Introduction to the Literature Review

The 10 Strategic Points

Broad Topic Area

1. Broad Topic Area:

The topic taken into consideration is the Central Line-Associated Bloodstream Infections (CLABSIs) and prevention Comment by Lane, Kari: I love your topic you are very timelyI will provide a great deal of feedback, this feedback is for your use to improve your next revision so you have a good direction for which to move forward. Also use this as your outline for your DPI project, the Literature Review section is the outline to use for your week 4 & 6 literature review

Literature Review

2. Literature Review:

1. Primary points basis four sections in the Literature Review:

a. Background of the problem/gap: Comment by Lane, Kari: Your introductions and background need to be really striking. Engage your reader, tell them the problem. Why should they keep reading?

· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs.

· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections

· The nurses need to have the significant knowledge associated with evidence-based practices for the Central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter (CVC) patients.

b. Theoretical foundations (models and theories to be the foundation for the project) Comment by Lane, Kari: You will need to choose 1-2 theories, they do not have to be nursing and one will work just fine. Right now your count is zero. Then, expand by discussing the theory, definition, purpose, all concepts and constructs. Define all concepts and constructs. Add a sentence or two about how this model will inform your project (more than what you have here). For each theory find the primary seminar source to cite, typically the primary sources for theories are much older, which is just fine.

· The efficacy of training of nurses over the prevention of Central line-associated bloodstream infections (CLABSIs) in neonates and children, through the exploitation of a questionnaire defining their socio-demographic data and their practical skills (Elbilgahy, A. A. et al., 2015). Comment by Lane, Kari: Literature Review with Example of Outline with Key Concepts and SubthemesSet up your literature review in terms of key concepts in an outline. Your subthemes will fall under each key concept. See below for an idea of what it might look likeNrg burnout impacts patient care Nrg shortage numbers across country Nursing shortage causes stressStress leads to burnoutPatient satisfactionImportanceMeasured by (discuss different ways measured and then the ways it is measured at your cite)Improvements needed at your siteMBSR (what it is and how it works)How usedWays to implementSuccessful projects using MBSRMeasuring successSummaryThis will be the basis for your literature review in week 4 & 6

· Knowledge about evidence practice reveals the discrepancies in the praxis, by the different nursing Pedagogics (Esposito, M. R. et al., 2017).

· Prophylactic measures to eradicate the incidence of CRIs or Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich, M. et al., 2014)

c. Review of literature topics with a key theme for each one.

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

· The efficacy of hygiene maintenance in the preponderance of CLABSIs rates in patients with CVCs, maintenance of patients with CVCs (Elbilgahy, A. A. et al., 2015); The key concepts in the study entail CLABSIs, ICU patients with CVCs, dressings, hygiene hub (Esposito, M. R. et al., 2017); The relevance of various interventions in reducing device-related infections. The key concepts are related to interventions (Hentrich, M. et al., 2014)

Setting

· Adult ICU (Elbilgahy, A. A. et al., 2015).

· The incidence of CRIs in cancer patients at the hospital (Hentrich, M. et al., 2014).

Summary

· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention including the nursing education

· Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting.

· Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia

2.

a. Background of the problem/gap:

Challenges to the higher level of compliance with the randomized trials in prevention strategies. The decolonization which is being universal impacts the CLABSI amongst the larger community

b. Theoretical foundations (models and theories to be the foundation for the project)

The theoretical model is associated wit hthe the strategies deployed and operational processes linked to prevetion of Central Line Association Bloodstream Infection (Hickok, J. et al., 2014).

c. Review of literature topic

Rapid Dissemination of Universal Decolonization in Adult Intensive Care Units (ICUs) Reduces Healthcare-Associated (HA) Central Line Associated Bloodstream Infections (CLABSI) in over 100 Community Hospitals in a Single Healthcare System

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The study conducted a randomized trial with respect to the 3 MRSA prevention strategies being deployed in 74 Intensive Care Units and reduction in the risk pertaining to the infections.

Setting

The 350 adults in Intensive Care unit formed part of the randomized trial and it was spread over 160 hospials (Hickok, J. et al., 2014).. The deployment of planning and the central coordination of infection took place with the resources available.

Summary

The universal decolonization amongst the ICU patients was being closely linked to the decline in CLABSI and the rapid implementation was a successful approach (Hickok, J. et al., 2014).

