Methods of Reducing Central Line Associated Bloodstream Infections
For patients with peripherally inserted central catheters (PICC), does the use of standard chlorhexidine and silver sulfadiazine-impregnated (CSS) central venous catheters or minocycline and rifampin-impregnated (MR) catheters better reduce central line associated bloodstream infections (CLABSI) during the duration of PICC use? If not, what tactics reduce incidences of CLABSI? (Bundle, monitoring insertion, reducing patient population applicable to receive PICC)
Consider the population in which the solution is intended, the staff that will participate, and the key contributors that must provide approval and/or support for your project to be implemented. These stakeholders are considered your audience.
Develop an implementation plan (1,500-2,000 words) using the "Topic 3: Checklist" resource. The elements that should be included in your plan are listed below:
Method of obtaining necessary approval(s) and securing support from your organization's leadership and fellow staff.
Description of current problem, issue, or deficit requiring a change. Hint: If you are proposing a change in current policy, process, or procedure(s) when delivering patient care, describe first the current policy, process, or procedure as a baseline for comparison.
Detailed explanation of proposed solution (new policy, process, procedure, or education to address the problem/deficit).
Rationale for selecting proposed solution.
Description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)
Resources required for implementation: staff; educational materials (pamphlets, handouts, posters, and PowerPoint presentations); assessment tools (questionnaires, surveys, pre- and post-tests to assess knowledge of participants at baseline and after intervention); technology (technology or software needs); funds (cost of educating staff, printing or producing educational materials, gathering and analyzing data before, during, and following implementation), and staff to initiate, oversee, and evaluate change.
Prepare this assignment according to the guidelines
Developing an Implementation Plan
• Explains method(s) of obtaining necessary approval(s) and securing support for proposal. _____ / 10
• Provides thorough description of current problem, issue, or deficit requiring change.
_____ / 20
• Provides detailed explanation of proposed solution. _____ / 20
• Discusses rationale for selecting proposed solution. _____ / 10
• Incorporates evidence from review of literature in Module 2 to support proposed solution. _____ / 20
• Provides a detailed description of implementation logistics.
_____ / 40
• Identifies resources required for implementation (Staff, education materials, assessment tools, technology, funds, etc.). _____ / 10
Written Format & Length Requirements • Assignment formatted according to APA.
• Word Count (1,500-2,000). _____ / 10
_____ / 10
TOTAL POINTS
_____ / 150
METHODS OF REDUCING CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS
By
Institution
Table of Contents TOC \o "1-3" \h \z \u Abstract PAGEREF _Toc467615357 \h 3Method of Obtaining Approval4Description of Current Problem PAGEREF _Toc467615359 \h 5Solution Strategy PAGEREF _Toc467615360 \h 6Rationale for selecting proposed solution PAGEREF _Toc467615361 \h 8Incorporated Theory PAGEREF _Toc467615362 \h 9Implementation of the Policy: Logistics and Resources PAGEREF _Toc467615363 \h 10Conclusion PAGEREF _Toc467615364 \h 11References PAGEREF _Toc467615365 \h 11APPENDIXES PAGEREF _Toc467615366 \h 12
Abstract
The use of catheter for intravenous injections is very popular in the world, with over 300 million catheters used per year in the U.S. alone (Kusek, 2012). Central venous catheters (CVCs) are useful in administering medications, blood products, parenteral nutrition, intravenous fluids, and allowing hemodialysis access. More than 60% percent of Catheter Line Associated Bloodstream Infections occur in the ICUs, which leads to the largest number of deaths associated with blood stream infections (Chopra et al., 2012). The fact that 48% of all patients in ICU have intravenous catheter injections makes it imperative in prevention of infections and complications arising from CLASBI. According to Moureau (2012), the greatest reason to patients’ having catheter infections is due to physicians and nurses failing to implement safety procedures in catheter management. The lack of training and knowledge concerning the best evidence-based care for catheter management has led to patients acquiring BSIs; a condition that is easily preventable.
This project aims to provide a concise criteria and procedures required to implement and evidence-based practice that shall greatly reduce CLABSI in the hospitals. The policy uses research-based care recommended by the Center for Disease Control and Prevention (CDC) in the continuum care. The implementation of the policy shall begin through creation of awareness among the nursing and medical fraternity. A special team comprising of highly trained nurses and physicians shall aid in implementation of the policy, with approval from the head nurse, the medical management director, and the overall supervisor. The oncology unit shall be fully equipped with the necessary equipments required for maintenance of evidence-based care.
KEY WORDS: Catheters; Venous; evidence-based; ICU; PICC.
