REVIEW CENTRAL LINE-ASSOCIATED BLOODSTREAM2REVIEW CENTRAL .docx

REVIEW: CENTRAL LINE-ASSOCIATED BLOODSTREAM2
REVIEW
CENTRAL LINE-ASSOCIATED BLOODSTREAM2
Central Line-Associated Bloodstream Infections
Grand Canyon University
Translational Research and Evidence-Based Practice
DNP-820-O501
Running head: CENTRAL LINE-ASSOCIATED
BLOODSTREAM 2
October 9, 2018
CLABSI Supporting Literature
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 (CVC), 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. There were
200 articles that were established to talk about the CVCs,
CLABSIs, risk factors, intervention, and benefits of preventive
measures. Through inclusion and exclusion criteria many
journal articles were left out because of being written in other
languages rather than English. Therefore, the use of the English
language index the Cumulative Index of Nursing and Allied
Health Literature (CINAHL) was used to search related journal
articles. Other search tools includeThe National Center for
Biotechnology Information (NCBI) – PubMed. Studies older
than five years were excluded to ensure that the research
remained current and up to date. Using real-time cases or
conditions helps to improve the quality and validity of the
resulted research.
Questions Posed in the Studies
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.
Education, Simulated Training, Experience, and Knowledge
Kadium (2015) inquired into how the education program for one
month, based on the evidence-based guidelines recommended by
CDC, will improve registered dialysis nurses’ knowledge
regarding CVC maintenance care? Other researchers that focus
on how education, experience, and workshops enhance
prevention or reduction of CVC infections include; El-Sol &
Badawy, (2017), Leistner, Thürnagel, Schwab, Gastmeier, &
Geffers (2013), and Soffle, Hayes, & Smith (2018). Dougherty
(2014) 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.
Surveillance

Xu, & Wu, (2017), Commonwealth of Australia, (2015),
Kadium, (2015), Morrison, Raffaele, & Brennaman, (2016),
Tomar, Lodha, Das, Sood, Kapil, (2016), Lin, Apisarnthanarak,
Jaggi, Harrington, Morikane, Thu, Ching, Villanueva, Zong,
Jeong, & Lee (2015), and Esposito, Guillari & Angelillo
(2017) concur with O’Grady, Alexander, Burns, Delilnger,
Garland, Heard, Lipsett, Masur, Mermel, Pearson, Raad,
Randolph, Rupp, & Saint (2015), the inquiry focused on how
Positive blood culture shows the relationship between CLABSI
and CDC surveillance.
Preventive Measures
Other researchers inquire into the CLABSI-related preventive
measures implemented among adult patients hospitalized in an
ICU. Such studies are by people like Perin, Erdmann, Higashi,
Sasso, Bianco, et al. (2016), Jones, Forsyth, Jenewein, Ray,
DiMarco, Pugh (2017), Masse, Edmond, & Diekema (2018),
Oliveira, Stipp, Silva, Frederico, & Duarte (2016). In research
by Basinger, (2014), the research question questions into the
causal effects of the Comprehensive Unit-based Safety
Programs (CUSP) on the reduction of CLABSIs within the
relationship CUSP team member webinar attendance has with
the reduction of CLASBIs. Other questions were on how
knowledge and education of the family and patient could help in
the prevention of CLABSIs attack. Among such studies are
Kadium, (2015) and Powell (2018).
Evidence-Based Practice
Other studies focused on how evidence-based practice,
insertion, and maintenance of CVC could protect the patients
from CLABSIs. Such research was done by Bianco, Coscarelli,
Nobile, Pileggi, & Pavia (2014), World Health Organization
(WHO, 2018) and Xu & Wu (2017). Perin, Erdmann, Higashi, &
Sasso, (2016)., Perin, Erdmann, Higashi, & Sasso, (2016),
Tomilnson (2015),
Risk Factors
Taveira, Lima, Araújo, & Mello, (2016), Tomar, Lodha, Das,
Sood, Kapil, (2016), Pepin, Thom, Sorkin, Leekha, Masnick,

Peras, Pineleas, & Harris, (2015), Morrison, Raffaele &
Brennaman, (2016) question the risk factors of CLABSI
Impact of Intervention
On the evidence-based impact of fighting CLABSI, there is an
evaluation by Baldassarre, Finkelston, Decker, Lewis, &
Niesley, (2014), and Scott II, Sinkowitz-Cochran, Wise, Baggs,
& Goates, (2016).
Then there is Han, Liang, & Marschall, (2015), who question
how the involvement of education to the family and the patient
can help prevent CLABSIs attacks among patients on CVC care.
Another study by Yazan & Regunath (2018) examines the
relationships between Positive blood culture and CLABSI.
Identified Subthemes
From this, there are various subthemes that emerge in this
study. These include; Hygiene and impact of this on the CVC
situation. Most studies show that the more hygiene is
considered and practiced, the lower the cases of CLABSI.
Another concept is the knowledge that is necessary among
nurses and patients handling CVC. Thorough knowledge on the
care for CVC improves and infections reduce. Besides, there are
Policies which enhance the correct application of knowledge
and maintenance of hygiene in the healthcare, hence decreasing
cases of infections.
Moreover, nurse experience is an essential subtopic due to
evidence that supports that with higher experience in the CVC
units; nurses tend to adhere and follow protocols and
precautions which help prevent infections. Finally, there are
Evidence-Based Practices/Interventions such as proper fitting,
disinfection and sterilization, insertion bundle, maintenance
bundle, and quality improvement.
The reviewed literature has shown that the nurse, patients,
family, and evidence versus non-evidence-based practice are
important in the analysis of the situation. Besides, the setting,
the type of catheter, and conditions affect the entire discussion.
Risk Factors Associated with CLABSIs
a. Contamination on Insertion

The catheter may gain entry into the bloodstream during the
insertion of the line into the body of the patient. The rate of
infections during insertion is substantially dependent on the
hygiene levels that are put in place by the health care providers
(Dick et al., 2015). The rates of infection during insertion
happen to be high showing ignorance or lack of professionalism
among the health caregivers. Contamination during insertion
may also result from the instruments used and how sterilized
they are.
b. Contaminated Skin of the Patient
The insertion is done on the body of the patient. A contaminated
skin of the patient may contain germs which may enter the body
during the insertion (Dombecki et al., 2017). The fact that
patients have negligible knowledge concerning the different
ways the infection may occur means that there is so much
responsibility placed on the health caregivers. The infection
rates due to unsanitary practices of the patients seem to have
drawn the attention of the authors of the different articles
analyzed. With the rates of CLABSIs rising each year, mortality
rates have also increased. Researchers have made CLABSIs
prevention a priority to address such risk factors to avoid or
reduce infection rates.
c. Non-Compliance with the Central Line Maintenance
There are guidelines for healthcare professionals meant to
reduce the chances of CLABSIs infection. Such guidelines
include not using antiseptics and ensuring complete dressing
changes (Orwoll et al., 2017). As much as these guidelines and
policies are in place does not mean that compliance is definite.
Cases of caregivers who do not comply with the stipulated
guidelines are common and such levels of unprofessionalism
have cost patients their lives.
Other Risk factors
In a study conducted by Tomar, Lodha, Das, Sood, Kapil,
(2016) among the common risk factors for central line
infections are factors such as; triple lumen, changing of the