3.

a. Background of the problem/gap:

The complication linked to the urinary tract infection and the Central Line Associated Bloodstream Infection and the costly diagnosis has led to the increase in morbidity

b. Theoretical foundations (models and theories to be the foundation for the project)

The model is associated with the evidenced based guideline and elevation of infection rates. The systematic approach is significant linked to the prrocess and the reduction resulting as part of intervention.

c. Review of literature topic

Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs.

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The prevention is based on the narrative review forming part of the study. The conceptual model being deployed is categorized into various stages that form part of the awareness and proper care using catheters.

Setting

The setting is based on the 2015 systematic review conducted for the Intensive Care Unit and the elevation of infection rates (Patel, P. K. et al., 2018). The categorization of the intervention takes place basis the deployment of catheters and the study evaluates the infections with the reduction in infections.

Summary

The categorization of the intervention takes place and addressal of multiple stages as recognized by the enhanced preventive action.

4.

a. Background of the problem/gap:

The problem is linked to the hematologic malignancy that is prevalent amongst the patients having boe marrow transplants. The risk of CLABSI tends to be more amongst such patients and the effect analyzed with the increased patient education tends to be significant.

b. Theoretical foundations (models and theories to be the foundation for the project)

The model pertains to the recognition of malignancy attributed as part of the core elements linked to the focus on hygience amongst patients and the minimizing linked to the line access.

c. Review of literature topic

Implementation of a Central Line-associated Bloodstream Infection (CLABSI) Prevention Bundle for Adult Hematologic Malignancy and Bone Marrow Transplant Patients

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The prevention with the adopted healthcare associated infections tends to be crucial. The multi disciplinary mode of control of infection and reducing the spread is a significant approach based on the study (Dombecki, C. et al., 2017). The observation with the 41% reduction in the non MBI CLABSI cases is crucial to note.

Setting

The setting involved the standardized process and 240 patients being evaluated as part of the experiment.

Summary

With the significant intervention, the identification of relevant strategies can bring about the increase in awareness of HH.

5.

a. Background of the problem/gap:

The challenges are associate dto the the infection control professionals while they playing a crucial role in the management of infections linked to CLABSI. The challenges pertaining to the prevention was significant.

b. Theoretical foundations (models and theories to be the foundation for the project)

Facilitating central line–associated bloodstream infection prevention: A qualitative study comparing perspectives of infection control professionals and frontline staff

c. Review of literature topic

Facilitating central line–associated bloodstream infection prevention: A qualitative study comparing perspectives of infection control professionals and frontline staff

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The implementation of standardization as part of the procedure with the enhanced success rate is crucial to the study.

Setting

Acomprehensive study deploying the eight hospitals that were part of the participation in the program led to the preventive initiative. The interview of informants were done and the 26 ICP’s too formed part of the study.

Summary

The interviews of more than 30 minutes with the participants led to a significant discovery with the informants well identifying the challenges pertaining to the CLABSI prevention.

6.

a. Background of the problem/gap:

The surgical site infection tends to be crucial. With respect to the the surgery done for hip joing replacement or the knee joint replacement, the quality of life for the patients gets impacted to a greater extent.

b. Theoretical foundations (models and theories to be the foundation for the project)

The theoretical foundation rests upon the monitoring increase linked to the compliance based on the infection prevention taking place.

c. Review of literature topic

Infection Prevention and Quality Coordinators Collaborating to Decrease Central Line Associated Blood Stream Infections (CLABSI) by Monitoring Central Line Catheter Maintenance

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The prevention with the compliance rates accounted for the 6 months prior to installation is significant. The retrospective analysis was critical to the study.

Setting

The setting involves the installation of hand held hygenic opportunities and the recording of the events over a period of fourteen months (White, L. A. et al., 2016). There was multicentre registry being collected as part of the study.

