Practice Experience: Applying Key Interventions to a Practice Problem CLASBI

CLABSI 2

Quality Improvement Process for Preventing Central Lines Blood Infection

Carrie Jones

Bachelor of Science in Nursing

NURS-4220

Dr. Jonhnson

Augusta 3, 2020

Quality Improvement Process for Preventing Central Lines Blood Infection

Over the past years, advancement in health care has been steady. However, one area that has shown tremendous success is in fighting the central line-associated bloodstream infections. Information from the centers for control and prevention shows that the number of sick individuals in the United States intensive care units airing from the disease declined by sixty percent. Through the collaboration of various stakeholders, clinicians, government agencies, and hospital associations, the infections have reduced. This collaboration has spread across states and has shown sustained outcomes in minimizing such infections and death rates. It accounts for an essential quantifiable national prosperity story in quality improvement and model for boosting Americans' medical and well-being.

Central Line-associated Bloodstream Infection

(CLABSI) is a laboratory-confirmed bloodstream germ that grows within forty-eight hours of central line positioning. It occurs when bacteria, viruses, or fungi pass through the central line and enter the bloodstream (GALURA NANCY, 2019). Research shows that the infection affects between two hundred thousand and five hundred thousand patients annually, causing a thirty percent mortality rate. The most affected patients are those with existing chronic illnesses such as diabetes and respiratory disease, the elderly and those in immune suppress states.

CLABSI is a patient safety issue that can be prevented by the healthcare system; however, the infection dramatically impacts the health system and patient safety. In this case, the disease leads to extended hospital stays, accumulated mortality rates, and healthcare costs. For instance, in the United States, the intensive care unit's infection rate accounts for 0.8 per nine hundred central line days. The increased healthcare cost poses a very high burden accounting for about forty-five thousand dollars per patient. However, most instances are stoppable if there are proper aseptic procedures, inspections, and leadership plans. As such, the primary purpose for performing quality improvement is to address some issues such as the increased death rates, extended stays at hospitals, and the high costs. With the help of the quality improvement model, such problems will significantly reduce.

Findings and Guidelines

Research shows that central line-associated bloodstream infections have affected many people due to several malpractices within the intensive care unit. Hence, making the practice problem a significant threat. Based on the findings, most healthcare workers do not have enough education or proper training to handle or prevent such infections. Most central lines are not in a sterile environment whereby they are being inserted at the bedside alongside ultrasound in the general medical wards and the intensive care unit. Also, hospitals are using the non-catheters that tend to be at high risk of CLABSI. Therefore, hospitals should provide training to its staff, find standardized treatment procedures, and reduce the incidence of the infections occurring.

Since CLABSI is a threat to the practice problems, healthcare providers need to put specific and intensive measures to prevent the infection from occurring. Several leaders aired their views and pointed out that there are practical measures that help prevent infections. These measures include, first, ensuring proper adherence to the recommended insertion procedure and practices when it comes to central line application to avoid the disease. These procedures involve observing good hygiene, monitoring the checklist, removing unrequired central lines, using subclavian vein, applying appropriate skin antiseptic, and ensuring that the nurse uses sterile gloves, caps, masks, and sterile drape (Salim Ali, Brown Carlos, & Kenji, 2018). The second is to ensure that healthcare providers in intensive care units have enough experience. The third is to ensure that daily disinfecting of the catheters before assessing the lines (O' & Samir, 2017). Lastly, ensure the removal of the central lines once they are no longer required to reduce the rate of reinfections (Chase, R, & D, 2019).

Plan Do Study Act Model

Quality improvement processes and models try to solve the malpractices found in any intensive care unit when dealing with bloodstream infections. One of the critical models is the Plan Do Study Act(PDSA) (Ling, 2016). It is a four-step problem-solving model that aims at improving a situation. The model is a structured trial and error process. The models have four steps that help develop a plan for the CLABSI in an intensive care unit. The improvement is incremental and requires evaluations and refinement of the process.

In this PDSA quality improvement model, several tools are useful. These tools include audit tools, line charts, and a processing map (Arrieta, 2019). An audit is essential and needs to be a requirement for all physicians who insert the central lines and clinicians who control them to ensure compliance with the set guidelines without fail. Line charts will help control the growth and success of the project. Processing maps will assist in gathering data. The PDSA model is useful since it gives a flow of all steps. In this case, the health care providers start by defining, finding the cause of the infections. The second is to invite infection prevention department employees to educate nurses about the quality improvement project. In this case, they tend to check on what will work out for the setting with parts of the bundle. The third is to ask staff to perform a literature review and understand the surveillance audits for bundle adherence. Lastly, they find why the patient had CLABSI and do all monthly inspections to determine whether to act, leave, or adapt the project.

In conclusion, quality improvement is essential because it helps reduce any infections within the intensive care units. To reduce CLABSI, healthcare facilities need to manage the central line and sick people. The health care providers should manage it according to their hospital policies and procedures. Also, healthcare professionals should educate patients about the management procedures and help they can protect themselves against a possible CLABSI. Once all the hospitals adhere to these guidelines, the risks of contracting the infection will reduce or eradicate. All stakeholders should join hands and fight CLABSI from occurring or reoccurring in intensive care units. Therefore, hospitals should implement models that help minimize or eliminate such diseases.

References

Arrieta, J. O. (2019). Adiós Bacteriemias': a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs. International Journal for Quality in Health Care. Chase, M. J., R, C. J., & D, C. J. (2019). Healthcare-associated infections in children: a guide to prevention and management. Cham, Switzerland: Springer. GALURA NANCY, H. S. (2019). ULRICH & CANALE'S NURSING CARE PLANNING GUIDES: prioritization, delegation, and critical thinking. [S.l.]: SAUNDERS. Ling, M. L. (2016). APSIC guide for the prevention of central line-associated bloodstream infections (CLABSI). Antimicrobial Resistance & Infection Control, 5(1) 16. O', G. N., & Samir, K. (2017). Complex Infectious Disease Issues in the Intensive Care Unit, An Issue of Infectious Disease Clinics of North America, E-Book. Elsevier. Salim Ali (. B., Brown Carlos, (. D. & Kenji, I. (2018). Surgical critical care therapy: a clinically oriented practical approach. Cham, Switzerland: Springer.