central-line, and frequency of accessing the central line.
However, avoiding unnecessary changing of the line, educated
workers on hygiene and full barrier precautions, as well as
ongoing surveillance through regular rounds helped to prevent
infections. Of 265 enrolled children with a central line, 13
developed bloodstream infections (incidence density 5.03/1000
central-line days). In another research by Pepin et al. (2015), it
is indicated that comorbidity conditions increase the risk for
surgical site infections and the acquisition of antibiotic-
resistant bacteria.
Additionally, Leistner, Thürnagel, Schwab, Gastmeier, &
Geffers, (2015) indicate that when nurses in infant units are few
infections rates are high. Taviera et al. (2016) purport that in
children-based units, low white blood cell content, malnutrition,
and CVC insertion before chemotherapy results in infections.
Finally, Xu & Wu (2017) note that implantable ports SCS have
the lowest risk while non-tunneled type had a very high risk.
Among such factors and age, disease condition, gender
(intrinsic factors) as well as prolonged hospital stay, multiple
CVCs, CVC duration, internal jugular access, parental
nutritional admission and insertion (extrinsic) CVCs are
contaminated due to patient’s skin contact with organisms or
direct contamination of catheter.
Interventions
a. Removal of Unnecessary Lines
The authors agree that there are times patients will have lines
which are no longer being used for any medical purpose. These
are mainly patients who have spent so much time in the
hospitals, and the chances of being discharged seem minimal
(Sodek, 2016). The caregivers are meant to remove lines once
they have served the purpose. The more these lines remain on
the body of the patients the more the chances of infection.
Bacteria and all other associated germs will quickly enter the
body.
b. Health Care Providers to Follow Recommendations
Healthcare professionals are trained on the best practices that

are meant to ensure that the chances of patient infections are
minimized or even eliminated. Unfamiliarity will occur at
times, and the well-being of the patients is jeopardized (Stone
et al., 2014). Just like any other profession, health care ties it’s
professionals around practices which ensure ethical
undertakings to safeguard the lives of the patients. The authors
are for the idea that health care professionals should be just to
patients and do what their work ethics dictates them to do. Such
will ensure improved health and safety of the patients.
c. Encouraging Teamwork
In any health care setting, there are two main participants.
These are the health caregivers and patients. One of the authors
suggests that teamwork between these two parties will go a long
way in reducing the rates of these infections (Stone et al.,
2014). Teamwork will ensure that there is knowledge sharing,
that key concerns and risks that may be known to one of the
parties are made known to the other. The impact teamwork will
have on preventing the cases of CLABSIs in hospitals is
immeasurable. The same should be embraced and upheld.
Implementation of policy and surveillance
According to Namita et al., (2015) cooperation between nurses
and the patient, e-learning, confidence offers better care for the
CVC. Besides, checking pre and post-treatment axillary
temperature, keeping the dressing closing, close monitoring of
the patient, using aseptic technique, and maintaining CVC
through anticoagulant as well as using polyurethane dressing
with an external cloth border instead of polyvinylchloride
catheter dressing reduce infection. In another study by
Commonwealth of Australia, (2016) CLABSI surveillance has to
offer a correct definition, blood culture, health-associated
infection or HAI-non-inpatient and settings which are often;
oncology, hematology, ICU, hospital-wide, high dependency
units, and hemodialysis patient. Furthermore, the right timing,
correct interpretation, and potential organisms should be
established for surveillance to serve in reducing infections in
CVC units. According to Tomlinson (2015) the study conducted

on the effect of surveillance, in 6 months, the application of
interventions right line, right time enhanced reduction on
infections. Morrison, Raffaele & Brennaman (2016) to indicate
that there is always improvement in service when nurses are
given feedback on the CLABSI and risk factors. Out of 620
visually audited lines from 14 nursing units for 16 weeks, 113
lines did not audit. 628 risk factors were established. Through
personalized nurse report cards infections decrease. Baldassarre
et al. (2014) note when audit tools are used alongside education
the compliance of nurses increases. Furthermore, Jones et al.
(2017) state that repeated skill assessment enhances the safety
of patients with CVC.
Education
El-Sol, A., & Badawy, A.I. (2017) studies how education
module affects CABSI and indicates that most of the
participants had a diploma in nursing and lacked proper practice
for CVC. The pre-and post-education mean scores varied before
and after training. It was established that knowledge,
experience, and practice positively resulted in lower infections.
Other interventions
Aloushi, S.M. & Alsarai, F.A. (2018) opine that as long as the
nurse-percent ration was lowered, the compliance in the
patient’s outcome. Perin et al. (2016) postulate that hand
hygiene and maximal barrier precautions; multidimensional
programs and strategies such as impregnated catheters and
bandages and the involvement of facilities in and commitment
of staff to preventing infections.
CLABSIs associated infections/Transmissions
a. Hematogenous Transmission
This is an infection that is characterized by a primary tumor
penetrating into blood vessels. They then get transported in the
blood vessels and eventually into the distant parts of the body
of the patient (Stone et al., 2014). Once at the distant sites, the
cells will penetrate the walls of the vessels again and build a
basis for another, a new tumor on the new site. Such are the
same cases that happen with CLABSIs. Examples include

catheter-associated Urinary Tract Infections (CAUTI) that can
lead to CLABSI’s.
b. Catheter-associated Urinary Tract Infections (CAUTI)
A urinary tract infection (UTI) refers to an infection in any part
of the urinary system. UTIs are also common healthcare-
associated infections reported by both patients and healthcare
givers. These infections are associated with urinary catheters, a
tube which is used by doctors through the urethra to drain urine
(Douglas, 2015). Most of the hospitalized patients end up with
urinary catheters inserted in their bladder. Prolonged use of the
catheters increases the risks of the infections. Health caregivers
should ensure that these catheters are removed when not being
used to reduce the risk of patients contracting the CLABSIs.
c. Contaminated Infusates
The term refers to the introduction of pathogens into the body
of patients. The introduction of these pathogens occurs through
the sterile used by the health care providers. During surgery or
during other procedures which may require line insertion,
bacteria may be introduced into the body of the patient (Stone et
al., 2014). Contaminated infuscate happen to be one of the ways
CLABSIs bacteria is introduced into the bloodstream. Patients
and the health care providers need to be educated on such risks.
Necessity for Interventions
a. Reduced incidences of CLABSIs
The preventive measures mentioned above by the authors of the
different articles will go a long way into reducing the incidents
that are reported by patients and caregivers concerning
CLABSIs (Klintworth et al., 2015). Encouraging adherence to
the hygiene standards, the policies and the recommendations as
they relate to CLABSIs infections will enable the creation of an
environment that will enhance the well-being of the patients and
also minimize the chances of contraction of the infections. The
infection is deadly and is already costing patients and nations
dearly.
b. Reduced morbidity
Morbidity has been defined as how often a disease occurs or is

reported in a population. The morbidity rate is determined by
examining the number of patients with a particular disease at a
given period (Kim & Biorn, 2017). Reduced cases of disease
mean that preventive and treatment measures are effectively
implemented by all stakeholders involved. CLABSIs infections
are no exceptions here. The literature work of the previous
authors appreciates that the health care institutions that have
adopted the interventions measures above report few and
reduced cases of the infection.
Safe Costs While Making Profits
In one study by Scott II, Sinkowitz-Cochran, Wise, Baggs, &
Goates, (2016) indicates that in a study on 40,556 and 75,067
central line-associated bloodstream infections were prevented in
Medicare and Medicaid patients in critical care units in the
period 1990-2008 with about $ 586-$862 million expenditure
and control efforts that lead to saving $44–$131 with net profits
of about 664 USD Million.
CLABSIs Symptoms
a. Site Discharge
The area where the catheter is placed should remain dry, and no
discharge should be coming from the area. Some patients,
however, may notice yellow or green discharge (Conley et al.,
2018). The drainage should be a cause for alarm, and the
authors have identified the discharges as some of the top
indicators that something has gone wrong and healthcare
providers should act up. Discharges show that the area is not
fresh and has been exposed to bacteria and germs, something
that should be of great concern.
b. Site Swelling
Patients may experience additional swelling at the place where
the catheter line has been inserted. The swelling is an indicator
that there is no healing that is taking place and that there is
every reason to worry about the well-being of the patient
(Castagna et al., 2016). The authors suggest that nurses should
give attention to the recovery process of patients and ensure
that such instances are noted and addressed. In cases where