Summary

The subject being patients who had the hip replacement or the knee replacement based on the intervention had been encouraged to adopt to the measures (White, L. A. et al., 2016). There was dramatic difference observed about HH

7.

a. Background of the problem/gap:

The services being provisioned for the outpatients needs to have changed. With the current setting, the infection control program and plan is challenged with the strategies that tend to be integrated with the outpatient treatment centers.

b. Theoretical foundations (models and theories to be the foundation for the project)

The models are associated with the delivery model and the analysis of the shift taking place concerning the treatment centers. The infection prevention being the prime focus stands to include the regulatory requirements too.

c. Review of literature topic

Decreasing CLABSI Incidence Associated with Decreasing MRSA Bacteremia LabID Incidence

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The prevention concerning CLABSI is taking effect in case of the inpatient and outpatients. The environmental safety rounds stand to be significant too.

Setting

The setting in the study involved the consideration of 5 hospitals along with the 110 outpatient treatment centers. The infection control risk was crucial to the study.

Summary

The OTC integration taking place with the resolution of integration challenges led to the enhancement basis the inpatients and outpatients forming part of the study. The outpatient IP also visited the facility on a routine basis (Beverly, A. L. et al., 2018).

8.

a. Background of the problem/gap:

The rise in the number of incidents wherein the changes were made concerning CLABSI attribution brought about the negative impact.

b. Theoretical foundations (models and theories to be the foundation for the project)

The theoretical foundation is based on the prevention of infection cases amongst the patients having urinary tract infection.

c. Review of literature topic

The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The prevention of CLABSI and the associated attribution confers to the prevention concerning the associated urinary tract infections that are crucial.

Setting

The setting involves the study of 502 patients at the hospital been taken into consideration.

Summary

The changes linked to the catheter-associated infections about the urinary tract can significantly enhance the central line association blood infection (Advani, S. D. et al., 2018).

9.

a. Background of the problem/gap:

With the revision in the definitions about CAUTI, the funguria along with the lower bacteriuria levels are impacted

b. Theoretical foundations (models and theories to be the foundation for the project)

The theoretical foundations which form part of the infection evaluation have been having a significant impact.

c. Review of literature topic

Definitional change in NHSN CAUTI was associated with an increase in CLABSI events: evaluation of a large health system

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The prevention involves taking into consideration the standardized infection rate and the evaluation of the same.

Setting

The setting involves the study taken into account with respect to 137 adults about 65 hospitals (Fakih, M. G. et al., 2017). The CLABSI SIR has also evaluated basis the study.

Summary

The improved catheter-associated tract infections do lead to a greater reduction in the infections.

10.

a. Background of the problem/gap:

The background is linked to the review of potentially impacted cases wherein the identifier for the causes leading to CLABSI can be evaluated.

b. Theoretical foundations (models and theories to be the foundation for the project)

The study brings about the significant models as part of the evaluation done and the review considered in accordance.

c. Review of literature topic

Presentation Number 16 - Suspected Origins of Bacteremia in Center for Disease Control (CDC) National Healthcare Safety Network (NHSN) Defined Central Line-Associated Bloodstream Infections (CLABSI) at a Tertiary Care Academic Medical Center

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

The prevention of CLABSI infections with the identification of root causes is crucial (Carpenter, A. D. et al., 2016).

Setting

The setting involves the 700-bed hospital associated with academic teaching.

Summary

The study involving the evaluation done in the arena of tertiary care segment is crucial. The infectious disease evaluation and the causes can be well traced.

Problem Statement

3. Problem Statement:

Though the studies have substantiated the CLABSIs to be a significant health concern as it impedes the recovery of the patients, the degree of efficacy of hygiene of hub, before each access in the prevention of CLABSIs, is not well documentedunknown

Clinical/ PICOT Questions

4. Clinical/PICOT Questions:

“In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) compared to standard care over a one-month period?” Comment by Lane, Kari: Add your site as previously directed in Topic 1 DQ1

P: Patients > 65 years of age with a central line

I: Staff training and reinforcement of central catheter, hub hygiene

C: Compared to standard care

O:  Reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections)

T: A period of one-month

Sample

5. Sample (and Location):

a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

b. Population: The population being sampled in the study is 120 adult ICU nurses (Elbilgahy, A. A. et al., 2015); 335 nurses were intrigued (Esposito, M. R. et al., 2017)

6. The selection of a sample population should not be haphazard for it will lead to biased results, furthermore, a large sample size helps in having precise results.

7. It necessary to calculate sample size for validity and reliability of results. The study will, therefore, allow an error of plus-minus 5 (Patino & Ferreira, 2016).

