venous catheter.
Immunosuppression.
Antibiotic therapy(Steffens et al., 2019,).
Poor nutrition;
Multiple invasive procedures.
nonoperative cardiovascular disease.
Central line bloodstream infection is associated with numerous predisposing risk factors. From healthcare stats, it can be said that central line catheters are the common causes of health callings linked to CLABSI. However there are many other risk factors that predispose patients to contracting or developing central line bloodstream infections. Contamination may occur within the central line and this may cause central line related illness. Such contamination include; non interact dressing, contaminated infusion, central venous access devices as well as patient's skin flora.
3
How to develop PICOT question for CLABSI
By analyzing the major components of PICOT, that is P-population, patients, or problem at hand, I-interventions required to solve the issue, C- control or alternative interventions to be compared, O-outcome or the objective to be achieved and T-time framework required to achieve desired outcome(Steffens et al., 2019).
This will help formulate questions such as;
Who and what is the issues that need to be addressed?
What is the proposed intervention and actions to remedy the issue?
What is desired outcome?
How much time is required to realized anticipated results?
To come up with PICOT statement of question on the clinical issues that I had chosen I had to analyze all the components of PICOT to identify their meanings so as to develop a questions that meets PICOT guidelines. The analysis of the PICOT components will help develop questions about the what are kind of population or patients affec ...
This document discusses catheters and catheter-associated urinary tract infections (CAUTIs). It provides background on catheters, their uses in urology care, and common types like Foley catheters. The document then discusses CAUTIs as the leading cause of hospital-acquired infections and challenges in preventing them. It reviews evidence that removing catheters as early as possible reduces CAUTI rates and presents examples of hospital programs that successfully implemented nurse-driven protocols to reduce unnecessary catheter use and lower CAUTI numbers.
Similar to NURS 411_Codi_Leggett Assignment 6 (20)
1. Running head: CENTRAL LINE PROTOCOL 1
Baylor Scott & White Central Line Maintenance Protocol
Codi Leggett
NURS 411: Evidence-Based Practice for Nurses
May 3, 2016
Abstract
2. CENTRAL LINE PROTOCOL 2
Baylor Scott & White Health (BSWH) has a central line protocol which provides direction for
providers in how to administer, access, maintain, and flush. These guidelines should be
evidence-based practices, but research should be evaluated to determine if the protocol is up to
date with the evidence. Evidence was found that supports the protocol is following recent
evidence-based practice. However, enforcement is the greatest concern for this protocol because
the criteria is evidence-based, but it cannot prove its effectiveness without proper adherence to
the protocol.
Baylor Scott & White Central Line Maintenance Protocol
3. CENTRAL LINE PROTOCOL 3
“Seven years of zero central-line-associated bloodstream infections” is what the Sutter
Roseville Medical Center PICC team has achieved after implementing their central line bundle
checklist and protocols (Harnage, 2012). If all facilities could achieve this kind of successful
infection prevention, it would completely change this area of medicine in the future. All hospitals
and healthcare facilities are supposed to have policies and protocols in place to keep the
healthcare providers in line with appropriate practices. A specific protocol from the Baylor Scott
& White Health (BSWH) guidelines was chosen to evaluate and determine if it follows best
practices according to research evidence, especially since this facility strives to use evidence-
based practice (EBP) (2011/2015). The BSWH protocol describes the guidelines for cleaning the
catheter ports, flushing the tubing (how and when), and requirements for changing the dressing
and maintaining the catheters. The following contains a synthesis of the evidence from several
scholarly articles, a summary of the BSWH protocol, and together both will be used to determine
best practice for central line protocols. Additional evidence can be found in Appendix B. It is
important to look at the evidence for the protocol to ensure the facility is using best practices,
and to prevent bloodstream infections which are often caused by lack of adherence to protocols
and best practices. The synthesis of evidence will be used to determine the validity of the
protocol and then compare it to what is used at the BSWH facility to see if it is supported by best
practice evidence. The strength of the evidence will be determined and then recommendations
will be made for practices based on the evidence.
