QI poster or power point presentation

Bloodstream infections refer to the infections that occur in the healthcare facilities and they are the new infections that are acquired within the facility. These infections lead to hospitalization, morbidity, and mortality in hemodialysis patients. There are about 30,100 reported incidences of infections in the United States. The bloodstream infections are caused by the equipment being used by the healthcare providers for example the surgical equipment, the environment of the facility, and the healthcare workers or patients who transmit such infection to the other. The paper aimed at discussing the adherence or the practices recommended by the CDC to help in the prevention and reduction of the bloodstream infection in hemodialysis patients. The CDC proposed some interventions to be followed in the reduction of these infections. These included the provision of the feedback, surveillance, audit of the hygienic practices, and the control strategies. Bloodstream is a life-threatening infection and affects the overall healthcare of the patients. The plan for the implementation was to create a bloodstream infection prevention and control programs; the development of the evidence-based guidelines; the introduction of education to the healthcare workers in the reduction of the infection; the surveillance of the infection; implementing the multimodal approaches to improve the practice aimed at reducing these infections; developing coordination and the facilitation program; ongoing monitoring and auditing the practices; considering the aspect of the workload, occupancy, and the staffing; and improvement in the environment, provision of the materials, and the equipment required. The implementation of the process must consider the ethical aspects of beneficence, justice, and non-maleficence. The benefits and well-being of the patients must be put into consideration.

The Center for Disease Control and Prevention (CDC) reports that there are about 30,100 reported cases of the central line-associated infections that occur every year in the United States especially in the intensive care units (ICU). The use of the hemodialysis catheter is linked to the eightfold higher cases of vascular associated bloodstream related infections as compared to the arteriovenous fistula.

The criteria for the diagnosis of the hemodialysis catheter-associated bloodstream infection based on the proposal of the Kidney Health Initiative's Catheter End Points Workgroup is related to any clinical suspicion of the infection with a fever or temperature greater than 37.50C or the possible alteration of the mental status and/or the new predialysis hypotension with a systolic blood pressure of less than 90 mmHg.

The bloodstream infection leads to high cases of hospitalization and is considered as the second leading factor of the death rate amongst hemodialysis patients. The control of the infection on patient in hemodialysis is used to measure used for the maintenance of the healthy environment and prevention as well as avoiding the process of disseminating infection amongst the immunocompromised patients. Hemodialysis patients are becoming vulnerable to infections as well as the localized infections of vascular access, blood-borne infections like Hepatitis B virus, Hepatitis C virus, and HIV. Other infections can also include airborne ones.

The sources of bloodstream infection on the hemodialysis patient is linked to the water, equipment, the surfaces of the hospital environment, and the infected patients who pass these infections to other patients and healthcare workers. The modes of bloodstream infections include the contaminated hands of healthcare providers as a result of poor hygiene. Several guidelines have been proposed by international organizations such as the CDC, the Association of Professionals in Infection Control (APIC), the Kidney Disease Outcomes Quality Initiatives (K/DOQI), and the Improving Global Outcomes (KDIGO) among others. These guidelines have been aimed at preventing and controlling infection and to be implemented with the hemodialysis settings. Nevertheless, despite the existence of such guidelines, the adherence to such procedures is poor and this has increased the cases poor hygienic practices in healthcare facilities and even in the hemodialysis settings thus exposing patients to the bloodstream infections that are passed from providers to patients and from one patient to the other.

According to the study by Soi et al (2016), the establishment of the dialysis access is considered to be amongst the challenging factors in the patient’s life especially those who are undergoing renal replacement therapy. Several factors like the anatomic host factors, the unwillingness of the patients, and the long-lasting maturation time have resulted to the multitude of dialysis catheter utilization. The nation-wide programs aimed at improving quality have not been effective (Soi, Moore, Kumbar, & Yee, 2016).

