This document presents a chapter on the methodology for a project aimed at preventing central line-associated bloodstream infections (CLABSIs). The project will take place at an intensive care unit and examine how staff training and consistent use of evidence-based practices like chlorhexidine gluconate bathing can impact infection rates. Nurses will be divided into a test group that receives training and a control group that does not. Questionnaires will assess the impact of the training on infection rates among patients aged 65 and older. Data will be collected from patients and nurses and analyzed statistically to determine if the training and interventions are effective in reducing CLABSIs.

1. Prevention of Central Line-Associated Bloodstream Infections
(CLABSIs)
2
Prevention of Central Line-Associated Bloodstream Infections
(CLABSIs)
Submitted by
Kerry Sean Murphy
DPI Project Proposal Chapter 3 - Methodology
Doctor of Nursing Practice
Grand Canyon University
Phoenix, Arizona
July 20, 2019
CHAPTER THREE: Methodology
Introduction
This project will be exploring the prevention of Central
Line-Associated Bloodstream Infections (CLABSIs). In this
chapter, the discussion will focus on examining the variables
that would help in preventing, controlling, and reducing the
incidences of bloodstream infections. The methodology section

2. will describe the objectives and describe the activities the
project will entail to meet the objective of lowering infection
rates. Further, the chapter will look into the methods of data
collection and ways of analyzing the data as well as the ethical
considerations the project will need to take into account.
Statement of the Problem
There is a need to have the CLABSI maintenance bundles due to
cases of infection that have been recorded involves the adults
that have been admitted to the intensive care units. According to
Mishra et al., (2016), there are still several cases reported in
India on such infections and in spite of the existence of
guidelines for maintenance Central Line-Associated
Bloodstream Infections (CLABSIs) continue to remain a
problem. Clear Lake Regional Medical Center in Webster Texas
reported a total of 18 hospital-acquired infections (HAI) in
2018. In 2019 in two quarters the facility has already reported
20 HAI ("SIR Report | HAI | CDC," 2019). There is a need to
develop procedures and expand education that would improve
and reduce the number of HAI like CLABSI. Comment by
Kathryn Flynn: Please describe what this is to the non nurse
before terminology is used. Comment by Kathryn Flynn: It
would be a lot more credible for the justification to be in
research from US. Comment by Kathryn Flynn: Use APA
format (author, year)
Clinical Questions
The clinical questions are how to develop different
ways in which the CLABSI can be minimized, specifically
among patients greater than 65 years of age. Objectives of the
project will look to answer the following questions
(i) What is the influence of the staff training on maintenance of
a higher level of hygiene after insertion and cleanliness of
insertion sites? Comment by Kathryn Flynn: This is subjective.
Use evidence based, etc. and nte why it’s better than existing
care.
(ii) How is consistency in the application of the evidence-based
practices likely to impact infections rates after insertion using

3. improved site maintenance? Comment by Kathryn Flynn:
How will this be measured? Has this question been approved?
Comment by Kathryn Flynn: Subjective. State what
intervention you are implementing and use the same name for
the intervention at every location in your writing. This will give
the reader clarity.
(iii) How CLABSI maintenance bundles (specifically the using
of chlorhexidine gluconate bathing (CHG)) lower the number of
HAI infections.
There is a need to have a higher level of training
among the staff regarding proper CHG bathing to maintain a
higher level of cleanliness that would consequently reduce the
number of infections. The cleaner the sites of insertion, the
better the possibility of reducing the infections related to
CLABSIs (Guerin, Wagner, Rains, & Bessesen, 2010). CHG
bathing is a part of the CLABSI maintenance bundle and
performed adequately with other aspects of the bundle can
prevent post-insertion infections. The measuring outcomes will
consist of a periodical survey among the nurses that have
CLABSIs patients before and after the maintenance bundle use.
A consistent survey of one month is effectively going to
determine if the intervention has achieved the objectives of the
lowering CLABSI rates. Comment by Kathryn Flynn: Justify
why Comment by Kathryn Flynn: Like what? Comment by
Kathryn Flynn: What’s the validated tool? Name it here and
refer to it in index. Comment by Kathryn Flynn: No, it will
give you the data to apply statistical significance to, so you can
see if a correlation exists.
Project Methodology
The project methodology describes the different ways
in which the project is likely to be conducted. The project will
combine both quantitative and qualitative analysis in collecting
and analyzing the data. The combination of the different
methods is to improve the accuracy of the results. The project
looks to send questionnaires to the patients within the ICU
Clear Lake Regional Medical Center, Webster, Texas to help in