Overview of the Practice Guideline
Baylor Scott & White Health provides nurses and other qualified personnel with
the “Maintaining, Accessing, and Flushing Central Lines Protocol” (BSWH, 2011/2015). The
policy, protocol, and associated charts for this can be found attached in Appendix A (BSWH,
4. CENTRAL LINE PROTOCOL 4
2011/2015). This protocol provides direction for the best way to perform care of central lines at
the BSWH hospital in College Station, Texas. They provide assessment frequency, how often
dressings need to be changed and which techniques to use. The hospital protocol utilizes a chart
for nurses to easily refer to proper flushing, maintenance, and accessing for each equipment type
(BSWH, 2011/2015). Nurses can use this protocol and tool to implement EBP when caring for
patients that have a central line. The target population is chronically ill patients or patients that
need more long term venous access for their treatment. The goal of this protocol is to reduce
infections by implementing evidence-based practice for the nurses of this facility to use when
caring for central lines (BSWH, 2011/2015). Central lines provide direct access to the blood in
the heart, and preventing infection from developing and spreading systemically is crucial. The
policy superseding this protocol stresses the use of EBP at Baylor Scott & White and references
are provided, however they are not easily accessible because they are formally cited in another
section of the hospital protocol database. It would be useful to have the resources more
accessible in order to check the validity of the sources. This protocol originated in January 2011,
and was last reviewed/revised in May 2015. Although this is recent, new research could have
developed within one year (BSWH, 2011/2015).
Synthesis of the Evidence
In a meta-analysis regarding prevention of central line infections, it was found that
quality improvement interventions reduced the rate of central line infections. Specifically, the
bundle and checklist intervention, along with education, evaluated before and after, showed
significant results for decreasing the rate of central-line associated infections (Blot, Bergs,
Vogelaers, Blot, & Vandijck, 2014). Although each bundle and checklist can be different, most
5. CENTRAL LINE PROTOCOL 5
included hand hygiene, chlorhexidine skin antiseptics, and sterile barrier precautions, all of
which contributed to the decreased rate overall by implementing all of these to prevent infection.
The meta-analysis is an ideal supporting article for the Central Line Protocol at Baylor
Scott & White Health (BSWH) because they utilize a bundle and checklist system to ensure
adequate protocol, and educate the patient before obtaining informed consent to the procedure
(BSWH, 2011/2015). Forty-one before-and-after studies revealed that bundle and checklist
interventions, along with education decreased the rate of central-line associated infections with
significance of P<.001 vs checklists alone were only P=0.3 (Blot, Bergs, Vogelaers, Blot, &
Vandijck, 2014). The combined multi-angle improvement technique proved a decreased rate
from 1.5 to 0 central line infections per 1000 catheter days (Blot, Bergs, Vogelaers, Blot, &
Vandijck, 2014). This article proves very effective in supporting the BSWH protocol.
A quantitative study discussed the effects of infection control by using a scrub-the-hub
technique or a disinfection cap when caring for central and peripheral IV lines. They revealed
that if only one item was used, the disinfection cap was the most effective in preventing
infection, however, if both techniques were used together, the disinfection rate could
significantly be reduced (DeVries, Mancos, & Valentine, 2014).
The BSWH central line protocol requires use of a disinfection cap on the tubing and
scrubbing the hub before using the line for anything (BSWH, 2011/2015). This is supported by
DeVries, Mancos, and Valentine’s quantitative study that reveals the rate of bloodstream
infections was reduced by 50% in central lines by using a disinfection cap (2014). It is also
suggested that if the two interventions are used together that the reduction in infection rate could
be greater than 50% (DeVries, Mancos, & Valentine, 2014).
6. CENTRAL LINE PROTOCOL 6
Bloodstream infections have an increased risk when errors occur during the insertion of
the line, according to Barreto and colleagues (2013). They completed a quantitative study to
evaluate a correlation between the number of errors in placing the devices and the rate of
bloodstream infections in patients (Barreto et al., 2013). Errors range from not cleaning
adequately and not wearing gloves, to any action that swayed from the protocol of the facility
being observed (Barreto et al., 2013).