According to the study by Farrington et al (2019), all indwelling vascular catheters harbors microbes. The entry of the bacteria into the lumen via the skin and hands of the healthcare providers occurs during the manipulation of the catheters. These microbes then moves from the skin surfaces along the catheter and it is becoming seed in the bloodstream. The CDC has come up with the non-pharmacologic proposals for the reduced catheter on the patients undergoing hemodialysis. The process of providing suitable education to the technical staffing via training and performing the auditing of the methods being employed helps in ensuring that there are an improvement and more interest amongst the personnel in the dialysis units. (Farrington & Allon, 2019).

According to Entesari-Tatafi et al (2015), healthcare facilities are required to perform the monthly surveillance for the bloodstream infections through the use of the National Healthcare Safety Network (NHSN) and the CDC to calculate the facility rates of infections and actively take part in the process of sharing the outcome with the staffs. Some healthcare facilities are encouraging the process of supervising suitable hand hygiene actions and sharing of the outcome (Entesari-Tafati, Orford, & Athan, 2015).

The study by Paglialonga et al (2014) reports that alcohol-based chlorhexidine solution is used as the first line antiseptic agent for the central line insertion as well as throughout the dressing change. The two approaches are used for the purposes of preventing bloodstream infections. This study aimed at comparing the use of chlorhexidine vs. povidone-iodine solutions and the outcome revealed a decrease in the exit site, tunnel infections, and the blood-stream associated infections with the utilization of the chlorhexidine. (Paglialonga, Consolo, & Biasuzi, 2014).

The hub of the catheters is known to the key source of entry that leads to bloodstream infections. This means that the prevention of the infection requires the process of rubbing the catheter hubs using a suitable antiseptic. The procedure is proposed to be carried every time the catheter becomes disconnected. The topical antibiotic is used since they have proven to be effective when it comes to the reduction of the bacteremia. The Society of Critical Care Medicine is proposing the use of the antimicrobial ointment to help in getting rid of the microbes that are resistant to the mupirocin. Some of the antimicrobial ointment used at the exit site include povidone-iodine antiseptic or bacitracin and the polymyxin B ointment especially after the insertion of the catheter at the end of every hemodialysis session (Murea, James K, & Russell, 2014).

The Antimicrobial lock (AML) therapy is also another form of infection reduction process and it involves the process of instilling the disinfectant solution into the intraluminal section of the dialysis catheter between the treatments to help in the sterilization of the interior of the catheter from the biofilm. Various research works have been carried out using various blends of antimicrobial agents combined with anticoagulants. Many studies that involve the assessment of the effectiveness of the antibiotic lock have been smaller and performed within a short duration, this therefore makes it hard to assess the resistance of the antibiotic for a long duration (Souweine, Lautrette, & Gruson, 2015).

Therefore, as a result of the antibiotic resistance to the AML, the use of other antiseptic solutions have been proposed. Some of the antiseptic solutions such as Taurolidine which an agent affecting the cell wall of the bacteria have brought some promising outcomes in the reduction of bloodstream infections in hemodialysis patients. Even though this agent is lacking the stigma of the antibiotic resistance, it has been associated with the increase in the thrombolytic therapy as a result of the occlusion issues (Solomon, Cheesbrough, & Bhargava, 2012). Ethanol has been suggested as a replacement of the AML due to the cheaper price and effectiveness against the wider group of microbes such as fungi. A study performs on the high-risk population of about 64 patients who were on chemotherapy through tunnel catheters indicated a reduction in the infection of the four-fold with three in ethanol group vs. the eleven in the control category especially with the use of the ethanol prophylaxis every day. Upon the weekly installation of the ethanol for two days inpatient in the hemodialysis showed, there was a 67 percent reduction in catheter-related bloodstream infections (Solomon, Cheesbrough, & Bhargava, 2012).

The bloodstream infection is a cultured-verified presence of the bacteria and or the fungi with the blood.

In 2009, the CDC developed a collaborative project to help in the prevention of the bloodstream infection in hemodialysis patients. Some of the key interventions proposed by the CDC were related to the surveillance and the feedback through the use of the National Healthcare Safety Network. Other recommendations made by the CDC included audits of the hygienic practices for example on the hand, the observation of the vascular access care, and other control approaches. Therefore based on these recommendations made by the CDC, healthcare centers have an obligation of ensuring that there is adoption and adherence to the collaborative interventions made by the CDC (World Health Organization, 2016).