there is no close relationship between the health caregivers and
the patients, such incidents may be hard to notice, and the
patients end up suffering and worse still, be exposed to the ugly
infection which may even cost them their lives.
c. Site Redness
A patient may develop red streaks at the area where the line has
been inserted. Another warning sign that the patient may be
headed to a CLABSIs. Again, if there is no close interaction
between patients and their caregivers such may be hard to
notice (Chesshyre et al., 2015). Worse still if the patient is not
aware that such are causes for alarm. They may never report the
same and end up risking their lives. Adult patients and children
are at the greatest risk of these symptoms because in most cases
they do not know what should be made known to the health care
providers and what should not be a cause for worry.
Research Questions
a. How does the training of health-care providers on the risks
and the preventive measures of CLABSIs impact the overall
infection rates?
b. What is the level of knowledge of nurses regarding the use of
evidence-based guidelines to prevent central venous catheter
bloodstream infections?
c. Does an increase in nurse’s knowledge concerning CLABSIs
infections reduce the number of infections in the Intensive Care
Units (ICU)?
Sample Populations
The authors have utilized different study populations to
accomplish their objectives. The two major categories of
respondents that are common to all authors are healthcare
professionals and adult patients suffering from or who have
suffered CLABSIs infections in the past (Hsu et al., 2014).
These two categories have a rich knowledge of the study topic.
Such enables researchers to collect adequate data for their
research topics and also draw logical conclusions.
There are several processes through which people sample
information in studies. For Alfonso et al. (2016) the search of

the various database using key terms gave 291 records,
however, based on relevance only four articles were suitable for
the study. Xu & Wu (2014) established 400 studies to establish
the various types of catheters and the level of risk each gives.
Similarly, Scott II, Sinkowits-Cochra, Wise, Baggs, & Goats
(2016) utilized Medicare and Medicaid data from 1990-2008 to
establish the cost saving after implementing preventive
measures against CABSI. As for Perin et al. (2016), there was
the use of 34 studies, but only 28 offered significant results in
measuring CVC insertion and maintenance strategies. Soffle,
Hayes, & Smith (2018) used a sample population of 20
traditional education and 78 for simulated-based teaching
methods in establishing their efficiency in practical-based
knowledge on prevention of CABSI. As for Namita et al.,
(2015) there was the use of 10 articles through which a deep
study was done. In a study by Dougherty (2015), there was
convenience sampling of a population of registered nurses in a
long-term acute care hospital (LTACH) setting after completion
of orientation to the unit. Out of 52 eligible nurses, 31
participated in the survey response. In Viana Taveira, Lima, De
Araújo, & De Mello (2016) the sample included 188 children in
pediatric cancer health care. While Leitine et al. (2016) put to
use the very low birth weight (VLBW) newborns from NICUs
who took part in the German nosocomial infection surveillance
system for ventilated preterm infants from Jan 2008-2009. In a
study by Elsol & Badawy (2017), there was convenience
sampling with 44 nurses working in ICU who filled the
questionnaire on demographic and CABSI related questions and
observational checklist. For Aloushi & Alsarai (2018) is 171
ICU nurses in 15 hospitals within 15 hospitals in 5 cities of
Jordan. The nurses were supposed to be registered, working as a
full-time in the ICU; and with at least one year of experience. A
panel of experts comprising members of 3 nursing faculties, two
infection control specialists and 5 ICU nurses participated in
the validation of the initial draft of the instrument, which
contained 13 items. The mean age of the participants was 32.5

years; 32.7 for males, and 31.5 for females. Seventy-two
participants (43%) had no previous education about CLABSI
prevention guidelines, and 154 (90%) reported a lack of
supplies in their hospital, such as antibiotic-impregnated central
venous catheters. In the study by Morris et al. (2016), there was
the utilization of 715 beds in the 2-campus acute care
community hospital healthcare system in Southwest Florida.
The study by Lin et al. (2015) utilized a cross-sectional design
in the qualitative analysis of sources based on the key concepts
of the study. Perin et al. (2016) explored a purposive sampling
and selection of 34 studies that formed a set through which to
assess results after a systematic review of academic and health
database. In the sampling process, Esposito (2017) utilized a
cross-sectional design in 16 non-teaching and teaching public
and private hospitals with units utilizing CVCs for adult
oncological patients. The target group was 472 nurses in the
oncology and outpatient chemotherapy units of the selected
hospitals.
Likewise, Oliveria et al. (2016) samples were collected through
a cross-sectional study with questionnaires to 76 professionals
in intensive care. Zu & Wu (2017) utilized the qualitative
process and a systematic search of databased on CINAHL, ABI
INFORM, and OVID through which they established more than
a hundred articles before applying the exclusion-inclusion
criteria and utilizing ten articles in the study. WHO (2018) held
comprehensive research in various facilities to establish
methods of improving infection prevention and control on
catheter units. Bianco et al. (2015) used samples from some
CLABSIs which were collected by the hospital-based IP in line
with the NHAN approach and definition of CLABIs. The CUSP
teams of hospitals receive monthly feedback on infections and
quarterly feedback on rates of infection per 1,000 catheter days.
Basinger (2016) samples were collected through a cross-
sectional study with questionnaires to 76 professionals of varied
gender, and ages in intensive care. In another study by
Chidambaram (2015) the samples used were acquired from

existent studies.
On the other hand, Kadium (2015) utilized a convenience
sampling of registered dialysis nurses in the hemodialysis unit
was used in a pre and post-test instructional interventional
design among 60 registered dialysis nurses. Tomilnson (2015)
focused on the population of inpatients who had peripheral IV
therapy for 5-29 days within a 600-bed community hospital.
Whereas Pepin et al. (2015) utilized patients aged 18 and more
in the ICU with CVCs. Eligible participants had to have a
central line for 48 hours and without prior CLABSI. In a study
by Tomars et al. (2016), there was a study using children who
stayed in PICU for more than 48 hours without infection at the
time of admission. The study involved 265 children.
Other more studies include, Powell (2018) investigated
information from 20 patients, three of whom were children and
the rest adults. Masse, Edmond, & Diekema (2018) surveyed
information from a literature review of studies ranging from
2008 to data to establish the infection prevention approaches
performed outside the operating room. In most of the studies,
the aspects of age, gender, and marital status were never
necessary for the study. The focus was on the usage of the
CVCs.
Limitations
There are several obvious limitations in the studies. For
example, Esposito et al. (2017) opine that self-reported
questionnaires affected accuracy in response, most respondents
gave information that was positive rather than genitive on
hygienic consideration of CVCs. Questionnaires ought to be
anonymous to encourage correct reporting. He also notes that a
cross-sectional study hindered establishing a causative
relationship with outcomes of interest. Future studies need to
focus on non-evidence-based practices and dressing of catheters
and how they relate with CLABSI (Han et al., 2015). Also, the
study by Basinger (2014) was limited by failure to separate the
efforts that aim at improving the use of CUSP, related

approaches, and technologies that reduce compliance in hygiene
situations of CVC.
In the study by Afonso et al. (2015) the limitation was in the
use of cumulative analysis on line-associated HABSI types
while reporting the catheter culture is a diagnosis of infection
lead to difficulties in isolating categorical data on attitudes,
knowledge, and practical application of knowledge. Moreover,
another study by Lin et al. (2015) showed that the limited time
and consideration of barrier towards quality, an aspect that
needed adequate time hindered acquisition of enough
information. Other researchers who complained of time that
limited them from acquiring adequate and reliable data as well
as having comprehensive studies include Kadium (2015), Pepin
et al. (2015) Aloushi & Alsarai (2018). Therefore, it resulted in
results that were not matching with the literature review and
they could not be generalized on any other population
Furthermore, Perin et al. (2016) note that the use of one type of
catheter hindered generalization of information to other health
departments.
Chidambaram (2015) assert that there was limited evidence as a
result of the utilization of the exploratory method when
conducting a study on CLABSIs hence a lot of data never
emerged clearly. According to Kadium (2015) the small sample
size and short duration within which it was conducted limited
the results that were acquired. Another problem emerged
because there was no assessment of the learning styles of the
patients. According to Powell (2018), some electronically
captured information gave collinearity that challenged in the
interpretation of results. In other studies, location-based data
was limited and focus on one type of catheter limited the
generalization of results on every catheter (Perin et al., 2016).
Conclusions and Recommendations
Overall, there are various issues that are addressed in the
various papers in this analysis. From the literature review, it is
observed that fighting CABSI results in saving a lot of money
that could be used by the healthcare in other projects (Scott,