It is crucial to minimize errors when caring for central lines because mistakes can affect
the safety of patients and increase the risk of infections when using central lines. The BSWH
central line protocol requires properly trained professionals and proper technique to be employed
during central line insertion and maintenance (BSWH, 2011/2015). This article supports the
protocol by revealing that the more errors that occurred, the higher the chance of bloodstream
infection occurring with significance (r=0.845 and p=0.000) (Barreto et al., 2013). The use of
correct techniques, education, and experience can help eliminate errors and increased infection
risk.
Even though we hope all nurses and providers follow evidence-based practice, there are
some things that interfere with compliance of guidelines. According to Gurses and colleagues’
qualitative study, five types of ambiguity exist: task, expectation, responsibility, method, and
exception (2008). Additionally, heavy workload, understaffing, disagreement, costs of
implementation, forgetfulness, and lack of supplies all contribute to the increase of infections
and medical errors (Gurses et al., 2008).
Compliance with guidelines also protects the safety of patients and staff. Without it, the
risk of infection increases. A qualitative study revealed that five types of ambiguity (task,
expectation, responsibility, method, and exception) affect compliance with protocols and can
7. CENTRAL LINE PROTOCOL 7
cause an increase in infection rates (Gurses et al., 2008). This supports the BSWH protocol
because it reinforces the need to follow the protocol itself because when ambiguity affects the
compliance, infection rates increase (BSWH, 2011/2015). Gurses et al. article also provides
insight for the BSWH facility to observe their contributors to non-compliance such as workload,
number of staff, costs, and the amount of supplies to see if they need changes to help protect the
safety of patients (2008).
Since occlusion of an IV catheter can lead to infection, vessel irritation, and embolus, a
quantitative study was completed to determine if the beginning of occlusion in catheters could be
predicted to decrease complications (Wolf et al., 2015). Catheter-resistance monitoring was used
to predict occlusion in catheters, and was found to be capable of predicting possible occlusions
(Wolf et al., 2015). Saline flushes are often used to ensure patency, but by measuring the
pressure, nurses could begin to predict the beginning of an occlusion before infection occurs.
Catheter occlusion can lead to infection, and the BSWH central line protocol provides
specific instructions for flushing techniques and frequency to prevent occlusion and infection
(BSWH. 2011/2015). A quantitative study was performed to determine the predictability of
occlusion using saline flushes and revealed p<0.01 prediction of occlusion within 10 days. The
study supported the BSWH protocol for flushing, but refuted it by displaying the need to add
catheter-resistance monitoring to the protocol as well in addition to flushing before and after use
of any line (Wolf et al., 2015).
Recommendations for Practice
The BSWH central line protocol follows a bundle checklist system for maintaining,
accessing, and flushing central lines. Blot et al. (2014) compares different improvement
interventions, and found that bundles or checklists revealed the largest decrease in infection rate.
8. CENTRAL LINE PROTOCOL 8
This Level I study (Polit & Beck, 2014, p. 22) provides useful evidence because it utilizes a
systematic review followed by a meta-analysis of multiple articles. It reveals that bundles and
checklists almost always include the major aspects that contribute to decreased infections, which
in this study, resulted in zero catheter infections in 1000 days (Blot, Bergs, Vogelaers, Blot, &
Vandijck, 2014). The evidence supports the checklists used for the BSWH protocol, and should
continue to be used in practice.
Scrubbing the hub or use of a disinfection cap is what is considered appropriate in the
BSWH protocol (2015). DeVries, Mancos, and Valentine (2014) reveal that the disinfection cap
decreased infection rates by 50% which supports the BSWH protocol (2011/2015). However,
this level III, prospective, observational study (Polit & Beck, 2014, p. 23) reveals that the use of
both the disinfection cap and scrubbing the hub would be the most beneficial based on the trial
(DeVries, Mancos, & Valentine, 2014). Although not the strongest level of evidence, the drastic
significance of the results reveal the importance of implementing these two techniques together
which would be the best recommendation for practice.