Bloodstream infections are potentially life-threatening infections ad this affects the healthcare services being received by the patients. Therefore, the prevention of these infections remains the priority. Nevertheless, the prevention of these infections has mainly been focused on acute-care facilities. This, therefore, implies that patients receiving healthcare services as outpatients for example those related to the maintenance during the hemodialysis are exposed to bloodstream infections. The prevention of bloodstream infections is always becoming a challenge in outpatient hemodialysis settings. Several interventions have been suggested for the prevention of these infections especially for the hemodialysis patients with the central line. There are evidence-based interventions that are supposed to be put into practice within the dialysis center to assists in the prevention of the bloodstream. The evidence0based interventions have been used for the development of the solutions to the challenges that are being for implementation and sustainability (World Health Organization, 2016).

Despite all these interventions, poor adherence to the guidelines aimed at promoting the safety of the patients and reducing the bloodstream infections among patients in the hemodialysis. At the facility of the operation, there is poor adherence to the proposed practices and the infection principles that have been set in place. This has therefore led to the alarming rate of bloodstream infections, high cases of hospitalization, a longer stay in the healthcare facility by the patient in hemodialysis, and the increase in the number of reported morbidity and mortality (World Health Organization, 2016).

The use of positive deviance helps in reducing the bloodstream infections in many healthcare settings. The increase in adherence with the preventive measures in the organization is important since it can lead to the positive deviance that is characterized by the improvement in the attention of the staff member. The efforts being concerning the prevention of the infection heavily rely on the inclusion of the strategies. The strategies helps in the engagement of all the staff members in the infection control activities and working together as a team with other healthcare facilities to find out about some of the practices that can be adopted to help in overcoming the barriers associated with the prevention efforts (World Health Organization, 2016).

To achieve these tasks, the team of the bloodstream infection control and prevention program in the facility are created. This is a team drawn from all healthcare providers that are involved in the performance of the dialysis procedure. The team is supposed to be dedicated and are well trained in handling the patients in the hemodialysis process. This is aimed at preventing or reducing the number of reported bloodstream infections among the hemodialysis patients. The dedicated and trained professionals are helping in reducing the bloodstream infections during that hemodialysis procedure (World Health Organization, 2016).

Education and the training of the essential healthcare workers on the guideline proposed as well as monitoring their compliance with the guidelines is performed to ensure that there is a successful implementation of the program. The implementation of the recommended practices and procedures helps in the reduction of bloodstream infections among patients during hemodialysis. This is effectively achieved through training and the education of healthcare providers. Bloodstream infection prevention practices are required to ensure that healthcare providers are adapting and adopting the guidelines. The guidelines being adopted are required to be evidence-based and according to the ones recommended by the national standards (Solomon, Cheesbrough, & Bhargava, 2012).

The development of these practices requires adequate infrastructure and supplies to allow the effective process of implementing the guidelines. The national practice related to the prevention and control of the bloodstream infection among patients undergoing hemodialysis procedures is supposed to help in ensuring that there is support and mandating the healthcare employees' education and the training focused on the recommended guidelines (World Health Organization, 2016).

It is important to ensure that the training received by the healthcare providers is based on the utilization of the participatory strategies i.e. the bedside and the simulation training to help in the reduction of the risk of the bloodstream infection during hemodialysis. The involvement of the frontline healthcare provider that is directly involved in the treatment of the patient in the hemodialysis procedure allows the hands-on strategies as well as the incorporation of the individual's experiences. This helps in the reduction of the bloodstream infections in the hemodialysis as well as increasing hand hygiene compliance. The introduction of education to all healthcare workers using an approach of the team- and task-oriented approach is helping in the reduction of bloodstream infections (World Health Organization, 2016).

