Infection Associated with Centrals Lines
Central line-associated bloodstream infection is one of serious infection that takes place germs commonly bacteria and viruses penetrate bloodstream via the central line. The infection causes millions of deaths every year despite the infections being preventable. The central line gets infected when contaminated catheter devices especially before the insertion, contaminated infusate, and contaminated catheter hub are used (Kirk, 2018). Skin organisms are also named as the cause of the infection. The central line of the patient gets infected when the virus or bacteria or other related germs enter into the bloodstream causing serious infections. Central line infection may become serious but can be successfully treated by health workers. The common central lines that are commonly infected are “Femoral central venous catheters”.
Most infections occur when doctors put the central line also called a central venous catheter in a large vein found in the neck, groin, chest, or arm so that to provide blood, other fluids, or medication in the areas. The insertion of the central venous catheters may not effective and therefore causing catheter malfunction, thrombosis or central vein stenosis, and other catheter-associated infections (Kuriakose, 2020). The common risks that have been found to increase central line infection include ICU placement of the central nervous catheter, the existence of the nonoperative cardiovascular illness, and the existence of the gastrostomy tube in the veins.
Problem Statement
The central line-associated bloodstream infections are regarded as the most lethal-hospital acquired disorder impacting high costs to health care institutions approximately $ 46 000 in every infection and causing a mortality rate of 18%. The health care institutions have noticed that when patients are infected with CLABSI, the number of days to 12 weeks is extended as well as the antibiotics to improve the situation of the patients. The infections of central lines in hospitals do not only affect the reimbursement but also create a negative perception of the hospitals and therefore training is required for the ICU nurses within one week (Tan et al. 2017). The hospital-acquired rates of infections are alarming hence there is need for training of ICU nurses or medics through establishing a compelling program that will help nurses remedy the situation. Preventing hospital-acquired CLABSI will improve the quality of care and enhance patient wellness. There is a need for quality interventions to be conducted to attain the goal of high infection of the central line and reduce the number of days taken in the ICU unit.
PICOT Question
It is unknown the application of an educational program to ICU nurses about central line management. Will improve central line infection rate compared with the infection rate before the teaching within12 week?
The ICU nurses play a vital role in proper maintaining of the central lines hence preventing the development of the CLABSI. The ICU nurses have more access to central lines daily when offering services as blood draws, medication administration as well as delivery of parenteral nutrition to the affected individuals. It is very critical for ICU nurses as the population of interest to be much aware of evidence-based interventions both the current and past to optimize the process of maintaining central lines and prevent infections (Ayala, 2019). ICU nurses should be trained for twelve weeks to improve service delivery that will help reduce the number of infections. Nurses should be equipped well enough to make them determined to offer quality and effective nursing services that will reduce the high cost and the lengths of care taken by the patients in the hospital. ICU nurses are one of the key components in the treatments of central line infections and should be equipped with adequate skills and knowledge through training. Implementing effective-based interventions in the field of nursing care especially in the occurrence of CLABSI will help to decrease the instances of infections among people. ICU nurse is the population of interest that can be improved and reduce the mortality and infections of CLABSI in hospital-based settings through competent nursing interventions.
Intervention of Interests
Training of ICU nurses is the key intervention used in this project to reduce infection of central lines. Training of ICU nurses within 12 weeks on how to manage and reduce the incidences of the infection was conducted based on nursing evidence-based approaches seeking to equip ICU nurses with sufficient knowledge of reducing the incidence associated with causing central line infections. Preventing the introduction of bacteria and viruses (microorganisms) to the central lines which take place in hospitals is the most key area the training focused on to control CLABSI. The efforts of preventing central line infections lie in the hand of nurses because they are the ones mandated for the routine care and maintenance of the central lines (Kuriakose, 2020). The actions and compliance of the nurses depicting the best evidence-based practices depicted a direct impact on patient outcomes. The intervention required the ICU nurses to strictly adhere to intervention measures of not introducing microorganisms in central lines. Putting more effort into the insertion and post-insertion maintenance should be well monitored and evaluated by nursing professionals through training because they are the major processes that cause risks of infections.