4. determining the influence on the training of the staff in the
prevention of the CLABSIs among the patients aged above 65
years. The results of the study will be analyzed using the
necessary statistical methods to help in establishing the
conclusion of the results. Further, a comparative analysis with
other existing studies would also be useful in improving the
quality of the result (Kumar, 2019). The method used in the
project would as such be valuable in the development of the
project Comment by Kathryn Flynn: Rephrase, what
questionnaires? Comment by Kathryn Flynn: Will you do
this? Comment by Kathryn Flynn: Clarify?
Project Design
The project has a design that is based on reviews of previous
literature on the ways of minimizing CLABSI in acute care
hospitals. According to Marshall et al., (2014) various methods
can be used in the prevention of the CLABSIs including the
sterilization of equipment, proper site selection, and training the
staff on the role of hygiene in the prevention of further
infections, and the use of CLABSI maintenance bundles
(Specifically CHG bathing). The challenge, however, has been
in the improper or the limited training of staff on the critical
part of the hygiene on the prevention of the infections. The
following project will develop ways in which the nursing staff
can undergo the training that will help in improving consistency
with patients care. Comment by Kathryn Flynn: Kerry , I
mentioned a n education intervention is not enough, per AQR.
You’ll need to add additional evidence based doctoral level
nursing interventions. List what they will be in all appropriate
sections.
The project will further look into the number of the
infections that are resulting from nurses not performed
benchmarked central line catheter maintenance. The project will
make a record of the use of the CLABSI bundle, specifically
CHG bathing. While carrying out the intervention, the nurses
should be keen to adhere to the guidelines and the procedures
related to the central line catheter maintenance. The nurses that

5. have undergone maintenance bundle training will be compared
to those nurses who have not undergone training, and statistical
comparison of the infections performed. It is through the
comparison that the understanding of the need to have training
and education would be determined to be a way of reducing the
infections from CLABSI. Comment by Kathryn Flynn:
unclear Comment by Kathryn Flynn: clarify. Comment by
Kathryn Flynn: Mention the guidelines and procedures here.
What has been used up until now, and what will you change
them to?
Population and Sample Selection
The research will be conducted at the Intensive Care Unit
(ICU) of the Clear Lake Regional Medical Center in Webster,
Texas. The hospital has a total of 60 nurses, all of who can give
the results out of the taking care of the patient in the hospital.
However, due to the limitations in the time and the resources
when carrying out the research, there is need to pick a sample
that would represent the rest of the nurses for the project (Chow
et al., 2017). Additionally, the use of the samples equally helps
in creating a focus on improving the accuracy of the results. All
of the patients that are participating in the research are equally
part of the research population in the study.
The choice of the sample will be done through the
purposive sampling method to help in choosing the type of
patients (those with central lines) that would help in attaining
the aims of the project. Using the PICOT question method, the
patients of 65 years and above with the central line catheter hub
hygiene are picked for the project to improve the level of the
accuracy (Rios, Ye, & Thabane, 2010). The 60 nurses will be
divided into two equal groups of 30 nurses. One of the groups
shall have undergone the training for the hygiene process of
CLABIs while the other 30 will not have undergone for the sake
of being used as a control group. Comment by Kathryn Flynn:
Good; Add this into your 10 strategic points to update and align
with all chapters. Comment by Kathryn Flynn: Explain
second population first

6. The process of the selection of the sample should be a
careful process to improve the accuracy of the project. The
process of the sample selection will be done through the
purposive method since the results are drawn from a particular
group of the patients that have central line catheters. The study
has a target of 60 nurses out of the total number of nurses
within the hospital. Comment by Kathryn Flynn: Explain how
you picked 60.
Instrumentation
To establish infections rates, the project will make use of a
questionnaire as the instrument in surveying the condition of the
patients after undergoing care by the nurses (Corchon et al.,
2010). The questionnaire will be designed such that the patients
can provide only yes or no answers. On the other hand, there
will be questionnaires that will equally be directed to the nurses
on the training process and with the compliance to the
maintenance procedures as prescribed in the training process.
The use of the questionnaire is an effective and economical way
of carrying out the research. Comment by Kathryn Flynn: Did
he use the q? it’s not clear what the citation is referring to.
Comment by Kathryn Flynn: Tool cannot be made up, per
AQR. Comment by Kathryn Flynn: Now is the time to
expose what the questionnaires are.
The Validity of the Research Comment by Kathryn Flynn:
Needs work. Include validity of tool
Research is only useful and meaningful to the extent
to which the standards of the results of the study are valid. The
validity of the research determines the quality of the research
and the ability of the research recommendation to be used. The
research is valid to the extent when the results of the study are
close to that which was to be measured (Taherdoost, 2016). This
project will be valid when it establishes the significance of the
training on the prevention of CLABSI patients. The project will
make use of a reasonable number of nurses and patients to
participate. While project is keeping the number of the
participants manageable, the number must be kept to the level