The successful implementation of the bloodstream elimination process requires the inclusion of organizational-based surveillance. This is important in guiding the bloodstream prevention practices which helps in the detection of the outbreaks as well as helping in ensuring that healthcare providers are given timely feedback on the outcome. The healthcare-based surveillance system is characterized by a reduction in bloodstream infections. The provision of a timely feedback outcome is positively contributing to the implementation of the successful bloodstream infection control practices. Therefore, this implies that it is important to carry out bloodstream infection surveillance characterized by timely feedback to help in guiding the prevention practices (World Health Organization, 2016).

The use of multimodal strategies is important in the effective improvement of the bloodstream infections prevention practices especially in hand hygiene compliance. The multimodal strategies, in this case, involve the changes in the system, education of the healthcare providers, creation of the awareness, bundle-based approaches, the advancement of the safety of the patient for example the commitment of the leadership and the positive support approaches. The multimodal approaches also help in the improvement of the accountability through monitoring process and provision of timely feedback. The adoption of the multimodal strategy helps in ensuring that there is the use of various elements that helps in the improvement of the outcome and change in the behavior. Such elements can include bundles and checklist that that is developed by the multidisciplinary teams (World Health Organization, 2016).

The implementation of the proposed changes requires an effective process of coordination among the created multidisciplinary team. The coordination process is made successful through the inclusion of multimodal strategies to improve care practices and reduction of bloodstream infections. The successful process of the implementation requires that healthcare providers work as a team. This is important in the reduction of any possibilities of errors that might be associated with poor communication processes as well as delivering the information. It helps in getting rid of the poor outcome that might be associated with a lack of sharing of the key information that is important in improving the safety of the patients through the performance of the bloodstream infection prevention activities (World Health Organization, 2016).

The successful implementation of the adherence to the practices aimed at eliminating the bloodstream infections on patients in hemodialysis requires a continuous and regular process of monitoring, auditing, and providing timely feedback on such practices. These activities help in ensuring that such practices are according to the standards and based on the guidelines provides by the CDC. It also helps in ensuring that there is adherence to such practices by healthcare providers. Regular monitoring and auditing processes as well as provision of the regular feedback is helping in ensuring that there is an increase in the adherence to the care practices and reduction in the overall bloodstream infections of patients on hemodialysis. Monitoring and the assessment process is helping in the process of tracking the effectiveness of the national policies as well as the strategies i.e. it provides the critical information that is required to support the implementation as well as the future development and improvement in the control and elimination of the bloodstream infections among patient in hemodialysis (World Health Organization, 2016).

Adherence to the guidelines concerning the control and prevention of the bloodstream infection on patients in hemodialysis is determined by the nurse-to-patient ratio. Poor adherence to the guidelines is linked to the heavy workload that is brought by the higher number of patients being cared for by the few healthcare providers. The staffing levels in the healthcare facility should be adequate to care for the number of patients in the facility. Therefore, the implementation of the practices aimed at eliminating the bloodstream infection on patients in hemodialysis requires an adequate number of staff. It is also important to ensure that bed spaces does not extend the standard capacity of the healthcare facility. The process of adhering to the bed occupancy that does not go beyond the standard capacity and having enough healthcare staffing levels based on the patient workload is important in reducing the risk of acquiring as well as the spread of the bloodstream infection on a patient in hemodialysis (World Health Organization, 2016).

It is always important to care for a patient in a clean and hygienic environment to help in the facilitation of the practices that are aimed at preventing and eliminating bloodstream infections. It is therefore important for the facility to ensure that there is the existence of suitable water and sanitation services, environment, materials, and other equipment required for the successful implementation of the practices aimed at eliminating bloodstream infections. The facility management needs to ensure that there is a sufficient hygienic environment. The implementation of the WASH programs helps in ensuring that there is the development of the standards and an overall improvement in the hygienic practices in the facility. The management must ensure that there is access to hand hygienic equipment or materials such as alcohol-based hand rubs (World Health Organization, 2016).

