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EmpiricalResearchEvaluationWorking.docxEVALUATION: EMPIRICAL RESEARCH 2
EVALUATION: EMPIRICAL RESEARCH 7
Evaluation: Empirical Research
Running head: EVALUATION: EMPIRICAL RESEARCH 1
Evaluation: Empirical Research
Introduction
The primary purpose of the research study has been to evaluate if, in adult patients with Central Venous Catheters (CVC), interventional staff education about hub hygiene provided to RN’s who access the CVC impact Central Line-Associated Bloodstream Infections (CLABSI) rates compared to pre and post-intervention assessments over a two-month period. CLABSI rates will be compared to the Patient Safety Component from the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network’s (NHSN) that includes identifying the causation and surveillance methods to track device-associated infections (Centers for Disease Control and Prevention, 2016). In addressing the issue and providing the answer the to the research question, this researcher will examine the literature available on the stated topic. Some of the research articles on the subject show similarities regarding research approaches and themes and some have differences. The researcher also looked for evidence that suggests that the data supported the conclusion, and, in some studies, the findings answered the research question.
Evaluation of Research
Regarding similarity in the theme, the researcher did find some regularity in the articles by O’Neil et al. and Salma et al. In the research study, “A Central Line Care Maintenance Bundle for the Prevention of Central Line-Associated Bloodstream Infection in Non-Intensive Care Unit Setting,” O’Neil et al. (2016) have suggested that there is a higher rate of compliance with optimal dressing care practices in the control group against the expectations. The primary theme of the research study has been the degree of hygiene maintained by nursing professionals in the context of caregiving in a central line care maintenance setting. In the research study a 12-month study was conducted by Caroline and associates to establish the effectiveness of a central line care maintenance bundle in the reduction of Central Line–Associated Bloodstream Infection (CLABSIs) in general medicine wards. They substantiated their research by disseminating educative guidelines and proper hands-on training for catheter insertion and care for nurses of the experimental group against those of a control group, along with asepsis (hygiene and evaluation of microbiological data). The trained nurses were instructed to examine the central line dressings twice a week for secureness or any purulent discharge. The results of the study revealed higher rates of compliance in optimal dressing care practices in the control group against the expectations. They exemplified a marginal reduction in the incidence of CLABSIs in the intervention group over the control group. The study lacks documentation of dating the dressing changes-a key factor in CLABSI prevention. Moreover, the research is restricted to a small number of patients, so the efficacy of the staff re-education cannot be standardized or generalized. But despite the limitations, the theme of the study has been observed to have been reverberated in the research study, “Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections.” Salma et al. (2016) have also emphasized hygiene factors and the chances of emergence of central line-associated bloodstream infections. Resounding this concern, the research study conducted by O’Neil et al. Salma et al. also focuses on the importance of maintaining hygiene regarding avoiding central line-associated bloodstream infections. In the research study, Salma et al. (2016) also stress the importance of proper hand hygiene; precautions upon insertion; antisepsis using chlorhexidine; selection of an appropriate site for the catheter insertion; and review and documentation of all the measures. It must be noted that in the study conducted by Salma et al. (2016) it was revealed that a significant decline in the incidence of CLABSIs in CVC patients and had advocated the efficacy of Central Venous Line Bundle (CVLB) in reducing the morbidity and cost in CLABSIs. The research, however, lacks documentation on the care of CVC post insertion site to prevent CLABSIs and only emphasize on the hygienic measures as a cleansing of the site with chlorhexidine and use of hand washing before the examination. The study was further restricted to a single adult ICU with no considerations to the financial cost of CLABSIs. Notably, if the previous studies show similarities regarding research theme then in the research study, “Interventions to improve professional adherence to guidelines for prevention of device-related infections,” Flodgren et al. (2013) has failed established a way in which the conclusion could have provided an answer to the research question. Though in this study, the theme has also been infection prevention, the conclusion has been inappropriate in providing answers to the research question. This can be argued by citing the fact that though Flodgren et al. (2013) highlighted the occurrence of secondary infections being a common phenomenon in hospitals, especially in patients with central or peripheral lines, they concluded with insufficient evidence to establish an effective counteractant to curtail the high number of the hospital-acquired contagions. The research by Flogren and his team primarily relies on researched literature rather than their practical implications and thereby, fails to render an effective intervention for CLABSIs. But it has been observed that in the research study, “Nursing Practice for Prevention of Central Line Associated Blood Stream Infection (CLABSI) in A Pediatric Intensive Care Unit,” Elbilgahy et al. (2015) strives to provide data that supports their conclusion. Interestingly in the study by Esposito, Guillari, & Angelillo (2017), “Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy,” provides some answers to some specific research questions. Like Hentrich et al. (2017) in “Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management, and prevention of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology” fails to document the optimal therapeutic measures to reduce Catheter-related infection (CRI) and the management of Catheter-related bloodstream infection (CRBSI), after the removal of the catheter. Similarly, the studies rely on opinions rather the practical applications or documentation of blood sampling for microbial infections.