Methods of Reducing Central Line Associated Bloodstream Infections
The use of peripherally inserted central catheters is very popular in many intensive care units all over the world, posing a great risk for people acquiring infection. There are many risks emanating from the use of PICCs, therefore, proper standards are requisite in safeguarding the life of patients and establishing high quality standards. The implementation of this policy entails sensitizing the staff, educating the providers and implementation of the evidence-based practice in care.
Method of Obtaining Approval
The Central Line Associated Bloodstream Infections (CLABSI) has a linkage to high costs, mortality, and morbidity among patients in the Intensive Care Units (ICU) (AHRQ, 2014). According to Chopra et al. (2012), over 48% of patients in ICU have indwelling central venous catheters, a great cause of blood stream infections (BSIs). The best way to secure support among the staff within the hospital where the new policy concerning reduction of CLABSI is to take effect is by building coalitions early (Gallo, 2010). This is by identifying a patient who mistakenly acquired CLABSI within the hospital, and sharing the story of the patient with the leaders and staff of the hospital. The stakeholders shall be aware of the gravity of the matter and the need to maintain quality standards towards provision of health care.
I shall generate a list of all the CLABSI cases and share with physicians and nurses of the number of cases the hospital has handled and the prevalence of the conditions among the patients (see APPENDIX A). To gain providers’ attention, raising awareness concerning the best evidence-based practice in reduction of CLABSI among patients in ICU shall be useful. This information shall be available to the nursing director, the medical management director, and the overall administrator.
Description of Current Problem
There are over 5 million peripherally inserted central catheters (PICCs) in acute care facilities internationally, with 2.5 million in U.S. alone per year (Moureau, 2012). Technology such as tip navigation and ultrasound; and the effortlessness provided by bedside placement has largely popularized the use of PICC. The danger of use of PICC arises due to lack of information from physicians concerning PICC-related complications. The determinants of a patient requiring PICC are intravenous treatments spanning over 5 days, problems with maintenance of peripheral access, infusions such as irritants and vesicants, which can destroy venal intima, and for patients having respiratory issues and coagulopathies (Moureau, 2012).
According to the Center for Disease Control and Prevention (CDC) in 2010, the main causes of CLABSI among PICC users relates to hygiene before, during and after catheter insertion (Gould, 2010). This mainly occurs during handling of the equipments by the provider, which may lead to transfer of bacteria or viruses into the blood stream and cause BSI. Physicians fail to maintain high hygiene standards during short and long term use of PICC, which causes more than 80, 000 CLABSI in U.S. per year with an estimated cost of up to $29,000 per infection (Sengupta, 2010). The new policy aims at replacing the flaws caused by these practices with robust procedures that shall address and implement the need for hygiene in care apart from other methods.
Solution Strategy
The policy suggested to reduce the prevalence of CLABSI among patients in ICUs consists of evidence-based procedures that produce the best results. The largest cause of CLABSI is due to entry of pathogens through the skin during catheter insertion. Therefore, it shall be mandatory for the physicians to maintain hand hygiene using antiseptic containing soap or alcohol-based foam before and after insertion of the catheter (Chopra et al., 2012). Chopra notes that, a study done on education of physicians concerning performance of hand hygiene led to a decrease of CLABSI incidences among patients “from 3.9 per 1000 catheter days to 1.0 per 1,000 catheter daysâ€.
The use of an “all-inclusive catheter carts or kits†has the potential to reduce significantly CLABSI. The use of catheter kit reduces instances of contamination by providing accessible equipments during catheter insertion. This also ensures usage of standard catheter types, which aid in cost reduction and lower rates of CLABSI. It shall also be mandatory for physicians to take precautions in ensuring maximum sterile barrier is present during catheter insertion (Chopra et al., 2012). The physicians shall use sterile gowns, masks, caps, sterile drape covering the whole body, and gloves. This shall establish a sterile environment, which shall minimize spread of skin pathogens.
Additionally, it shall be requisite for physicians to use chlorhexidine gluconate as a skin antisepsis before CVC insertion. According to Chopra et al. (2012), this antisepsis has a potential of reducing the risk of CLABSI by 50% compared with povidone iodine. It also reduces incidences of CLABSI by 1.6%, decreases the risk to death by 0.23% and saves up to &113 on every catheter, when used for disinfection of insertion site over povidone iodine. The use of standard chlorhexidine and silver sulfadiazine-impregnated (CSS) central venous catheters or minocycline and rifampin-impregnated (MR) catheters would be useful in cases where there is persistent prevalence of CLABSI in the hospital (Chopra et al, 2012). However, the use of these antimicrobial CVCs will be limited due to their potential to stimulate antimicrobi...