Week 9 Assignment – Capstone Paper
Week 9 Assignment – Capstone Paper
Running head: LITERATURE REVIEW ON CLABSI Literature Review on Central Line-Associated Bloodstream Infection (CLABSI) Laura Kilmer Grand Canyon University- NRS 490 January 27, 2019 1 LITERATURE REVIEW ON CLABSI 2 Literature Review on Central Line-Associated Bloodstream Infection (CLABSI) Introduction Central Line-Associated Bloodstream Infection (CLABSI) has become a significant problem in healthcare facilities. Indeed, the centers for Disease Control and Prevention (CDC) established that the cases of CLABSI are more than 80,000 annually within the Intensive Care Units (ICU) alone. The cases rise to 250,000 yearly if all the hospital data is considered. Various researchers have made attempts to find how the issue can be controlled and prevented. For instance, Atilla et al. (2016) showed that CLABSI cases are the most costly leading to the use of $46,000 per case. Also, Guenezan, Drugeon, Marjanovic, and Mimoz (2018) showed that the risks of CLABSI are common in the use of Central Venous Catheters (CVC) for the treatment of patients who are critically sick. It has also been shown that the risks in CVCs are associated with the development of multi-resistant pathogens that cause infections to children. Additionally, Miliaraki et al. (2017) reported that
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CLABSI always causes prolonged hospitalization among children. Consequently, Perin, Erdmann, Higashi, and Sasso (2016) investigated the possible ways by which CLABSI can be prevented and showed that the use of care bundles in conjunction to commitment and education can be used to reduce the rates of the infections. Together, these researchers have made a significant contribution to the understanding and management of CLABSI. This essay presents a literature review that compares the research questions, sample populations, limitations, and recommendations for further research. Comparison of Research Questions Different researchers have developed their own research questions towards the investigation of the CLABSI and the ways in which it can be managed. Mostly, these research questions are developed following the PICOT criteria. The research question for LITERATURE REVIEW ON CLABSI 3 Atilla et al. (2016), for example, addressed the importance of the care bundle in the management of CLBSI in the ICUs. Similarly, Guenezan et al. (2018) developed a research question on the effective ways for the treatment of CLABSI. Still, Perin et al. (2016) developed research questions that investigated the evidence-based care that can be used in the management of adult patients who are admitted in the ICUs. On the other hand, the research questions of Venturini et al. (2016) assisted in determining the prevalence of CLABSI among the admitted children. Also, Miliaraki et al. (2017) addressed the risk factors for CLABSI among children who are admitted in the ICUs. From the research questions developed by the various researchers, it is clear that all of the researchers are interested in finding the possible ways by which CLABSI can be managed among the patients who are admitted in the ICU and other departments in the hospital. It can also be deduced from the research questions that the researchers are determined to find the intervention and treatment strategies for CLABSI. A Comparison of Sample Populations Similarities and differences have also been flagged in the available literature on CLABSI. The commonest sample population has been patients with CVCs in ICUs. For example, the sample population used by Atilla et al. (2016) included 114 patients who had CVCs in medical ICUs. Similarly, Venturini et al. (2016) used a sample population of children below the age of 18 in Mayer Children’s hospital who had ever experienced CLABSI cases between Mid-October 2014 and Mid-October 2015. On the other hand, Guenezan et al. (2018) considered patient under 15 days of antibiotics treatment for CLABSI. As opposed to other researchers, Perin et al. (2016) conducted their study using a systematic review of the previous literature in Brazil to determine the preventive measure of CLABSI. Moreover, the sample population used by Miliaraki et al. (2017) included pediatric patients below the age of 16 with CVCs as they were receiving their care. It is apparent from the LITERATURE REVIEW ON CLABSI 4 sample population used by these researchers that CVCs and ICUs are common. This shows that CLABSI is common to patients who are critically ill. A Comparison of the Limitations of the Studies Every researcher encountered unique limitations in the course of their study. For example, Atilla et