Errors while administering central lines can greatly affect the risk of infection according
to Barreto et al. (2013). This level IV, longitudinal, prospective study (Polit & Beck, 2014, p. 23)
shows the connection of administration errors and maintenance errors increase infection risk
(Barreto et al., 2013). This supports the BSWH protocol (2011/2015) because it requires
specifically trained personnel to administer central lines, and requires maintenance guidelines to
prevent infection. The best recommendation is to enforce the protocol in place at BSWH.
Another level IV, prospective study (Polit & Beck, 2014, p. 23) revealed that catheter
occlusion can be predicted and prevent the development of a bloodstream infection (Wolf et al.,
2015). The BSWH protocol (2011/2015) contains flushing recommendations to prevent
9. CENTRAL LINE PROTOCOL 9
occlusion, but it does not measure pressures to predict occlusions (Wolf et al., 2015). This study
supports the BSWH protocol criteria of flushing, but could also be improved by adding pressure
measurements to the flushing protocol.
Gurses et al. (2008) utilized a grounded theory level VII study (Polit & Beck, 2014, p.
48) to evaluate the ambiguity that causes protocols to not be followed and determine the social
influences on protocol adherence. Although this study does not directly support the criteria
within the protocol, it supports the need for the protocol as a whole, and encourages the
recommendation of eliminating ambiguities which interfere with protocol adherence (Gurses et
al., 2008). If the protocol is followed, the risk for infection in central lines will be reduced, and it
is recommended that the facility enforce its protocol that is in place.
Conclusion
These articles are all supporting the Baylor Scott & White Health central line protocol,
and provide evidence that the protocol is following evidenced based practice. Not every criteria
within the protocol is explained in depth with evidence, but these articles validate many of the
important aspects within the protocol. Some of the evidence focuses on ensuring that the
protocol is actually enforced and utilized, because even though many protocols exist, they do not
provide benefits unless they are utilized the way they are written. Having evidence to support the
protocol ensures patients receive care that has demonstrated proven results. Overall, the best
recommendation is to adhere to the protocol that already exists, specifically utilizing the
checklist, the hub disinfection, and the flushing techniques. According to Harnage (2012),
bundles and checklists, if they are evidence-based and are followed as written by providers, can
have the potential to almost completely eradicate central line infections. More research should be
10. CENTRAL LINE PROTOCOL 10
completed to evaluate the best practice of each specific criteria of the protocol, but overall the
BSWH protocol proves to be following best practice.
11. CENTRAL LINE PROTOCOL 11
References
Baylor Scott & White Health. (2015). Maintaining, accessing, and flushing central lines protocol.
Central line management (X.1079.3.SW.059). (pp. 1-4). (Original work published 2011)
Blot, K., Bergs, J., Vogelaers, D., Blot, S., & Vandijck, D. (2014). Prevention of central line–
associated bloodstream infections through quality improvement interventions: A
systematic review and meta-analysis. Clinical Infectious Diseases, 59(1), 96-105.
DeVries, M., Mancos, P. S., & Valentine, M. J. (2014). Reducing bloodstream infection risk in
central and peripheral intravenous lines: Initial data on passive intravenous connector
disinfection. Journal of the Association for Vascular Access, 19(2), 87-93 7p.
doi:10.1016/j.java.2014.02.002
Filgueira Gouveia Barreto, A., Yurà Araújo Farias Dias, T., Fernandes Costa, I. K., de Sousa
Martins Melo, G., Elza Oliveira de Mendonça, A., & de Vasconcelos Torres, G. (2013).
Infection of central venous catheter and the non-compliance of protocols in the intensive
care unit. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 7(2), 430-437 8p.
doi:10.5205/reuol.3073-24791-1-LE.0702201314
Gurses, A. P., Seidl, K. L., Vaidya, V., Bochicchio, G., Harris, A. D., Hebden, J., & Xiao, Y.