Usually the focus of the healthcare providers is to ensure that the health and well-being of the patients are improved. Healthcare providers are required not to harm to the patients, but make efforts to help in improving the overall healthcare outcome. The conduct of the healthcare providers during hemodialysis is always compromised which exposes patients to increase complications and infections by healthcare-associated diseases. Most of these complications as a result of the negligence of the healthcare providers especially due to the fatigues and poor adherence to the guidelines on their conduct (Mousavi, Agharahimi, Daryabeigi, & Rezaei, 2014).

Nurses or any other healthcare provider are required to behave ethically while caring for the patients. Nevertheless, several challenges are being faced to observe these ethical guidelines or principles especially when handling a large number of patients with the low nurse-to-patient ratio. Healthcare providers are required to respect autonomy, justice, beneficence, and non-maleficence principles (Mousavi, Agharahimi, Daryabeigi, & Rezaei, 2014).

In caring for the patient in the hemodialysis, the safety of the patients is multidimensional and guided by the ethical and legal imperatives. It is therefore important to put into consideration the challenges related to this aspect. Based on the non-maleficence principle of medical ethics, ensuring that the safety of the patients and the prevention of the injuries need to remain the major priority. The negligence of the healthcare providers when it comes to the elimination of the bloodstream infections exposes patients to new infections and this increases their length of stay in the healthcare facility, increase in the cost of the healthcare, and the possibilities of death when the situations become more complicated (Mousavi, Agharahimi, Daryabeigi, & Rezaei, 2014).

The report by the World Health Organization reveals that the chances of causing harm to the patient during the process of delivering healthcare services are 1 out of 300. Ethical conduct requires healthcare providers to ensure the safety of the patients by ensuring that the patient safety guidelines and standards are followed. The healthcare providers must, therefore, pay full attention to the ethical and the legal facets of the issue when providing healthcare services to the patients in hemodialysis (Kadivar, et al., 2017).

Based on the beneficence ethical principle, it is the responsibility of the healthcare providers to refrain from any form of maltreatment, to reduce harm, and to ensure that there is the promotion of the good towards the patients receiving healthcare services. The well-being and health promotion of the patient in hemodialysis are supposed to be free from the bloodstream infections that expose them to other diseases such as Hepatitis B and even causing death to them. The beneficence ethical principle requires healthcare providers to ensure that there is the existence of a balance of the benefits against the risks to the clients. It is important to ensure that patients are well educated on the means of preventing bloodstream infections by maintaining their hygiene while in the ward. The healthcare providers are also required to observe the guidelines that concern the prevention and the elimination of bloodstream infections.

The provision of safe care to the patient in hemodialysis needs to be maintained irrespective of the age, gender, or the ethical background of the patients. The approaches aimed at reducing the bloodstream infections for patients in hemodialysis should cover all the patients regardless of their status, gender, or ethnic origin. All patients have equal rights to healthcare services and safety. The justice ethical perspectives require healthcare providers to treat patients correspondingly even to the point of preventing their exposure to bloodstream infections (Hadda & Geiger).

The required resources for the effective implementation of the practices aimed at preventing and eliminating the bloodstream are those which are helping in ensuring that there is a successful process of performing all the activities about the bloodstream infection for the patients in hemodialysis. One of the resources is water especially from an improved source within the premises of the facility. Water is important for the handwashing after handling of the patient, improvement for the personal hygiene for both patients and nurses, and for the cleaning to ensure that patients are staying in a clean and safe environment (World Health Organization, 2016).

It is also crucial for the management to provide hand hygiene facilities equipment that has alcohol-based hand rubs and water, soap, and disposable or clean towels especially when delivering healthcare service within 5 meters from the areas assigned for the sanitation purposes. The organization needs to have improved sanitation facilities that are found in the organization. The healthcare facility must have not less than a single toilet that is chosen to serve women or girls to help in the management of the menstrual hygiene needs and not less than a single separated toilet to serve the staff and another one that meets the needs of the individuals with limited physical disabilities (World Health Organization, 2016).

