Research Critiques and PICOT Statement Final Draft
Dayana Fornaris
Grand Canyon University
January 27, 2019
Nursing Practice Problem
Patients in the Intensive Care Unit setting have been washed by certified nursing assistants with water and soap. This task is delegated by nurses because of their heavy workload. However, catheter-related bloodstream infections acquired in ICU setting are projected to affect more than 100,000 patients in the United States (Kramer et al., 2017). Such infections affect patient’s stay length in the Intensive Care Unit. Most of the infections are preventable. In most cases, these infections are caused by bacteria that reside on the patient’s skin. By use of antiseptic agents, can help to reduce the bacterial burden and also prevent infections related to central lines.
PICOT Statement
The CLABSI’s issue has remained to be a main concern when it came to dealing with the issue of central line infections. This issue have hurt patients since they have been made patients to stay for longer time in the health care facilities than expected making patients to dig deep into their pockets. The economic problems result from various bills needed to cater for during the prolonged stay in health care facility. This the main reason behind the importance of prevention against infections.
Qualitative Study
Background
This study explores on various ways to improve patients’ outcomes when using a central line. Kramer et al., (2017) central line can be either central venous catheter or peripherally-inserted central catheter. In some cases, patients obtain central lines at the hospital during their stay due to lack of veins for peripheral IVs. Also, in other cases, central lines have to be inserted in administering medicines, which cannot be suffused via peripheral veins. Various measures being undertaken towards preventing central line infections affects how health care providers are going about their daily routine and caring for the patients. Also, such measures must be made clear to the hospital staff and also such routines have to be improved for better patients’ care. The new patients’ outcomes reflect on the health care given to the patient. The major aim of the study is comparing as well as contrasting the health care facilities that minimized CLABSI incidences and on the other hand, the ones that were not successful to eliminate the infections. Also, the study outline what successful health care facilities used into their patients’ in their effort to minimize CLABSI occurrences.
Methods
Research for this study utilized a qualitative technique. Qualitative method implies that materials are collected through interview as well as receiving data from the interviewers. The study made use of a software to compute the data being analyzed. In the study 8 hospitals were included, where five of them were considered successful and the other three unsuccessful. These hospitals were ranked depending on how better they put effort to decrease CLABSI incidences within the 5 month of study by use of new measures to prevent CLABSI. 70 interviews that took almost an hour were conducted. The candidates had different positions in the hospitals including doctors, nurses and management. The ranking of successful and unsuccessful emanated from the interviews and the effort from the hospitals to prevent CLABSIs incidences.
Results
Strategies difference were mainly compared between the successful and unsuccessful groups. In this case, it was a trend that the successful hospitals set their objectives towards eliminating CLABSIs rate to zero. On the other hand, the difference with the unsuccessful hospital was that though they state their objectives was set towards zero rate of CLABSIs, they failed to believe on the achievability of the goal. These hospitals seemed being content in their goal to decrease the CLABSIs occurrences. Also, the hospitals differed in the level of priority to eliminate CLABSIs. Nurses and doctors collaboration was better at the successful hospitals where they shared same goals towards eliminating CLABSIs. Kramer et al. (2017) when nurses and physicians work in cooperation to achieve the goal, the final result is become greater.
Ethical Considerations
Grand Canyon University approved the study. The interviewees as well as hospitals privacy has been respected when the results were published. Decent ethics were used towards publishing this study. Also, good ethics must be used towards preventing this hospital assimilated infection. The hospital staff have to take as many possible measures as they can to prevent central Line-associated bloodstream infections so the patient will not have to be hospitalized for long for an additional infection. Although the central Line-associated bloodstream infections prevention process takes more education as well as more new steps it is the right thing to do for patients suffering from central Line-associated bloodstream infections.
Quantitative research
Background
The study’s researcher is mainly motivated to learning about various methods to prevent infections associated with central lines of bloodstream infections in patients (Kaur, 2015). Mortality rates are a result of CLABSI are more than 15% and increase medical cost as well as stay length in the hospital. CLABSI being one of the main cause of health care related infections that are serious, this study tries to identify the mechanism on how such infection takes place. CLABSI is prevalent in the acute care context and mostly in ICU in spite of using various preventive measures. The main purpose of this study is based on finding the appropriate CLABSI measures that should be embraced by various healthcare physicians and examining the effectiveness of CLABSI prevention practices already being used.