(2008). Systems ambiguity and guideline compliance: A qualitative study of how
intensive care units follow evidence-based guidelines to reduce healthcare-associated
infections. Quality & Safety in Health Care, 17(5), 351-359.
doi:10.1136/qshc.2006.021709
Harnage, S. (2012). Seven years of zero central-line-associated bloodstream infections. British
Journal Of Nursing, S6-S12 1p.
Polit, D. F., & Beck, C.T. (2014). Essentials of nursing research: Appraising evidence in nursing
practice (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
12. CENTRAL LINE PROTOCOL 12
Wolf, J., Tang, L., Rubnitz, J. E., Brennan, R. C., Shook, D. R., Stokes, D. C., & ... Flynn, P. M.
(2015). Monitoring central venous catheter resistance to predict imminent occlusion: A
prospective pilot study. Plos ONE, 10(9), 1-15. doi:10.1371/journal.pone.0135904
17. CENTRAL LINE PROTOCOL
17
Appendix B: Evidence Grid
Citation (APA) Purpose Sample Design Measurement Results/Conclusions Level of
Evidence
Blot, K., Bergs, J.,
Vogelaers, D., Blot, S., &
Vandijck, D. (2014).
Prevention of central
line–associated
bloodstream infections
through quality
improvement
interventions: A
systematic review and
meta-analysis. Clinical
Infectious Diseases,
59(1), 96-105.
Determine the
effects of quality
improvement
interventions for
central lines
reduce
bloodstream
infection rates
based on different
studies and
different
interventions.
N= 584 ICUs
Article samples:
634 screened
75 articles assessed
for eligibility
63 articles in
systematic review
43 studies included
in meta-analysis
Intervention
category and
number of studies:
Education (33),
training (4),
feedback (20),
clinical reminders
(15), bundle (11),
checklist (18),
empowerment to
stop procedure
(10), surveillance
(12), leader
designation (11),
prepackaging (16),
infrastructure
changes (2),
organizational
changes (4)
Systematic review
followed by
random-effects
meta-analysis
(Eligible studies
used before-after,
interrupted time
series (ITS),
controlled before-
after,
nonrandomized
controlled trial,
and randomized
controlled studies)
Before-after and
ITS are preferred
27 questions were
used to evaluate the
validity and power of
each study
the DerSimonian-
Laird
estimator obtained
odds ratios for
rate reductions. The
Higgins I2 test was
predefined to
quantify
heterogeneity (I2 ≤
25% for low, 25% <
I2 < 50% for
moderate,
and I2 ≥ 50% for
high), and funnel
plots assessed
publication
bias; subgroup
analysis through
meta-regression
compared checklist
interventions.
Quality improvement interventions
reduce central-line infection rates.
The infection rate was decreased the
most with bundles or checklist
interventions.
Feedback intervention was the least
improvement rate, however
significant rate reduction in
infection still occurred.
Further research should be done to
determine requirements of
successful adaptation of the
interventions.
Level I
18. CENTRAL LINE PROTOCOL 18
DeVries, M., Mancos, P.
S., & Valentine, M. J.
(2014). Reducing
bloodstream infection risk
in central and peripheral
intravenous lines: Initial
data on passive
intravenous connector
disinfection. Journal of
the Association for
Vascular Access, 19(2),
87-93 7p.
doi:10.1016/j.java.2014.0
2.002
Determine if the
use of a
disinfection cap
decreases the rate
of bloodstream
infections in
central/PICC and
peripheral lines.
3 intensive care
units for a 3-month
span (all patients
with a
central/PICC or
peripheral line)
Prospective
observational
study that is not
randomized
Bloodstream
infection rate was
tracked for the 3
months and no
infections occurred
during the 3 month
trial. Pre-intervention
and post-intervention
rates were compared
later to determine the
reduction rate with
the intervention.
The combined reduction rate for
central lines and peripheral IV lines
was decreased by 50.0%.
Use of the disinfection cap offers
protections that “scrub-the-hub”
cannot provide alone.
The disinfection cap used with the
“scrub-the hub” technique together
shows a significant bloodstream
infection rate in central lines and
peripheral lines (P < .000001).