Adequate and the recommended personal protective equipment and puncture-resistant sharps containers must be provided and this, helps in the separation of other categories of healthcare wastes and other supplies that requires the cleaning process. It is crucial to have regular clean hygienic conditions in the cleaning examination rooms, waiting areas, surface, and the toilets. There is a need to have an incinerator and autoclave to help in the segregation of the healthcare wastes that are being treated and later disposed of for safety purposes. It is important to have sufficient power for sterilization purposes, incineration, and medical devices that use power (World Health Organization, 2016).

The proposed change is the adherence to the practice or guidelines that are aimed at preventing, controlling, or eliminating the bloodstream infection rates. Effective clinical leadership is important in ensuring that there is the existence of high-quality healthcare that is consistent with safe and effective care. It is therefore important for a healthcare facility to make an effort in the identification of the leadership style and the theories that essential to the nursing practice. The identification of effective leadership skills is helping in the development of the skills that are required to be perfect leaders and improving the relationship with colleagues and other healthcare workers.

The issue of bloodstream infection in the facility especially on patients in hemodialysis is becoming a concern and this requires some changes in the manner in which the safety practices of the patients are being handled. To ensure that it is effective in the implementation of the practices or guidelines related to the prevention of the bloodstream infection in hemodialysis patients, the shared leadership theory can work best towards the implementation of the practices and adherence.

This theory is based on the process of empowering the staff or team members towards deciding on the process that is confining their work. The theory considers the process of developing new strategies as a way of increasing morale and satisfaction. The lack of teamwork leads to low morale and a lack of satisfaction. The effective teamwork through a shared leadership leverages efficiencies that are important in the alignment of the values of the team. Shared leadership is important in ensuring that the group or the facility is realizing the improvement in patient outcomes.

The recommendations against the spread of the bloodstream infections or reduction in these infections require teamwork from the top management to the junior staff. The top management must be able to collaborate with other healthcare providers in the organization to understand the type of challenges to implementing the practices and adherence to the guidelines aimed at reducing and eliminating the bloodstream infections among hemodialysis patients. The healthcare providers must work together through sharing the challenges and continuously consulting each other when these challenges are being experienced. Efforts to the implementation of the practices aimed at eliminating bloodstream infections require joint efforts from all the stakeholders to provide healthcare services to the patients in hemodialysis. The top management, nurses, and other healthcare providers, and even patients are positively contributing to the overall elimination of bloodstream infections in hemodialysis patients (Frey, 2018).

The common cause of the lack of adherence to the practice proposed by the CDC to help in the reduction of the bloodstream infection in hemodialysis patients is related to the behavior that has become a common culture among healthcare providers. The implementation of the practices proposed to eliminate the bloodstream infections is affected by the failure of the healthcare providers to follow the guidelines of the CDC. The success of the implementation requires commitment from the management of the organization in providing adequate resources as well as setting the standards to be followed by the healthcare providers within the organization in terms of controlling and preventing the bloodstream infections among patients in hemodialysis (Jeong & Kim, 2016).

Behavioral change theories try to explain the change in the behaviors and it supports the interventions through describing the development of the behaviors and change over time. The behavioral models are developed to help in understanding the behavior and the identification of the underlying factors that impact on the behavior. The development of an effective intervention for example adherence to the CDC recommendations requires the process of understanding the behavioral aspects. There is evidence showing that the use of the behavioral theory in the development and the implementation of the behavioral change interventional assists in the improvement in the effectiveness of the interventions (Jeong & Kim, 2016).

The behaviors of the healthcare providers in the organization especially those that are related to the poor adherence to the guidelines aimed at reducing the bloodstream infections act as barriers to the implementation process. The behavioral barriers are affecting hand hygiene practices and the implementation of other CDC guideline practices that are aimed at reducing bloodstream infections. The removal of the behavioral barriers is helping in the change of the culture that this is influencing the behavior of the individuals. The effective process of implementing and the promotion of the adherence process is helping in the change in the behaviors of the healthcare providers as well as the adoption of those practices thus making them the culture of the organization. Adherence to the CDC guidelines and practices is helping in the improvement of the individual behaviors, development of the peer-based initiatives that help in the promotion of the collective responsibility accompanied by management-driven resolutions to help in handling issues of the non-adherence with prevention of the hemodialysis patients (White, et al., 2015).