Methods of Study
The study by Gonzales et al. is quantitative research that studied Central Venous Line with the organizational protocols and to develop more standards on CLABSI prevention. A protocol bundle for Central Venous Line was established by the team that comprised hand hygiene, daily CHG bath, central line assessment as well as standardization of different procedures that include Central Venous Line dressing change, Central Venous Line access as well as needleless connector change. The procedure was tested on different hospitals. The study also examined various ways to report CLABSI, the effect of legislation of affordable care act on prevention of CLABSI and the effect of mandatory reporting, which has affecting practices for CLABSI prevention. The study also, showed that there were limitations on the manner reports were made by local level health care facilities. The researcher promised to address the gap concerning CLABSI definition and whether the program of reducing the payment incentive to health care facilities makes a better result in preventing CLABSI.
Results of the study
This quantitative study concluded that the data received after implication of standardized Central Venous Line bundle in inpatient patient indicated a decrease in CLABSI. In this case, the researcher suggested that establishing standards for Central Venous Line maintenance practices is possible mainly through multidisciplinary involvement and also helps in CLABSI prevention. The study also concluded that nursing professionals are a key determinant in CLABSI prevention and hospital cost reduction through implementation of best practices for CLABSI prevention. Some of the limitations of this study included limited financial resources that affected the research negatively. Limited financial resources made it difficult for the researcher to analyze the data using various software.
Ethical Consideration
The study followed the required ethical consideration as they acquired an approval as well as a permit from the Institutional Review Board (IRB) before conducting the study. The study also ensured privacy for participants by using hypothetical statements when referring to patients.
CONCLUSION
There is various evidence found from this study towards supporting the development of a standard protocol for Central Line-associated Bloodstream infections prevention and also adhering to such protocols can help to prevent CLABSI. The research shows that practices bundle, which need to be followed by physicians has effects on CLABSI prevention. Finally, from the research, it is evident that the nurses are the main factor in reducing CLABSI as well as reducing hospital cost. Therefore, nurses are needed towards solving the CLABSI issue and developing more standard protocols for prevention of CLABSI.
Proposed Evidence-Based Practice Change
The PICOT statement, nursing practice problem as well as research articles relate to one significance subject, which is the use of CHG bathing as well as CLABSI reductions. The articles used in this paper provides evidence of why nurses have to use CHG bathing for patients in ICU because of greater risks of infections. A large number of nursing staff have different beliefs on use of CGH bathing as well as ordinary soap. The proposed evidence-based practice change involves supplying ICU settings with Chlorhexidine-cloths and also to ensure that the bathing practice is a major routine for nurses. Educating nursing staff on such practice can be supported through CEU courses. Though some patients might be reluctant to CHG bathing, nursing professionals have to educate the patients on the importance without forcing them to embrace the practice.
Conclusion
Studies as well as research will continue emerging on prevention of CLABSI by use of CHG bathing. The research show that CHG bathing is beneficial to patients in ICU. Based on the research, CLABSI rates were minimized in high-risk patients by implementation of CHG bathing. Daily use of CHG bathing does not need a substantial change, hence nurses can offer an essential, cost-effective and safe strategy towards preventing infections for hospitalized patients.
Reference
Benjamin, W., & Reba, U. (2016). Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting. SAGE Open, Vol 6, Iss 4 (2016), (4).
Gonzales, M., Rocher, I., Fortin, É., Fontela, P., Kaouache, M., Tremblay, C., & ... Quach, C. (2013). A survey of Preventive Measures Used and their Impact on Central Line Associated Bloodstream Infections (CLABSI) in Intensive Care Units (SPINBACC). BMC Infectious Diseases, 13(1), 1-14.
Kaur, G. (2015). An Interdisciplinary Approach to Reduce Intensive Care Unit (ICU) Central line Associated Bloodstream Infections (CLABSIs) using LEAN Six Sigma...42nd Annual Conference Abstracts, APIC 2015, Nashville, TN June 2015. American Journal Of Infection Control, 43S64.
Kramer, R. D., Conte, M., Mann, J., Saint, S., Chopra, V. (2017). Are antimicrobial peripherally inserted central catheters associated with reduction in central line–associated bloodstream infection? A systematic review and meta-analysis. American Journal of Infection Control, 45, 108-114.
Patel, P. A., Boehm, S., Zhou, Y., Zhu, C., Peterson, K. E., Grayes, A., & Peterson, L. R. (2017). Major Article: Prospective observational study on central line–associated bloodstream infections and central venous catheter occlusions using a negative displacement connector with an alcohol disinfecting cap. AJIC: American Journal Of Infection Control, 45115-120.
Trotter, T. (2016). Development of an Evidence-Based Maintenance Bundle for Preventing Central Line Associated Blood Stream Infections (CLABSIs) to Standardize Processes and Reduce CLABSI Rates. Journal of the Association for Vascular Access, 21(4), 269.