Sinkowitz-Cochran, Wise, Baggs, & Goates, 2016). Afonso et
al. (2016) conclude that hospitals achieve zero infections of
CLABSI rates meaning the continued usage of surveillance
together with a washcloth bathing for they curtail Gram-positive
bacteria. Similarly, Namita et al., (2015), besides, Viana
Taviera et al., (2016) remind the health care practitioners on
assessing other risks such as white blood cell content,
malnutrition status, bone marrow aplasia, and CVC risks before
chemotherapy because they increase the risks of infection
among children. Thus, hospitals with high baseline hygienic
standards of care and lower CLABSI rates might benefit less
fromchlorhexidine gluconate (CHG) washcloth bathing.
Additionally, Lin et al. (2016) note that the adherence to the
current evidence-based practice guidelines, education, and
consideration or compliance to hygiene, and use of
chlorhexidine antiseptic bathing instead of the soap helps in the
prevention of CLABSIs. For example, according to O’Grady et
al. (2015), maximal sterile, cautious insertion of catheters,
avoidance of routine catheter replacement, usage of the
antiseptic/antibiotic impregnated short-term central venous
catheters and chlorhexidine-impregnated sponge dressings help
to prevent and manage CLABSIs.
Similarly, Perin et al., (2016) opine that the consideration of
necessary interventions on the catheters can prevent infections.
Among such interventions is the proper selection and timing of
the insertion of a CAVAD, intervention and the commitment of
the clinical leader, reduce infection of CLABS (Tomilnson,
2015). The evaluate-treat order was an essential process in
preventing infections. This evaluation could be through audit
tools on awareness and compliance, together with policies like
Stay connected and closed-circuit system in which proper
maintenance of cars is ensured (Baldassarre, Finkelston,
Decker, Lewis, & Niesley, 2014). According to Esposito et al.
(2017) in situations where nurses have a positive attitude, and
perceive hygiene as a risk in CLABSIs as well as where
evidence-based practice programs are used, infection is likely to

be prevented. The reason behind the high infections is low
adherence to handwashing. Xu & Wu (2017) note that patient
cooperation and knowledge of proper care for CVC prevent
infections. There is a need for studying practical clinical nurse
interventions in the care for CVC. In the study by Han et al.
(2015) state that blood culture is necessary for managing CVC
patients. Formal training, years of experience, written policies,
enhance compliance with proper CVC care and reduce
infections (Han et al., 2015). In a study by Bianco et al. (2015),
there is a conclusion that less costly evidence-based education,
CUSP prevent infections. It is also indicated that
multidisciplinary education programs improve assistance to
patients (Oliveira et al., 2016). Similarly, Soffle et al. (2018)
suitable simulation program should have educational sessions,
video training, problem-based learning, mixed methods, and
appropriate timing. Besides, the management should be aware
that some of the challenges to the program include; cost, space,
time, faculty support among others.
According to Afonso et al. (2016), an analysis into the topic
requires separate primary, secondary and central line-associated
HABSI types in reporting catheter culture during the diagnosis
of bloodstream infection that increases certainty and lowering
of risks of bias as a result of improper attribution of blood
culture contaminants.
The choice of catheters should also be carefully considered.
According to Xu & Wu (2017), the type of catheter, external
and internal factors as well as the mode of infection is a critical
element during the evaluation and care for CVC. Furthermore,
Powell (2018) notes that if hospitals use surveillance for
antimicrobial use and resistance options in ambulatory surgery
and acute care hospitals, then infections will be eliminated.
Pepin et al. (2015) indicate that the surveillance should be more
critical among patients with any given comorbid conditions
because they have a higher risk of CLABSI as compared with
another patient. Morris et al. (2016) suggest that through central
line audit analysis and provision of the unit case reports to

nursing managers and 1-on-1 personalized nurse report cards
there is increased compliance with established guidelines for
the management of central lines. In the study by Chidambaram
(2015), the conclusive view offers that the dental care process
as necessary for pediatric CKD patients if studies on CVC are
being held. Besides, CVC benefits CKD patients but poses a
threat for long-term candidates due to negligence on
disinfection and sterilization processes. According to Kadium
(2015), high education levels do not affect pretest, but the
completion of infection control course affects pretest scores.
Similarly, more experienced nurses, those registered in the
dialysis nurse knowledge, those with updated knowledge on
CVC care, offer better care for a patient with CVCs. Another
argument is that evidence-based care allows students to work
purposefully.
Moreover, the provision of continuous education enhanced
retention and application of knowledge in tasks. In another
study by Masse, Edmond, & Diekema (2018) as expert opinion
high-quality evidence practice through sufficient evidence via
training and assessment result in proper care for patients with
catheters. Ultimately, WHO (2018) suggests that as long as
health care establishes a comprehensive action plan, assessment
baseline, execution, checks the impact and establishes a
sustainable long-term plan, CLABSI cases can be prevented.
Aloushi & Alsarai (2018) recommend having adequate nurses
because it encourages them to be compliant to right practices.
Tomar et al. (2016) give an overall observation that all central-
line associated bloodstream infections can be prevented through
the application of intervention strategist that target the primary
bacteremia. Likewise, Leistner, Thürnagel, Schwab, Gastmeier,
& Geffers, (2016) recommends that infant units should have
adequate nurses to reduce infection cases. It is thus necessary
for future studies to focus on more than one type of catheter for
results to be relevant to various departments of health.
From the above literature review, it is clear that evidence-based
practice, policies, hygiene, education and attendance of

workshops are essential aspects that need to be studied. Besides,
the consideration of the study population, using adequate time
for the study, having confidential questionnaires are part of the
essentials of conducting a useful study on CVCs and CLABSI’s.
The conclusions and recommendations are drawn from what the
authors had from their results. There is the need for continued
monitoring and feedback concerning compliance with the set
hygiene practices aimed at preventing CLABSIs infections. The
infection basics, such as patient and healthcare providers’
education, should be addressed (Beverly et al., 2018). Public
health funding has also been suggested as a recommendation
towards the prevention of the infection. Further areas of the
study should address different ways of tracking infections,
whether they are high at the emergency rooms or the operation
rooms. The areas for further research should also focus on
strategies aimed at removing barriers in policies and practices.
Reference
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7917.es.2016.21.46.30400
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the prevention of central line-associated bloodstream infections
among nurses in oncological care: A cross-sectional study in an
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Han, Z., Liang, S. Y., & Marschall, J. (2015). Current strategies
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Hsu, Y., Weeks, K., Yang, T., Sawyer, M. D., &
Marsteller, J. A. (2014). Impact of self-reported guideline
compliance: Bloodstream infection prevention in a national
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S191-S196. doi:10.1016/j.ajic.2014.05.010
Jones, G. F., Forsyth, K., Jenewein, C. G., Ray, R. D.,
DiMarco, S., & Pugh, C. M. (2017). Research Residents'
perceptions of skill decay: Effects of repeated skills
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Kadium, M. J. (2015). Improving Nurses' Knowledge to Reduce
Catheter-Related Bloodstream Infection in Hemodialysis Unit.
Retrieved from
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Kim, R., & Biorn, J. (2017). Healthcare-Associated Clostridium
difficile Infection

Solution
Guide. American Journal of Infection Control, 45(6), S103.
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Klintworth, G., Stafford, J., O'Connor, M., Leong, T.,
Hamley, L., Watson, K., … Worth, L. J. (2015). Beyond the
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Leistner, R., Thürnagel, S., Schwab, F., Piening, B.,
Gastmeier, P., & Geffers, C. (2015). The impact of staffing on
central venous catheter-associated bloodstream infections in
preterm neonates – results of a nation-wide cohort study in
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Ling, M. L., Apisarnthanarak, A., Jaggi, N., Harrington, G.,
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Morrison, T., Raffaele, J., & Brennaman, L. (2017). Impact of
personalized report cards on nurses managing central
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Oliveira, F. T., Stipp, M. A., Silva, L. D., Frederico, M., &
Duarte, S. D. (2016). Behavior of the multidisciplinary team
about Bundle of Central Venous Catheter in Intensive
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Ameling, J. M., & Meddings, J. (2017). Review of Strategies to
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(2016). Evidence-based measures to prevent central line-
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Viana Taveira, M. R., Lima, L. S., De Araújo, C. C., & De
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90.s11
Practice Hours Completion Statement DNP-820
I, (Kerry Murphy), verify that I have completed (30) clock
hours in association with the goals and objectives for this
assignment. I have also tracked said practice hours in the
Typhon Student Tracking System for verification purposes and
will be sure that all approvals are in place from my faculty and
practice mentor.