7. that they can represent the full number of the population.
The Reliability of the Research
The reliability of the research is the measure of the
extent to which the instruments used in collecting and analysis
the data are useful and have a high level of accuracy. The
project looks to make the research reliable by picking all of the
participants in the same environment while carrying out the
improvement project. Further, there is a division of the
participant's, the number of the patients taken care of by the
nurses that have undergone the maintenance bundle training and
another group among the patients that have not undergone the
training as a control group. The analysis of the data will be
done through the statistical package for social sciences (SPSS)
upon which the data can be subjected to establish the
Cronbach’s alpha (Heale & Twycross, 2015). The greater the
value of the Cronbach’s alpha, the more the reliable the results
of the study. The Centers for Disease Control and Prevention’s
(CDC’s) National Healthcare Safety Network (NHSN)
developed and use standardized infection ratios (SIRs) to
measure healthcare-associated infection (HAI) incidence. SIR is
what Clear Lake Regional Medical Center using for data
collection and will also be utilized in this project.
Data Collection Procedures
The researcher will work on getting the data among
the respondents that will help in answering the research
questions. The nurses identified to participate in the research
will make a confirmation of their participation as a way of
complying to the ethical standards. The sampled nurses will be
divided into two groups, half of which would be taken through
the comprehensive training on the CLABSI maintenance bundle.
The time taken for the training would be in a month so that all
of the aspects of the training are taken into consideration and
that the nurses can get the skills needed for proper maintenance.
Upon the training, the project will look at the possible patients
that the trained nurses will take care of against the patients that
are going to be taken care of by the nurses that have not

8. undergone the process of training. The results of the studies can
be collected through the administration of the questionnaires.
The project will collect the results on the aspects of the
infection of the patients.
Data Analysis Procedures Comment by Kathryn Flynn:
How will you analyze? What data will you place in SPSS?
The collected data can be subjected to the analysis
process so that the data can create meaning out of the available
information. The information filled in the questionnaire will be
collected and coded to help in carrying out an unbiased
analysis. The coded data will be analyzed using the SPSS
software to assist in getting the quantitative aspects of the data
(Mihas, 2019). Equally, the research will work on the
descriptive aspect of the data to assist in making meaning out of
the complex scientific elements of the data. The analysis of the
data will be critical clinically in achieving the objective of the
project and answering the clinical questions regarding CLABSI
prevention maintenance.
Ethical Considerations
The research should be carried out in a manner that
would meet the expected ethical standards as well as within the
laws and regulations in the areas of operation. The project will
take care of the details of the respondents such that they are not
accessed by third parties but only used for the sake of the
project. The biodata of the respondents and any other
information that reveals the identity of the participants will be
deleted. All of the respondents participating in the research will
be consulted and made aware of the intent to get them to
participate in the project (Wester, 2011). Consequently, the
respondents will confirm their consent to participate in the
process. The confirmation will be done through an email to have
as records. No participant should, as such, be coarsened to
participating in the research.
The ethical practices in the project should be expressed by
both the participates. The respondents should confirm their
readiness and declare they are in the right state of mind as they

9. participate in the research. Also, the information in the project
improvement should not be used in a manner that would harm
any of the parties when the project improvement is being
conducted and after the project improvement (Wester et al.,
2018). Further, the project will work to inform and get the
permission of the Clear Lake Regional Medical Center. The
adherence to the ethical consideration encourages the
participants to gain the trust of the participants and give their
best efforts in making the project improvement a success.
Limitations of the Research
The project improvement may come with several limitations
that would see the objectives of the research not conclusively
met. There is no way in which the project can control the
responses from the patients. The analysis of the responses is
based on the assumption that the patients are honest and adhere
to the highest ethical standards. Additionally, the project is
carried out within one hospital in Texas. As a result, it is a
challenge that the results of the project in one region would
apply to the rest of the world. There is a need to have the same
research conducted in different parts of the world to determine
the accuracy of the research study (Lefcourt, 2013). The
limited scope and the inability to control the responses of the
researcher respondents are could have an impact on the results
of the project.
Summary
In this section, the projects description of the methods through
which the data will be collected and analyzed to achieve the
results of the study were discussed. The chapter has defined the
objectives of the project and states the research questions that
would be answered to meet the project's objectives.
Additionally, the research describes the population and the
sample selection used in the study. The method of data
collection and analysis are equally discussed in the chapter. The
section also describes the ethical considerations the study would
be looking to take into account to help in achieving the results
of the project. The precautions the project is taking in making

10. the study both valid and reliable are equally described.
Comment by Kathryn Flynn: Kerry, Add rubric, and
develop all content according to rubric and my comments, then
resubmit. Thanks.
References
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(2017). Sample size calculations in clinical research. Chapman
and Hall/CRC.
Corchon, S., Watson, R., Arantzamendi, M., & Saracíbar, M.
(2010). Design and validation of an instrument to measure
nursing research culture: the Nursing Research Questionnaire
(NRQ). Journal of Clinical Nursing, 19(1‐2), 217-226
Guerin, K., Wagner, J., Rains, K., & Bessesen, M. (2010).
Reduction in central line-associated bloodstream infections by
implementation of a postinsertion care bundle. American journal
of infection control, 38(6), 430-433.
Heale, R., & Twycross, A. (2015). Validity and reliability in
quantitative studies. Evidence-based nursing, 18(3), 66-67.
Kumar, R. (2019). Research methodology: A step-by-step guide
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Lefcourt, H. M. (Ed.). (2013). Research with the locus of
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11. Mishra, S., Misra, R., Azim, A., Baronia, A., Prasad, K.,
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