Level III
Filgueira Gouveia
Barreto, A., YurÃ
Araújo Farias Dias, T.,
Fernandes Costa, I. K., de
Sousa Martins Melo, G.,
Elza Oliveira de
Mendonça, A., & de
Vasconcelos Torres, G.
(2013). Infection of
central venous catheter
and the non-compliance
of protocols in the
intensive care unit.
Journal of Nursing UFPE
/ Revista de Enfermagem
UFPE, 7(2), 430-437 8p.
doi:10.5205/reuol.3073-
24791-1-LE.0702201314
Determine if
central venous
catheter infections
are being caused
by non-
compliance of
staff with protocol
of insertion or
maintenance of
the line.
N= 31 patients
undergoing central
venous catheter
insertion
Longitudinal,
prospective study
Researchers observed
insertion and
maintenance of
central venous
catheters and
considered errors that
occurred for both
insertion and
maintenance.
to compare the
mean scores of errors
in the procedure of
inserting and
maintaining the
catheter, and
the Spearman
Correlation test (r
<0.50 = poor,
0.50 ≤ r ≥ 0, 74 =
moderate, r ≥ 0.75 =
strong)
The higher number of errors that
occur during the insertion and
maintenance of central catheters
revealed increased risk for infection.
(2-9 errors resulted in infection & 0-
5 errors did not result in infection)
-risk of
infection at the insertion time:
strong and significant
(r = 0.845 p = 0.000)
-risk of infection in
Maintenance: moderate and
significant
(r = 0.551 p = 0.001)
Level IV
19. CENTRAL LINE PROTOCOL 19
Gurses, A. P., Seidl, K.
L., Vaidya, V.,
Bochicchio, G., Harris, A.
D., Hebden, J., & Xiao,
Y. (2008). Systems
ambiguity and guideline
compliance: A qualitative
study of how intensive
care units follow
evidence-based guidelines
to reduce healthcare-
associated infections.
Quality & Safety in
Health Care, 17(5), 351-
359.
doi:10.1136/qshc.2006.02
1709
Evaluate if
evidence-based
practices are
being followed by
health care staff to
prevent infections
caused by central
venous catheters,
ventilator-assisted
pneumonia,
surgical site
infections, and
catheter
associated UTI.
What causes
protocol to not be
followed by staff.
N=20
Sample of 3
physicians, 2
residents, 6 nurses,
3 quality
improvement
coordinators, 2
infection control
practitioners, 2
respiratory
therapists, and 2
pharmacists
Grounded Theory 20 semistructured
interviews
(14-66 min
interviews)
Systems ambiguity plays a major
role in non-compliance of evidence-
based guidelines.
Things that contribute to non-
compliance are heavy workload,
understaffed, disagreement, costs of
implementation, forgetfulness, lack
of supplies and equipment.
There are 5 types of ambiguity that
exist: task, expectation,
responsibility, method, and
exception. All of which contribute
to hospital acquired infections,
medical errors and an obstacle for
learning.
Level VII
Wolf, J., Tang, L.,
Rubnitz, J. E., Brennan,
R. C., Shook, D. R.,
Stokes, D. C., & ... Flynn,
P. M. (2015). Monitoring
central venous catheter
resistance to predict
imminent occlusion: A
prospective pilot study.
Plos ONE, 10(9), 1-15.
doi:10.1371/journal.pone.
0135904
Determine the
feasibility,
acceptability, and
efficacy of
monitoring central
venous catheters
for signs of
occlusion
(resistance).
n=10 pediatric
patients over 113
central-resistance
monitoring visits
Prospective study Catheter-resistance
monitoring was
performed weekly for
up to 12 weeks.
Normal saline was
injected while inline
pressure rates were
measured using a
syringe pump with an
incorporated
pressure-sensing
inducer
Catheter occlusion occurred
frequently and CRM was helpful in
predicting these event.
Some analysis showed p<0.01
prediction of occlusion within 10
days; another predicted p=0.01
prediction of occlusion within 10
days.
The sensitivity and specificity are
reasonable but imperfect.
Level IV