IT4683 Management of ITExercise 4- Providing IT Assurance
Your name:
Policies:
· Submissions made through a means other than the
GeorgiaView (D2L) Dropbox will be ignored and earn a 0.
· Submissions without your name stated above earn a 0.
· Submissions not in a docx or pdf file or with the original
questions and/or formatting removed from the file earn a 0.
· Submissions without adequate references or
acknowledgements will earn a discounted grade, potentially a 0.
· Submissions that I cannot open or require a password will earn
a 0.
· Second chances might be requested at any time through
GeorgiaView email, and are awarded at the sole discretion of
the instructor.
Review, Evaluate and Adopt Approaches for Providing IT
Assurance and Doing Case Studies
Being successful in this course requires you to review, evaluate,

adapt and adopt methods for analysis and evaluation that might
be incorporated into your approach to managing IT, providing
IT assurance and pursuing a case study. This exercise intends
to aid you in doing so.
Readings for this assignment:
· Selected readings on the web
· Course Textbook [1]- Preface through Chapter 4 (Pages 1-23)
Actions/Deliverables for this assignment:
· Read as per above
· Research what you read
· Respond to this assignment within the docx file (leaving all
questions and formatting intact)
· Deliverable: Upload your response using the Dropbox tool in
GeorgiaView
· Deliverable: Cite all references and indicate which method
used at the end of the file.

Question 1) 25 points From the textbook’s use of concepts and
terminology in Chapters 3 and 4, pick the top ten of the terms
and concepts useful for managing IT risks, providing IT
assurance and utilizing sound Human Computer Interaction
(HCI) principles in IT operations. Tell why you have made each
choice. (Example terms and concepts include risk, controls,
assurance, users, etc.)
Question 2) 25 points You have been promoted to Call Center
Director [2] and your organization follows CobiT [1]. Part of
your promotion was to recognize your abilities in working in
the HCI part of IT that is, working with users, including human
factors, ergonomics and user-centered computing. In awarding
the promotion, the CIO specifically mentioned that you were a
key player in bring about outstanding user experience for the
call center. Since user experience is the key to your call
center’s success, you want to incorporate that user-centric
flavor into the Call Center IT. You see this can be incorporated
into the IT assurance program that is ongoing within your
organization.
Once again you turn to a web search and discover that

accessibility is a key HCI concept for the Call Center. You are
especially aware that the Call Center wants to move to use more
web-based presentation and interaction and that many of your
regular callers are disabled. Develop a list of 10 to 20
“discussion points” about accessibility of the IT within the Call
Center that will contribute to both business strategy and IT
assurance.
Question 3) 20 points Complete Caselet 4 covering ClaimProof
Insurance writing at most 2 pages on the following questions:
You have been hired to respond to these concerns in ClaimProof
and answer the following questions:
· What are the five steps required for the IT assurance of a
specific area?
· Based on the results of question 1 and your understanding of
the control environment, identify the high-risk areas requiring
audit attention.
· How would you assess the control design?
· How would you test the control effectiveness?
Question 4) 20 points Mobile computing is growing in
importance each and every day, and the IT manager must take
that into account. Do some web research and develop a one-
page description of the five most important things about HCI of

mobile computing that the IT manager should know.
Question 5) 10 points: Complete GeorgiaView Discussion
Posting:
· Using your answers to the questions above, review and
summarize your ideas about IT assurance and the role of HCI in
doing so.
· Record your answers here in this assignment.
· Also, enter your answers on the Module 4 Discussion.
Sources and works used in completing this exercise:
a. Textbook: IT Governance Institute. IT Governance Using
COBIT and ValIT: Student Book, 2nd Edition. 2007.
b. http://en.wikipedia.org/wiki/Call_centre does a good job of
describing what a call center is all about and was retrieved on
28 April 2013.
c. http://en.wikipedia.org/wiki/Accessibility does a good job of
describing what accessibility is all about and was retrieved on
28 April 2013.
http://www.w3.org/WAI/ describes accessibility for the web and
has many good pieces of advice and guidance. It was retrieved
on 29 April 2013.

d. Case lets: IT Governance Institute. IT Governance Using
CobiT® and ValIT™, 3rd Edition. 2010.
Required: Please add your list of sources.
Required: Please complete the following:
___ I did not use any method of citation (maximum B on the
assignment).
___ I used the ACM approach and have cited my references as I
went in the text and also listed them at the end.
___ I used the APA approach and have cited my references as I
___ I used the MLA approach and have cited my references as I
Required: Acknowledgements of people and discussions used in
completing this exercise:
Week 6 Assignment Instructions
Tutor MUST have a good command of the English language
Tutor MUST have a good command of the English language
Sources need to be less than five years old and journal/scholarly
articles.
Use only articles that are published between 2014-2018 (except
for your theory articles which will be older as you must cite

primary sources).
No textbook or direct quotes
Rubric Requirements must be met
This is a continuation of the literature review that is attached.
The new assignment needs to be added to the attached
document.
In this assignment, you will draft the body of a literature
review. You will continue to add and revise this draft literature
review (Chapter 2 of your DPI Project) as you progress through
the program. You may be able to use the feedback and
suggestions from your instructor (on the Introduction to the
Literature Review assignment in Topic 4) to expand the
literature review for this assignment.
General Requirements:
Use the following information to ensure successful completion
of the assignment:
· Use the "Empirical Research Checklist" worksheet to ensure
that each article you select meets all of the established criteria.
· Use the "Research Article Chart" to provide a summary review
of each component of your assignment.
· Submit the completed Research Article Chart to your
instructor.
· Refer to the most recent prospectus template found in the DC
Network (dc.gcu.edu) for details and criteria for the Literature
Review (Chapter 2).

· Doctoral learners are required to use APA style for their
writing assignments. The APA Style Guide is located in the
Student Success Center. An abstract is not required.
· This assignment uses a rubric. Please Review the rubric prior
to the beginning to become familiar with the expectations for
successful completion.
· You are required to submit this assignment to Turnitin. Please
refer to the directions in the Student Success Center.
Directions:
Part 1: Selection of 15 Articles
Select 15 empirical articles related to your PICOT question. Use
the "Empirical Research Checklist" worksheet to ensure that
each article you select meets all of the established criteria. At
least one article must demonstrate a quantitative methodology.
Part 2: Research Article Chart
Using the articles acquired in Part 1, provide a summary review
of each component using the "Research Article Chart" template.
Part 3: Literature Review
Prepare a Literature Review (Chapter 2) of 2,000-3,000 words
for your scholarly project.
Utilizing the major concepts identified in the Topic 4
assignment, further develop each major concept and subtheme
by locating 15 more empirical articles related to your project
topic (30 articles total: 15 from Topic 4 assignment and 15 from
Topic 6 assignment).

Use the "Research Article Chart" as a guide to analyze and
synthesize (summarize) the literature into the paper you began
in the Topic 4 assignment.
Based upon your review of the 15 additional research articles,
expand on your summary of each major concept and your
synthesis of the three identified subthemes that support each
concept. At the end of each major concept, include a summary
statement.
Apply Rubrics
Benchmark - Drafting a Literature Review
1
Unsatisfactory
0.00%
2
Less Than Satisfactory
74.00%
3
Satisfactory
79.00%
4
Good
87.00%
5
Excellent

100.00%
70.0 %Content
20.0 %Identification of Major Concept and Related Scholarly
Sources (C.5.1)
The identification of major concept and related scholarly
sources is either missing or incomplete.
Major concept to be included in the literature review are
present, but the sources cited do not relate to the concept or are
not from scholarly sources.
present, and the sources cited distantly relate to the concept.
Sources cited are from both scholarly and nonscholarly sources.
present, and the sources cited relate to the concept. Sources
cited are from scholarly sources though some sources may be
outdated.
present, and the sources cited directly and clearly relate to the
concept. Sources cited are from current scholarly sources.
30.0 %Identification of Subtopic, Related Scholarly Sources,
and Quantitative Research Elements (C.5.1)
The identification of subthemes, related scholarly sources, and
quantitative research elements is either missing or incomplete.