Conclusion
Considering the research studies and observing some flaws in all the reviews it becomes quite imperative for the researcher to ask the authors about how to provide a solution that would be effective in preventing the concerned type and mode of contamination. Almost all the research studies have suffered from limitations, and due to such limitations it becomes quite essential to ask the authors regarding the way in which the deficiencies could be addressed, and the concerned types of contamination can be prevented. It should be noted that the purpose of this 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. Proper hygiene will be defined as the use of hand washing before the application of a central line and utilize antiseptic techniques at the insertion site. The goal is the reduction of CLABIs in patients with central line catheters. The authors should be asked how such a goal could be accomplished overcoming the limitations with which the research studies were conducted.
Despite the observed limitations in the research studies, the evidence obtained from the studies can be used efficiently to refine the PICOT question, and it can also come to the aid of the researcher regarding formulating and implementing the DPI project. The PICOT question, “In adult patients with CVC, does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to pre and post-intervention assessments over a two-month period?”, can be well defined by the application of the evidence gathered from the research studies. It should be noted that the evidence has provided a proper answer to the PICOT question by supporting the fact that interventional staff education about hub hygiene (supplied to RN’s who access the CVC) does impact CLABSI rates when compared to pre- and post-intervention assessments. CLABSI rates will be compared to Patient Safety Component from the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network’s (NHSN) that includes identifying the causation and surveillance methods to track device-associated infections (Centers for Disease Control and Prevention, 2016). Congruence between the evidence and the elements in the PICOT is necessary for providing a valid means for helping the researcher in coming to a practical conclusion regarding an answer to the PICOT question.
References
Centers for Disease Control and Prevention. (2016). Central Line-associated Bloodstream Infection (CLABSI) | HAI | CDC. Retrieved from https://www.cdc.gov/hai/bsi/bsi.html
Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. doi: 10.1371/journal.pone.0180473
Elbilgahy, A. A., Davidson, P. M., Sharps Mohamed, P. W., & Elassmy, M. (2015). Nursing Practice for Prevention of Central Line Associated Blood Stream Infection (CLABSI) in A Pediatric Intensive Care Unit. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 5(6), 150-154.
Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy.
Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews.
Hentrich, M., Schalk, E., Schmidt-Hieber, M., Chaberny, I., Mousset, S., Buchheidt, D., … Karthaus, M. (2014). Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management, and prevention of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Annals of Oncology, 25(5), 936-947. doi:10.1093/annonc/mdt545
O’Neil, C., Ball, K., Wood, H., McMullen, K., Kremer, P., Jafarzadeh, S. R., … Warren, D. (2016). A Central Line Care Maintenance Bundle for the Prevention of Central Line–Associated Bloodstream Infection in Non–Intensive Care Unit Settings. Infection Control & Hospital Epidemiology, 37(06), 692-698.
Salama, M. F., Jamal, W., Al Mousa, H., & Rotimi, V. (2016). Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections. Journal of Infection and Public Health, 9(1), 34-41.