8. To avoid oversampling so as to have a minimal sample size that we are targeting are the 120 adult nurses out of the 335 (Andersomn, Kelley, & Maxwell, 2017).

9. Inclusion/exclusion criteria of the subjects

· People who are 65 or above and are from ICU Lake Regional Medical Centre, the central line catheter hub clinic section.

· The nurses who are not from the Central line of ICU Lake Regional Medical Centre will be excluded (Patino & Ferreira, 2018).

· Those who will have signed consent will be included in the study because of having fulfilled the research ethics standards.

· When the interviews and questionnaires have been conducted, the incomplete questionnaire forms will be excluded while the interview subjects who have not attended the interview will not be considered.

· Questionnaires that are fully filled and interview subjects who will turn for the interview and response will be included in the findings.

a.

Define Variables

10. Define Variables:

a. Independent Variables: crystalloid fluids, hub hygiene and line changes

b. Dependent Variables: pedagogy Comment by Lane, Kari: ?When the criteria asks for a definition you should provide a definition. To define variables in research you should use an operational definition. (see below) Also add a scholarly reference for each. Also please add demographic variables for the patients you pull data on. You can use demographic variables such as age, gender, socioeconomic status, marital status, etc for patients. An operational definition is the articulation of operationalization (or statement of procedures) used in defining the terms of a process (or set of validation tests) needed to determine the nature of an item or phenomenon (a variable, term, or object) and its properties such as duration, quantity, extension in space, chemical composition, etc. Since the degree of operationalization can vary itself, it can result in a more or less operational definition. The procedures included in definitions should be repeatable by anyone or at least by peers.An example of operational definition of the term weight of an object, operationalized to a degree, would be the following: "weight is the numbers that appear when that object is placed on a weighing scale". According to it, the weight can be any of the numbers shown on the scale after, including the very moment the object is put on it. Clearly, the inclusion of the moment when one can start reading the numbers on the scale would make it more fully an operational definition. Comment by Lane, Kari: interview questionnaires need described in variables

Methodology and Design

11. Methodology and Design:

· The appropriate study methodology is the mixed methods approach through which questionnaires, interviews, and the reading of existing articles will be applied in the study. Comment by Lane, Kari: Questionnaires must be described under variablesYou must be specific, name the exact questionnaires, use valid and reliable questionnaires, make sure this is consistent with rest of document (put a copy of the questionnaire in the appendix). Describe:The purpose of the surveyHow it has been used in other researchThe total number of questionsHow are the questions answered (short answer, yes/no, Likert scale, etc.)?What is the total score and how is the score interpreted (for example, a lower number indicated poor patient satisfaction)? If you are going to use subscores, describe those and how they are calculated as well. What is the level of measurement for the total score? How long does it take to complete the surveyThe validity and reliability measures of all surveys. Obtain a letter of permission to use the survey, start by searching for the original authors, and email them to ask permission or check for a website the survey uses. Even if the survey is open access you will need a letter of permission to use. Do this for ALL survey’s, instruments, and/or questionnaires you plan to use to collect data.

· The interview questionnaires will be acquired from the previous literature that handles the same issues in the study.

· The data sources will be interviewers who are the healthcare professionals who have allied staff as information will be collected through the interview process.

· For evidence-based practice in a healthcare setting, it is proper to have the nurses asked questions about the particular practices in relation with the staff training, reinforcement of the Central line catheter hub hygiene once it has been inserted, the cleansing of the site and cases of Central Line-Associated Blood-stream Infections.

· While the reading of existent articles will offer a source of information through which questions can be asked of the participants, the questionnaire will serve as the instrument for validating the study.

· The process will assist in acquiring the observational, additional, and the basic data that is targeted. Comment by Lane, Kari: This section should tell the reader what the method and design is and why it is appropriate. Methods & DesignQuantitative Method (add description and rationale with citations for why this is correct)define Design (add description and rationale with citations for why this is correct)

· The questionnaires will focus on the Adult ICU practices (Rodrigues, Correia, & Kozak, 2016).

· The data tools were exploiting the practices of nurses in Adult ICU, questionnaire responses, and a review of the other related articles.

· The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues.

· The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews. Comment by Lane, Kari: Need to revise this significantly

Purpose Statement

12. Purpose Statement:

The purpose of this quantitative project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff at hospitals in Webster, Texas for the prevention of CLABSIs.