Subthemes to be included in the literature review are present,
but the sources cited do not relate to the themes or are not from
scholarly sources. The quantitative research elements are
incorrectly identified.
and the sources cited distantly relate to the themes. Sources
cited are from both scholarly and nonscholarly sources. The
quantitative research elements are correctly identified.
and the sources cited relate to the themes. Sources cited are
from scholarly sources though some sources may be outdated.
The quantitative research elements are correctly identified.
and the sources cited directly and clearly relate to the themes.
Sources cited are from current scholarly sources. The
quantitative research elements are correctly identified.
20.0 %Synthesis of the Research in Each Subtheme (C.5.1)
The synthesis of the research in each subtheme is either missing
or does not address all of the required components.
The synthesis of the research in each subtheme incompletely or
inaccurately conveys to the reader what is known and what is
not known. It does not demonstrate that the learner has a solid
grasp of existing literature on the topic.
The synthesis of the research in each subtheme provides a

cursory review that conveys to the reader what is known and
what is not known. It demonstrates a superficial understanding
of existing literature on the topic.
The synthesis of the research in each subtheme provides a solid
review that conveys to the reader what is known and what is not
known. It demonstrates a moderate understanding of existing
literature on the topic.
The synthesis of the research in each subtheme provides a
thorough review that conveys to the reader what is known and
what is not known. It demonstrates a thorough grasp of existing
literature on the topic.
20.0 %Organization and Effectiveness
7.0 %Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis is insufficiently developed or vague. Purpose is not
clear.
Thesis is apparent and appropriate to purpose.
Thesis is clear and forecasts the development of the paper.
Thesis is descriptive and reflective of the arguments and
appropriate to the purpose.
Thesis is comprehensive and contains the essence of the paper.
Thesis statement makes the purpose of the paper clear.

8.0 %Argument Logic and Construction
Statement of purpose is not justified by the conclusion. The
conclusion does not support the claim made. Argument is
incoherent and uses noncredible sources.
Sufficient justification of claims is lacking. Argument lacks
consistent unity. There are obvious flaws in the logic. Some
sources have questionable credibility.
Argument is orderly, but may have a few inconsistencies. The
argument presents minimal justification of claims. Argument
logically, but not thoroughly, supports the purpose. Sources
used are credible. Introduction and conclusion bracket the
thesis.
Argument shows logical progressions. Techniques of
argumentation are evident. There is a smooth progression of
claims from introduction to conclusion. Most sources are
authoritative.
Clear and convincing argument that presents a persuasive claim
in a distinctive and compelling manner. All sources are
authoritative.
5.0 %Mechanics of Writing (includes spelling, punctuation,
grammar, language use)
Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice and/or
sentence construction are used.

Frequent and repetitive mechanical errors distract the reader.
Inconsistencies in language choice (register) or word choice are
present. Sentence structure is correct but not varied.
Some mechanical errors or typos are present, but they are not
overly distracting to the reader. Correct and varied sentence
structure and audience-appropriate language are employed.
Prose is largely free of mechanical errors, although a few may
be present. The writer uses a variety of effective sentence
structures and figures of speech.
Writer is clearly in command of standard, written, academic
English.
10.0 %Format
5.0 %Paper Format (Use of appropriate style for the major and
assignment)
Template is not used appropriately or documentation format is
rarely followed correctly.
Appropriate template is used, but some elements are missing or
mistaken. A lack of control with formatting is apparent.
Appropriate template is used. Formatting is correct, although
some minor errors may be present.
Appropriate template is fully used. There are virtually no errors
in formatting style.
All format elements are correct.

5.0 %Documentation of Sources (citations, footnotes,
references, bibliography, etc., as appropriate to assignment and
style)
Sources are not documented.
Documentation of sources is inconsistent or incorrect, as
appropriate to assignment and style, with numerous formatting
errors.
Sources are documented, as appropriate to assignment and style,
although some formatting errors may be present.
Sources are documented, as appropriate to assignment and style,
and format is mostly correct.
Sources are completely and correctly documented, as
appropriate to assignment and style, and format is free of error.
100 %Total Weightage
CENTRAL LINE-ASSOCIATED BLOODSTREAM
INFECTIONS2
CENTRAL LINE-ASSOCIATED BLOODSTREAM
INFECTIONS16

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 INFECTIONS1
Central Line-Associated Bloodstream Infections Literature
Review
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 (CVC), 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. There were
200 articles that were established to talk about the
CVCscatheter, CLABSIs, risk factors, intervention, and benefits
of preventive measures. Through inclusion and exclusion
criteria many journal articles , wereere left out because of being
written in other languages rather than English. Therefore, the
use of the English language index the Cumulative Index of
Nursing and Allied Health Literature (CINAHL) was used to
search related ,journal articles. Other search tools
includeThe National Center for Biotechnology Information
(NCBI) – PubMed. Studies older than five years were excluded

to ensure that the research remained current and up to date.
Using real-time cases or conditions helps to improve the quality
and validity of the resulted research. having done years ranging
from 2012 and backwards, and lacking openness to the public.
Therefore, 29 were used in the study.
Questions Posed in the Studies
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. Kadium, M. (2015) inquired into how the education
program for one month, based on the evidence-based guidelines
recommended by CDC, will improve registered dialysis nurses’
knowledge regarding CVC maintenance care? Dougherty
(20142) 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. Lin,
Apisarnthanarak, Jaggi, Harrington, Morikane, Thu, Ching,
Villanueva, Zong, Jeong, & Lee , (2015), and Esposito, Guillari
& Angelillo (2017) concur..
O’Grady, Alexander, Burns, Delilnger, Garland, Heard, Lipsett,
Masur, Mermel, Pearson, Raad, Randolph, Rupp, & Saint
(20151), the inquiry focused into how Positive blood culture

shows the relationship between CLABSI and CDC surveillance.
Other researchers inquire into the CLABSI-related preventive
measures implemented among adult patients hospitalized in an
ICU. Such studies are by people like Perin, Erdmann, Higashi,
Sasso, Bianco, et al. (2016), Masse, Edmond, & Diekema
(2018), Oliveira, Stipp, Silva, Frederico, & Duarte (2016). In a
research by Basinger, (2014), the research question questions
into the causal effects of the Comprehensive Unit-based Safety
Programs (CUSP) on the reduction of CLABSIs within the
relationship CUSP team member webinar attendance has with
the reduction of CLASBIs. Other questions were on how
knowledge and education of the family and patient could help in
the prevention of CLABSIs attack. Among such studies are;
Kadium, (2015) and Powell (2018).
Other studies focused on how evidence-based practice,
insertion, and maintenance of CVC could protect the patients
from CLABSIs. Such research was done by Bianco, Coscarelli,
Nobile, Pileggi, & Pavia (20143), WHO (2018) and Xu & Wu
(2017). The final research is by Han, Liang, & Marschall,
(20150), who question how the involvement of education to the
family and the patient can help prevent CLABSIs attacks among
patients on CVC care. Another study by Yazan & Regunath
(2018) questions examines the relationships between Positive
blood culture and CLABSI with CDC.
Identified Subthemes