The evaluation of the program or the practice of the CDC guidelines on the reduction of the bloodstream infection is important since it helps in determining the success of the program that has been made. The evaluation process is helping in providing a systematic technique that is used for the documentation of the progress and effects of the proposed change on the defined indicators (Ulrich & Manning-Crider, 2017).

The implementation of the practices or CDC guidelines is aimed at reducing the problem that is being faced in providing safety services to hemodialysis patients. The problems are associated with poor adherence to the recommended guidelines by the CDC. Some of the problem associated with the poor implementation of the practices in the reduction of the bloodstream infections is the increase in the length of the hospital stay, increase in the rate of hospitalization, increase in the healthcare cost, increase in the morbidity, and the increase in the mortality rates. Therefore the evaluation of the effectiveness of the implementation program is based on looking at the reported cases of morbidity, hospitalization, length of the stay, and the mortality rates (Ulrich & Manning-Crider, 2017).

The sustainability of the practice in the reduction of the bloodstream infection in hemodialysis patients is achieved through auditing and monitoring process. The auditing and monitoring are done on the indicators. There is also a provision of the feedback on the outcome following the implementation to help in the achievement of the behavioral change or other modification processes that helps in the improvement of the healthcare quality and the efforts made to achieve the goals aimed at reducing the risk of bloodstream infections (Ulrich & Manning-Crider, 2017).

There is a process of monitoring the feedback and this allows for the process of engaging the stakeholders thus leading to the creation of the partnerships and the development of the working relationships and networks. The sustainability is also achieved through sharing the audit outcome and providing the feedback to the individuals audited and with the hospital management and the senior administration is helping in making possible improvements in the implementation process. There is a periodic assessment of the degree to which the goals of the implementation are met. This helps in determining whether the goals have been achieved or whether the implementation activities are being carried out as per the requirements as well as identifying the need for improvement through auditing whether the standards have been met (Entesari-Tafati, Orford, & Athan, 2015).

The main concern associated with the poor adherence to the CDC guidelines or the practices aimed at reduction of the bloodstream infection is the poor healthcare outcome especially patients in hemodialysis. The CDC guidelines recommend some of the practices to be followed to ensure that the safety of the patients is improved. However, these guidelines are not followed thus interfering with the safety and the healthcare outcome of the patients. It is expected that the proper implementation helps in addressing the key indicators concerning the reduction of the bloodstream infection. These indicators include hand hygiene, provision of a safer environment, and adherence to other procedures recommended by the CDC (World Health Organization, 2016).

The effective implementation of the practices recommended by the CDC leads to the improvement of the overall healthcare outcome of hemodialysis patients. It also reduces the length of the hospital stay for the patients undergoing dialysis. The reduction in the length of stay in the healthcare facility implies that there will be fewer healthcare costs for the medication procedures. The implementation of such procedures also leads to a reduction in the rate of morbidity and mortality (World Health Organization, 2016).

The issue of bloodstream infections continues to remain a major public healthcare concern about the safety of the patients especially about the hemodialysis patients. Bloodstream is affecting the overall healthcare outcome of the patients due to the new infections that they acquire within healthcare facilities. Some guidelines were developed by the CDC in 2009 to help in the control and prevention of bloodstream infections. Even though these guidelines are in place, the adherence to these guidelines is poor thus making the number of reported cases of bloodstream infections to be on the rise. The implementation of the practice aimed at reducing bloodstream infections needs to focus on teamwork to help in ensuring that there is collaboration in a fight against these infections. The healthcare management is required to provide necessary resources to aid the process of implementing the activities in the reduction of the bloodstream infection that occurs amongst the hemodialysis patients. The sustainability of the implementation of the practices requires continuous auditing, monitoring, and making necessary improvements are required. It is also important to ensure that feedback on the areas of improvement and areas of failure so that necessary adjustments can be made.

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