Data Collection Approach

13. Sample (and Location):

a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

b. Population: The population being sampled in the study is 120 adult ICU nurses (Elbilgahy, A. A. et al., 2015); 335 nurses were intrigued (Esposito, M. R. et al., 2017).

14. Determining the Sample Size

· A sample population is often selected based on the PICOT question the evidence-based study is being held on people who are 65 years and more. The patients are with a Central line catheter hub hygiene.

· The sample population be targeted from ICU Clear Lake Regional Medical Center, Webster, Texas.

· After a focused consideration of the required population, a random sampling of nurses from the target group will be picked and that will help in acquiring comfortable to deal with in terms of the study expenses and data acquisition, the researcher used focused group (Nayak & Singh, 2015).

· The selection of a sample population should not be haphazard for it will lead to biased results, furthermore, a large sample size helps in having precise results.

· It necessary to calculate sample size for validity and reliability of results. The study will, therefore, allow an error of plus-minus 5 (Patino & Ferreira, 2016).

· To avoid oversampling so as to have a minimal sample size that we are targeting are the 120 adult nurses out of the 335 (Andersomn, Kelley, & Maxwell, 2017).

· With the confidence level of 95 calls upon usage of 180 nurses so as to have an error of 5 per cent only. This population will be equally divided between the treatment group and the control group. The particular ratios of gender are not necessary yet the ration of re-trained and those left without that are of significance.

· The study will select diverse participants in terms of gender while ensuring that they are 65 years and above and attending of adult CVC patients.

· It will be important to calculate sample size for validity and reliability of results (Patino & Ferreira, 2016).

· The study will allow an error of plus-minus 5 to avoid oversampling so as to have a minimal sample size that we are targeting are the 120 adult nurses out of the 335 (Anderson, Kelley, & Maxwell, 2017).

· This population will be equally divided between the treatment group and the control group.

Data Analysis Approach

16. Data Collection Instruments Comment by Lane, Kari: This all goes under variablesFor data analysis you need to Begin with a description of your stats to describe your demographic data. Mean, median, mode, frequency, percentiles, etc as appropriate. Then describe exactly what statistics you will use to analyze your main outcome variables. You will learn more about this in 830, but when you have a little downtime explore levels of variables to determine what level your variables are and which statistics would be appropriate. Add references that support your choices. Add your apriori alpha level (this means you specified the alpha level before you began your project). This is an important part of the project process and increases the reliability and validity of your findings. This means tell me which Alpha level you plan to use (0.05 or 0.01). I wouldn’t expect you to get it perfect yet, but begin to explore for your next revision. Talk with your mentor too for some assistance and ideas.

· The instruments utilized in the research are the interview questions and a questionnaire. The creation was founded on the PICOT question and the statement of the problem, so as to acquire the desired information.

· While the questionnaire had most questions as closed, the interview questions will be open to allow attainment of supplementary data from the participants.

· Direct questions are expected to occur at the end of the interview (Nayak & Singh, 2015), Nevertheless, in this interview process, there will be utilization of indirect question with more direct questions for the target information from the nurses who have been retrained on hygiene of the hub at Clear Lake Regional Medical Centre and they are handling adult patients with CVC versus others who might not have had a similar training from two other hospitals and not every other nurse anywhere.

· The questions will be simplified as much as possible and they will allow one response at a time. The questions will avoid the analysis, hearsay, and opinions so as to obtain objective data.

· The questionnaires will contain demographic questions on the gender, the CLABSI prominence among the adult patients with CVC, how regular the cleansing process is conducted by the trained nurses, and any other hygiene process that are carried out by the re-educated nurses.

The dietary practice, interview guidelines and demographic questionnaire were as clear as possible to allow the response of the clients.

Ethical Consideration

· A research design that is valid will be created while taking into account the methods used, the theories and the findings on crisis management from different organizations. Comment by Lane, Kari: This is close but not quite what we will look for. Keep searching for the right details

· Since crisis management as a subject matter is very sensitive to the organization, compliance with confidentiality agreements is paramount (Mkunga, 2017).

· In this research studyproject not a study, any details that the respondent will not want it disclosed will be removed and deleted from any written or oral records, while others are candidly presented.

· Before the recruitment process, the participants will be contacted and be informed of the research and its significance (Castillo-Montoya, 2016).