al. (2016) found no superiority of chlorhexidine to povidone-iodine which is a contradiction to other research in terms of skin antisepsis. Guenezan et al. (2018) also encountered limitations with their study in that they were unable to compare the individual class outcomes among the causative organism classes. Additionally, Perin et al. (2016) were also faced with the limitations of lacking literature in Brazil that can be used in determining the treatment strategies for CLABSI. Venturini et al. (2016) also had deficiencies with the extrapolation of their results to the overall incidence of CLABSI with regard to the implanted catheters. Also, Miliaraki et al. (2017) experienced sampling techniques that derailed their ability to present reliable data. From the limitations of the study, it is evident that the available research is still not specific to the point of presenting clear management strategies for CLABSI. Conclusion This paper has been a presentation of literature review comparing the research questions, sample populations, and study limitations. It has nee found that CLABSI is a significant problem in healthcare facilities. Comparison of the research questions in the literature review indicates that the researchers are determined to find the intervention and treatment strategies for CLABSI. Also, the sample populations used in the studies indicated that CLABSI is common to patients who are critically ill. Moreover, the study limitations show that the available research is still not specific to the point of presenting clear management strategies for CLABSI. Therefore, more specific research on the management of CLABSI with respect to specific catheters is recommended. LITERATURE REVIEW ON CLABSI 5 References Atilla, A., Doğanay, Z., Çelik, H. K., Tomak, L., Günal, Ö., & Kılıç, S. S. (2016). Central line-associated bloodstream infections in the intensive care unit: the importance of the care bundle. Korean Journal of Anesthesiology, 69(6), 599. https://doi.org/10.4097/kjae.2016.69.6.599 Guenezan, J., Drugeon, B., Marjanovic, N., & Mimoz, O. (2018). Treatment of central lineassociated bloodstream infections. Critical Care, 22(1), 303. https://doi.org/10.1186/s13054-018-2249-9 Miliaraki, M., Katzilakis, N., Chranioti, I., Stratigaki, M., Koutsaki, M., Psarrou, M., … Stiakaki, E. (2017). Central line-associated bloodstream infection in childhood malignancy: a Single-center experience. Pediatrics International, 59(7), 769–775. https://doi.org/10.1111/ped.13289 Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016). Evidencebased measures to prevent central line-associated bloodstream infections: a systematic review. Revista Latino-Americana de Enfermagem, 24. https://doi.org/10.1590/15188345.1233.2787 Venturini, E., Montagnani, C., Benni, A., Becciani, S., Biermann, K. P., De Masi, S., … Galli, L. (2016). Central-line associated bloodstream infections in a tertiary care children’s University hospital: a prospective study. BMC Infectious Diseases, 16(1), 725. https://doi.org/10.1186/s12879-016-2061-6 Laura We have addressed the two spaces after the punctuation at the end of the sentence several times throughout the class. Make sure you review how to set your Microsoft Word to show when you do not have two spaces so you can fix this in all future assignments. Additionally, LITERATURE REVIEW ON CLABSI 6 some of your wording will need improvement for inclusion in the Week 9 final paper. The reference list has https://doi.org/xxxx but when you use the doi, it should just be doi:xxxxxxx Substituting the doi number for the x’s. Thanks for submitting on time. Professor O’Brien 1 PICOT Statement PICOT Statement Laura Kilmer Grand Canyon University: NRS-490 December 23, 2018 2 PICOT Statement PICOT Capstone Project According to the Centers for Disease Control and Prevention (CDC) there are 80,000 central Line-associated Bloodstream infection (CLABSIs) every year exclusively in Intensive Care Units (ICU). This estimate rises to 250,000 CLABSIs every year when entire hospital values are incorporated (CDC, 2011). CLABSIs have been observed to be the second most fatal type of hospital acquired infection. CLABSIs are a predominant and expensive issue in human services and are a preventable contamination. The effects of Chlorhexidine Gluconate (CHG) bathing on decreasing infection rates of central venous catheter (CVC) has heightened showing healthcare-related infections prompt mortality and restorative expenses. In the United States alone, each year 75,000 individuals with hospital acquired infections die (Zimlichman et al., 2013). The purpose of this paper is to present PICOT statement related to prevention of