The interventions through training purposed to analyze the intrinsic and extrinsic factors to have a better understanding of the disease considering the age, patient’s gender, or other underlying conditions of the patients because they are the main clients served by ICU nurses on matters relating to central lines. The training also intervened and articulated conditions that lead to –prolonged hospitalization before the process of insertion is enacted. The education on the use of Chlorhexidine gluconate (CHG) was emphasized (antiseptic solution) due to its ability to possess wide spectrum activity that reacts against bacteria, viruses, and other microorganisms that are to the central line-associated bloodstream infections (Lacerna, 2020).
The use of CHG helps to prevent CLABSI, especially on the skin. Other evidence-based steps that the training as the intervention addressed for CLABSI prevention include the use of the appropriate hand hygiene during and after central line insertion, use of "chlorhexidine” for skin preparation, stopping using the "femoral vein” by the ICU nurses for catheters especially in adult patients, removing catheters that are considered unnecessary and lastly utilizing full barrier precautions or warnings during the insertion process of the central venous catheter (Moore, 2016).
Comparison
The central line-associated bloodstream infections rate will have analyzed and concluded after the interventions that involve training of ICU nurses and making a comparison with the outcomes or results obtained before starting the training and at the end of the 12 weeks where will evaluated the knowledge of nurses. The outcome of this alternative intervention will better outcomes in preventing central line-associated bloodstream infection.
Outcome
The training process aims to reduce the baseline incidences of CLABSI, according to Taylor et al. (2017) are 40/1000 days of central line, after the training of ICU nurses, it is expected that there will be a significant reduction. Likewise, it is intended to reduce the incidence of central line-based bloodstream infections, showing the positive impact of training in the effort to prevent or reduce central line infections that occur in the hospital environment.
Approximately 98 ICU nurses (sample convenience) will be used in the project. At the end of the 12 weeks of training for ICU nurses, a maximum reduction of 50% in CLABSI is expected after the adoption of prevention measures, compared to starting the training. CLABSI rates tend to vary from healthcare to healthcare based on facilities (Kirk, 2018). Therefore, reduction in the costs of post-training care is also expected. Likewise, it is expected to take into account associated factors such as limited space between beds, shortage of ICU nursing staff, little knowledge and training of hospital institutions for health personnel, incomplete documentation, among other possible reasons that are also intended. identify before the 12 week training is completed.
Time
The period taken for the interventions listed above to achieve an outcome is 12 weeks. The training of ICU nurses to achieve the intended purpose of reducing the infection incidences of central lines was completed at the end of the twelve weeks. This stipulated time allowed ICU nurses to be equipped with sufficient knowledge that aimed to influence patients positively.
Conclusion
The intensive education through training sessions with the response originating from ICU nurses over 12 weeks led to the significant improvement of matters about central line-associated bloodstream infections. The recollection of data in phase three of the training reaffirmed the significance and role of education in reducing infection incidences. During the project, it was found that high adherence to the “CL bundle intervention’’ adopted through training of ICU seemed to correlate positively to the reduction of central line infections in the ICU (Taylor et al. 2017). The study reveals that data from NHSN was more comprehensive as well as an effective benchmarking tool that established comparison to INICC as it tries to represent or depict those countries developing surveillance systems. More studies on projects should be conducted to formulate or design the national policy that can be used to benchmark the surveillance outcome of proposed devices or tools that are associated with infections of central lines in ICU.
References
Ayala, J. L. (2019). Development and Evaluation of a Nurse Leader-Directed Compliance Coach Program to Improve Central Line Maintenance. Wilmington University (Delaware).
Kuriakose, L. (2020). Decreasing Central Line-Associated Bloodstream Infection Through Limiting the Use of Central Venous Catheters for Routine Blood Draws. Journal of Doctoral Nursing Practice.
Moore, M. A. (2016). Evaluation of Central Line Insertion Bundle Practices in a Trauma/Surgical Intensive Care Unit.
Kirk, M. P. H. (2018). Healthy Work Environment Improves Nurse-Sensitive Patient Outcomes (Doctoral dissertation, Grand Canyon University).
Lacerna, C. (2020). Application of Sustainability Framework for Quality Improvement in an Integrated Health System.
Taylor, J. E., McDonald, S. J., Earnest, A., Buttery, J., Fusinato, B., Hovenden, S., ... & Tan, K. (2017). A quality improvement initiative to reduce central line infection in neonates using checklists. European journal of pediatrics, 176(5), 639-646.
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