· They will then be asked to declare their readiness to partake in the study and the free times they have for the interview process or questionnaire filling process.

· The form will have the clinical question, the usability of results, assurance of anonymity and confidentiality in which the researcher will indicate how the results will be exposed, to whom they will be exposed and how the subjects will be prevented from harm.

· The only harm could be labelling the nurses as unhygienic, hygienic, effective or ineffective, and mentioning their particular names.

· Since the study is checking on evidence-based care and its impact, the subjects will not be mentioned and the results will be written in a manner that they do not openly show which health care has a particular condition (Kamat, 2018).

· It is necessary that the health care centres be informed of the study.

· Before the study, the researcher will acquire their permission through formal e-mails which will be sent to the administration of the centres for approval.

The 10 Strategic Points

Broad Topic Area

17. Broad Topic Area:

The topic taken into consideration is the Central Line-Associated Bloodstream Infections (CLABSIs) and prevention

Literature Review

18. Literature Review:

2. Primary points basis four sections in the Literature Review:

e. Background of the problem/gap:

· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs.

· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections

· The nurses need to have the significant knowledge associated with evidence-based practices for the Central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter (CVC) patients.

f. Theoretical foundations (models and theories to be the foundation for the project)

· The efficacy of training of nurses over the prevention of Central line-associated bloodstream infections (CLABSIs) in neonates and children, through the exploitation of a questionnaire defining their socio-demographic data and their practical skills (Elbilgahy, A. A. et al., 2015).

· Knowledge about evidence practice reveals the discrepancies in the praxis, by the different nursing Pedagogics (Esposito, M. R. et al., 2017).

· Prophylactic measures to eradicate the incidence of CRIs or Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich, M. et al., 2014)

g. Review of literature topics with a key theme for each one.

h. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

· The efficacy of hygiene maintenance in the preponderance of CLABSIs rates in patients with CVCs, maintenance of patients with CVCs (Elbilgahy, A. A. et al., 2015); The key concepts in the study entail CLABSIs, ICU patients with CVCs, dressings, hygiene hub (Esposito, M. R. et al., 2017); The relevance of various interventions in reducing device-related infections. The key concepts are related to interventions (Hentrich, M. et al., 2014)

Setting

· Adult ICU (Elbilgahy, A. A. et al., 2015).

· The incidence of CRIs in cancer patients at the hospital (Hentrich, M. et al., 2014).

Summary

· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention including the nursing education

· Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting.

· Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia

Problem Statement

19. Problem Statement:

Though the studies have substantiated the CLABSIs to be a significant health concern as it impedes the recovery of the patients, the degree of efficacy of hygiene of hub, before each access in the prevention of CLABSIs, is not well documented

Clinical/ PICOT Questions

20. Clinical/PICOT Questions:

“In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of Central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections)?”

P: Patients > 65 years of age with a Central line

I: Staff training and reinforcement of Central Catheter, Hub Hygiene

C: Other area hospitals

O: Reduce probability of CLABSIs

Sample

21. Sample (and Location):

a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

b. Population: The population being sampled in the study is 120 adult ICU nurses (Elbilgahy, A. A. et al., 2015); 335 nurses were intrigued (Esposito, M. R. et al., 2017)

Define Variables

22. Define Variables:

a. Independent Variables: crystalloid fluids, hub hygiene and line changes

b. Dependent Variables: pedagogy

Methodology and Design

23. Methodology and Design:

The data tools were exploiting the practices of nurses in Adult ICU, questionnaire responses, and a review of the other related articles.

**The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues. The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews.

Purpose Statement

24. Purpose Statement:

The purpose of this quantitative project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff at hospitals in Webster, Texas for the prevention of CLABSIs.

Data Collection Approach

25. Data Collection Approach:

The primary instruments were nursing observations being done. The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues. The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews.

Data Analysis Approach

26. Data Analysis Approach:

The specific data analysis approach was chi-square and t-test are exploited for data analysis, and analysis was performed by using descriptive statistics through SPSS Statistics, Version 16.0. Also, The approach used for analysis of data will be thematic analysis as the data collected from interviews will be coded and these codes will further assist in the development of themes based on similarity in the content of interview data. Thematic analysis will facilitate in answering the clinical question developed.