From this, there are various subthemes that emerge in this
study. These include; Hygiene and impact of this on the CVC
situation. Most studies show that the more hygiene is
considered and practiced, the lower the cases of CLABSI.
Another concept is the knowledge that is necessary among
nurses and patients handling CVC. Through knowledge m the
care for CVC improves and infections reduce. Besides, there are
Policies which enhance the correct application of knowledge
and maintenance of hygiene in the health care, hence
decreasreducing cases of infections.
Moreover, nurse experience is an essential subtopic for due to
evidence that supports that with higher experience in the CVC
wardsunits;, nurses tend to takeadhere and follow ptoticls and
precautions and which help prevent infections that those
without. Finally, there are Eevidence- Based
Practices/Interventions such as proper fitting, disinfection and
sterilization, iInsertion bundle, maintenance bundle, and quality
improvement.
The reviewed literature has shown that the nurse, patients,
family, and evidence versus non-evidence-based practice are
important in the analysis of the situation. Besides, the setting,
the type of catheter, and conditions affect the entire discussion.
Risk Factors Associated with CLABSIs
a. Contamination on Insertion
The catheter may gain entry into the bloodstream during the

insertion of the line into the body of the patient. The rate of
infections during insertion is substantially dependent on the
hygiene levels that are put in place by the health care providers
(Dick et al., 2015). The rates of infection during insertion
happen to be high showing ignorance or lack of professionalism
among the health caregivers. Contamination during insertion
may also result from the instruments used and how sterilized
they are.
b. Contaminated Skin of the Patient
The insertion is done on the body of the patient. A contaminated
skin of the patient may contain germs which may enter the body
during the insertion (Dombecki et al., 2017). The fact that
patients have negligible knowledge concerning the different
ways the infection may occur means that there is so much
responsibility placed on the health caregivers. The infection
rates due to unsanitary practices of the patients seem to have
drawn the attention of the authors of the different articles
analyzed. With the rates of CLABSIs rising each year, mortality
rates have also increased. Researchers have made CLABSIs
prevention a priority to address such risk factors to avoid or
reduce infection rates.
c. Non-Compliance with the Central Line Maintenance
There are guidelines for healthcare professionals meant to
reduce the chances of CLABSIs infection. Such guidelines
include not using antiseptics and ensuring complete dressing

changes (Orwoll et al., 2018). As much as these guidelines and
policies are in place does not mean that compliance is definite.
Cases of caregivers who do not comply with the stipulated
guidelines are common and such levels of unprofessionalism
have cost patients their lives.
Interventions
a. Removal of Unnecessary Lines
The authors agree that there are times patients will have lines
which are no longer being used for any medical purpose. These
are mainly patients who have spent so much time in the
hospitals, and the chances of being discharged seem minimal
(Sodek, 2016). The caregivers are meant to remove lines once
they have served the purpose. The more these lines remain on
the body of the patients the more the chances of infection.
Bacteria and all other associated germs will easily enter the
body.
b. Health Care Providers to Follow Recommendations
Healthcare professionals are trained on the best practices that
are meant to ensure that the chances of patient infections are
minimized or even eliminated entirely. Unfamiliarity creeps in
at times, and the well-being of the patients is jeopardized
(Stone et al., 2014). Just like any other profession, health care
ties the professionals around practices which ensure ethical
undertakings to safeguard the lives of the patients. The authors
are for the idea that health care professionals should be just to

patients and do what their work ethics dictates them to do. Such
will ensure improved health and safety of the patients.
c. Encouraging Teamwork
In any health care setting, there are two main participants.
These are the health caregivers and the patients. One of the
authors suggests that teamwork between these two parties will
go a long way in reducing the rates of these infections (Stone et
al., 2014). Teamwork will ensure that there is knowledge
sharing, that key concerns and risks that may be known to one
of the parties are made known to the other. The impact
teamwork will have ontowards preventing the cases of CLABSIs
in hospitals is immeasurable. The same should be embraced and
upheld.
CLABSIs associated infections/Transmissions
a. Hematogenous Transmission
This is an infection that is characterized by a primary tumor
penetrating into blood vessels. They then get transported in the
blood vessels and eventually into the distant parts of the body
of the patient (Stone et al., 2014). Once at the distant sites, the
cells will penetrate the walls of the vessels again and build a
basis for another, a new tumor on the new site. Such are the
same cases that happen with CLABSIs. Examples include
catheter-associated Urinary Tract Infections (CAUTI) that can
lead to CLABSI’s.
b. Catheter-associated Urinary Tract Infections (CAUTI)

A urinary tract infection (UTI) refers to an infection in any part
of the urinary system. UTIs are also common healthcare-
associated infections reported by both patients and healthcare
givers. These infections are associated with urinary catheters, a
tube which is used by doctors through the urethra to drain urine
(Douglas, 2015). Most of the hospitalized patients end up with
urinary catheters inserted in their bladder. Prolonged use of the
catheters increases the risks of the infections. Health caregivers
should ensure that these catheters are removed when not being
used to reduce the risk of patients contracting the CLABSIs.
c. Contaminated Infusates
The term refers to the introduction of pathogens into the body
of patients. The introduction of these pathogens occurs through
the sterile used by the health care providers. During surgery or
during other procedures which may require line insertion,
bacteria may be introduced into the body of the patient (Stone et
al., 2014). Contaminated infuscate happen to be one of the ways
CLABSIs bacteria is introduced into the bloodstream. Patients
and the health care providers need to be educated on such risks.
Necessity for Interventions
a. Reduced incidences of CLABSIs
The preventive measures mentioned above by the authors of the
different articles will go a long way into reducing the incidents
that are reported by patients and caregivers concerning
CLABSIs (Klintworth et al., 2014). Encouraging adherence to

the hygiene standards, the policies and the recommendations as
they relate to CLABSIs infections will enable the creation of an
environment that will enhance the well-being of the patients and
also minimize the chances of contraction of the infections. The
infection is deadly and is already costing patients and nations
dearly.
b. Reduced morbidity
Morbidity has been defined as how often a disease occurs or is
reported in a population. The morbidity rate is determined by
examining the number of patients with a certain disease at a
given period (Kim & Biorn, 2017). Reduced cases of a disease
mean that preventive and treatment measures are effectively
implemented by all stakeholders involved. CLABSIs infections
are no exceptions here. The literature work of the previous
authors appreciates that the health care institutions that have
adopted the interventions measures above report few and
reduced cases of the infection.
CLABSIs Symptoms
a. Site Discharge
The area where the catheter is placed should remain dry, and no
discharge should be coming from the area. Some patients,
however, may notice yellow or green discharge (Conley et al.,
2018). The drainage should be a cause for alarm, and the
authors have identified the discharges as some of the top
indicators that something has gone wrong and healthcare

providers should act up. Discharges show that the area is not
fresh and has been exposed to bacteria and germs, something
that should be of great concern.
b. Site Swelling
Patients may experience additional swelling at the place where
the catheter line has been inserted. The swelling is an indicator
that there is no healing that is taking place and that there is
every reason to worry about the well-being of the patient
(Castagna et al., 2016). The authors suggest that nurses should
give attention to the recovery process of patients and ensure
that such instances are noted and addressed. In cases where
there is no close relationship between the health caregivers and
the patients, such incidents may be hard to notice, and the
patients end up suffering and worse still, be exposed to the ugly
infection which may even cost them their lives.
c. Site Redness
A patient may develop red streaks at the area where the line has
been inserted. Another warning sign that the patient may be
headed to a CLABSIs. Again, if there is no close interaction
between patients and their caregivers such may be hard to
notice (Chesshyre et al., 2015). Worse still if the patient is not
aware that such are causes for alarm. They may never report the
same and end up risking their lives. Adult patients and children
are at the greatest risk of these symptoms because in most cases
they do not know what should be made known to the health care

providers and what should not be a cause for worry.
Research Questions
a. How does the training of health-care providers on the risks
and the preventive measures of CLABSIs impact the overall
infection rates?
b. What is the level of knowledge of nurses regarding the use of
evidence-based guidelines to prevent central venous catheter
bloodstream infections?
c. Does an increase in nurse’s knowledge concerning CLABSIs
infections reduce the number of infections in the Intensive Care
Units?
Sample Populations
The authors have utilized different study populations to
accomplish their objectives. The two major categories of
respondents that are common to all authors are healthcare
professionals and adult patients suffering from or who have
suffered the CLABSIs infections in the past (Hsu et al., 2014).
These two categories have a rich knowledge ofn the study topic.
Such enables researchers to collect adequate data for their
research topics and also draw logical conclusions.
There are several processes through which people sample
information in studies. For Alfonso et al. (2016) the search of
the various database using key terms gave 291 records,
however, based on relevance only 4 articles were suitable for
the study. In a study by Dougherty, there was convenience