infection by implementation of daily CHG baths in patients with central lines. PICOT Does Using CHG baths prevent Central line infections performed daily during hospitalization compared to patients that received typical bath daily? Population: Patients with Central lines Intervention: Give CHG wipe bath with proper technique daily during hospitalization Comparison: Patients not receiving CHG baths or receiving them improperly Outcome: Decrease in Central line infections Timeline: 5 weeks Evidence-Based Solution 3 PICOT Statement Evidenced-based interventions can be implemented with a specific end goal to decrease CLABSIs, such as daily CHG baths. Musuuza (2017) noted that “Healthcare associated infections (HAIs) lead to increased morbidity, mortality and medical costs. “In the United States alone, about 722,000 people get a HAI every year and 75,000 people with HAIs die.” There is a substantial need for a daily chlorhexidine bath to be established as an economic and preventative practice to support the innovation’s permanence (Musuuza et al., 2017 p. 1). According to (Musuuza et al., 2017) questions such as • How does a nurse communicate that CHG baths were completed during the shift? • What do you know about the policy for CHG bathing? informs logical components that affect execution and maintainability of the intervention. Nursing Intervention Mandatory daily CHG bathing encounters many nursing practice challenges. Research has demonstrated that chlorhexidine prevents infection, yet there is conflicting evidence on CHG bathing preventing CVC infections better than customary bathing techniques in these articles. Although, these studies provide considerable amounts of evidence supporting obstacles in compliance, decreased CVC rates were also indicated. Musuuza et al., (2017) identifies factors such as • Nurse burn out related to patient load • Delegation • Communication deficiency • Supplies • Patient compliance • Perception of CHG impregnated wipes 4 PICOT Statement • General hygiene of the patient have a direct effect on whether the CHG bath is proven effective. Each of these factors proposed its own set of dilemmas. Although the barriers where widely assessed and documented, “Daily use of CHG in the ICU has been shown to be effective in reducing the rate of MRSA and VRE acquisition and bloodstream infections associated with these organisms” (Lowe et al., 2017 p. 256). Chlorhexidine has been reported to have few negative consequences and showed inconclusive evidence of decreasing CVC infections related to CHG bathing. The CLABSI rates decreased among the neonates receiving CHG baths (Quack et al., 2014). Patient Care All patients with CVC will bath daily utilizing moistened CHG wipes. A few studies have shown an extreme decline in CLABSIs from every day utilization of CHG washing. Lowe et al., (2017) reported that, “Despite daily CHG bathing compliance of 58%, rates of hospital-associated MRSA and VRE were significantly reduced compared with bathing with soap and water” (p. 257). Thus, research supports the nursing care; utilization of CHG showering over soap and water. Health Care Agency This Capstone Project will Utilize BayCare Health System Inpatient hospital. This facility is not for profit center that serves the community. St. Joseph’s Hospital has been a part of the community since 1934. The research will be performed in the Pediatric population of this hospital. Nursing Practice PICOT Statement Being that the CDC creates central line infection guidelines and one of the recommendations outlined is CHG bathing in patients with central lines I think it is safe to say daily chlorhexidine impregnated wipes should be utilized for all patients with central venous access that meet the guidelines of administration. 5 6 PICOT Statement Reference Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining nurses’ perspectives and experiences. BMC Infectious Diseases, 17(1). doi:10.1186/s12879-017-2180-8 Karki, S., & Cheng, A. C. (2012). Review: Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multiresistant organisms: a systematic review. Journal of Hospital Infection, 82, 71– 84. https://doi-org.lopes.idm.oclc.org/10.1016/j.jhin.2012.07.005 Quach, C., Milstone, A. M., Perpête, C., Bonenfant, M., Moore, D. L., & Perreault, T. (2014). Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections. Infection Control & Hospital Epidemiology,35(02), 158-163. doi:10.1086/674862 Zimlichman E, Henderson D, Tamir O, et al. Health care–associated infections: A meta-analysis of costs and financial impact on the us health care system. JAMA Intern Med. 2013;173(22):2039–46.
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