sampling of a population of registered nurses in the LTACH
setting after completion of orientation to the unit. Out of 52
eligible nurses, 31 participated in the survey response.
The study by Lin et al (2015) utilized a cross-sectional design
in the qualitative analysis of sources based on the key concepts
of the study. Perin et al. (2016) explored a purposive sampling
and selection of 34 studies that formed a set through which to
assess results after a systematic review of academic and health
database. In the sampling process, Esposito (2017) utilized a
cross-sectional design in 16 non-teaching and teaching public
and private hospitals with units utilizing CVCs for adult
oncological patients. The target group was 472 nurses in the
oncology and outpatient chemotherapy units of the selected
hospitals.
Likewise, Oliveria et al (2016) samples were collected through
a cross-sectional study with questionnaires to 76 professionals
in the intensive care. Zu & Wu (2017) utilized the qualitative
process and a systematic search of databased on CINAHL, ABI
INFORM, and OVID through which they established more than
a hundred articles before applying the exclusion-inclusion
criteria and utilizing ten articles in the study. WHO (2018) held
a comprehensive research in various facilities to establish
methods of improving infection prevention and control on
catheter units.. Bianco et al. (20153) used samples from a
number of CLABSIs which were collected by the hospital-based

IP in line with the NHAN approach and definition of CLABIs.
The CUSP teams of hospitals receive monthly feedback on
infections and quarterly feedback on rates of infection per 1,000
catheter days. Basinger (2016) samples were collected through a
cross-sectional study with questionnaires to 76 professionals of
varied gender, and ages in the intensive care. In another study
by Chidambaram (2015) the samples used were acquired from
existent studies. On the other hand, Kadium (2015) utilized a
convenience sampling of registered dialysis nurses in the
hemodialysis unit was used in a pre and post-test educational
interventional design among 60 registered dialysis nurses.
Powell (2018) investigated information from 20 patients, three
of whom were children and the rest adults. Masse, Edmond, &
Diekema (2018) surveyed information from a literature review
of studies ranging from 2008 to data to establish the infection
prevention approaches performed outside the operating room. In
most of the studies, the aspects of age, gender, and marital
status were never necessary forin the study. The focus was on
the usage of the CVCs.
Limitations
There are several obvious limitations in the studies. For
example, Esposito et al. (2017) opine that self-reported
questionnaires affected accuracy in response, most respondents
gave information that was positive rather than genitive on
hygienic consideration of CVCs. Questionnaires ought to be

anonymous to encourage correct reporting. He also notes that a
cross-sectional study hindered establishing a causative
relationship with outcomes of interest. Future studies need to
focus on non-evidence-based practices and dressing of catheters
and how they relate with CLABSI (Han et al., 20153). Also, the
study by Basinger (20144) was limited by failure to separate the
efforts that aim at improving the use of CUSP, related
approaches, and technologies that reduce compliance in hygiene
situations of CVC.
In the study by Afonso et al. (2015) the limitation was in the
use of cumulative analysis on line-associated HABSI types
while reporting the catheter culture is a diagnosis of infection
lead to difficulties in isolating categorical data on attitudes,
knowledge, and practical application of knowledge. Moreover,
another study by Lin et al. (2015) showed that the limited time
and consideration of barrier towards quality, an aspect that
needed adequate time hindered acquisition of enough
information. Furthermore, Perin et al. (2016) note that the use
of one type of catheter hindered generalization of information to
other health departments.
Chidambaram (2015) assert that there was limited evidence as a
result of the utilization of the exploratory method when
conducting a study on CLABSIs hence a lot of data never
emerged clearly. According to Kadium (2015) the small sample
size and short duration within which it was conducted limited

the results that were acquired. Another problem emerged
because there was no assessment of the learning styles of the
patients. According to Powell (2018), some electronically
captured information gave collinearity that challenged in the
interpretation of results.
The Conclusions and Rrecommendations
Overall, there are various issues that are addressed in the
various papers in this analysis. From the literature review,
Afonso et al. (2016) conclude that hospitals achieve zero
infections of CLABSI rates meaning the continued usage of
surveillance together with a washcloth bathing for they curtail
Gram-positive bacteria. Thus, hospitals with high baseline
hygienic standards of care and lower CLABSI rates might
benefit less from CHG washcloth bathing. Additionally, Lin et
al. (2015) note that the adherence to the current evidence-
based practice guidelines, education, and consideration or
compliance to hygiene, and use of chlorhexidine antiseptic
bathing instead of the soap helps in the prevention of CLABSIs.
For example, according to O’Grady et al. (20151), maximal
sterile, cautious insertion of catheters, avoidance of routine
catheter replacement, usage of the antiseptic/antibiotic
impregnated short-term central venous catheters and
chlorhexidine-impregnated sponge dressings help to prevent and
manage CLABSIs.
Similarly, Perin et al., (2016) opine that the consideration of

necessary interventions on the catheters can prevent infections.
According to Esposito et al. (2017) in situations where nurses
have a positive attitude, and perceive hygiene as a risk in
CLABSIs as well as where evidence-based practice programs
are used, infection is likely to be prevented. There is still a low
adherence to handwashing. Xu & Wu (2017) note that patient
cooperation and knowledge of proper care for CVC prevent
infections. There is a need for studying practical clinical nurse
interventions in the care for CVC. In the study by Han et al
(20153) state that blood culture is necessary for managing CVC
patients. Formal training, years of experience, written policies,
enhance compliance withto proper CVC care and reduce
infections (Han et al., 20153). In a study by Bianco et al.
(20153), there is a conclusion that less costly evidence-based
education, CUSP prevent infections. It is also indicated that
multidisciplinary education programs improve assistance to
patients (Oliveira et al., 2016)
According to Afonso et al. (2016), an analysis into the topic
requires separate primary, secondary and central line-associated
HABSI types in reporting catheter culture during the diagnosis
of bloodstream infection that increases certainty and lowering
of risks of bias as a result of improper attribution of blood
culture contaminants.
Furthermore, Powell (2018) notes that if hospitals use
surveillance for antimicrobial use and resistance options in

ambulatory surgery, and acute care hospitals, then infections
will be eliminated. In the study by Chidambaram (2015), the
conclusive view offers that the dental care process is necessary
for pediatric CKD patients if studies on CVC are being held.
Besides, CVC benefits CKD patients but poses a threat for long-
term candidates due to negligence on disinfection and
sterilization processes. According to Kadium (2015), high
education levels do not affect pretest, but the completion of
infection control course affects pretest scores. Another
argument is that evidence-based care allows students to work
purposefully. Moreover, the provision of continuous education
enhanced retention and application of knowledge in tasks. In
another study by Masse, Edmond, & Diekema (2018) as expert
opinion high-quality evidence practice through sufficient
evidence via trainings and assessment result in proper care for
patients with catheters. Ultimately, WHO (2018) suggests that
as long as a health care establishes a comprehensive action plan,
assessment baseline, execution, checks the impact and
establishes a sustainable long-termn plan, CLABSI cases can be
prevented. It is thus necessary for future studies to focus on
more than one type of catheter for results to be relevant to
various departments of health.
From the above literature review, it is clear that evidence-based
practice, policies, hygiene, education and attendance of
workshops are important aspects that need to be studied.

Besides, the consideration of the study population, using the
adequate time for the study, having confidential questionnaires
are part of the essentials of conducting a useful study on CVCs
and CLABSI’s.
The conclusions and recommendations are drawn from what the
authors had from their results. There is the need for continued
monitoring and feedback concerning compliance with the set
hygiene practices aimed at preventing CLABSIs infections. The
infection basics, such as patient and health care providers’
education, should be addressed (Beverly et al., 2018). Public
health funding has also been suggested as a recommendation
towards the prevention of the infection. Further areas of the
study should address different ways of tracking infections,
whether they are high at the emergency rooms or the operation
rooms. The areas for further research should also focus on
strategies aimed at removing barriers in policies and practices.

References
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