Direct Practice Improvement Project

Broad Topic Area:

The topic taken into consideration is the Central Line-Associated Bloodstream Infections (CLABSIs) and prevention

Literature Review

2. Literature Review:

1. Primary points basis four sections in the Literature Review:

a. Background of the problem/gap:

· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs.

· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections

· The nurses need to have the significant knowledge associated with evidence-based practices for the Central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter (CVC) patients.

b. Theoretical foundations (models and theories to be the foundation for the project)

· The efficacy of training of nurses over the prevention of Central line-associated bloodstream infections (CLABSIs) in neonates and children, through the exploitation of a questionnaire defining their socio-demographic data and their practical skills (Elbilgahy, A. A. et al., 2015).

· Knowledge about evidence practice reveals the discrepancies in the praxis, by the different nursing Pedagogics (Esposito, M. R. et al., 2017).

· Prophylactic measures to eradicate the incidence of CRIs or Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich, M. et al., 2014)

c. Review of literature topics with a key theme for each one.

d. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

· The efficacy of hygiene maintenance in the preponderance of CLABSIs rates in patients with CVCs, maintenance of patients with CVCs (Elbilgahy, A. A. et al., 2015); The key concepts in the study entail CLABSIs, ICU patients with CVCs, dressings, hygiene hub (Esposito, M. R. et al., 2017); The relevance of various interventions in reducing device-related infections. The key concepts are related to interventions (Hentrich, M. et al., 2014)

Setting

· Adult ICU (Elbilgahy, A. A. et al., 2015).

· The incidence of CRIs in cancer patients at the hospital (Hentrich, M. et al., 2014).

Summary

· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention including the nursing education

· Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting.

· Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia

Problem Statement

3. Problem Statement:

Though the studies have substantiated the CLABSIs to be a significant health concern as it impedes the recovery of the patients, the degree of efficacy of hygiene of hub, before each access in the prevention of CLABSIs, is not well documented

Clinical/ PICOT Questions

4. Clinical/PICOT Questions:

“In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of Central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections)?”

P: Patients > 65 years of age with a Central line

I: Staff training and reinforcement of Central Catheter, Hub Hygiene

C: Other area hospitals

O: Reduce probability of CLABSIs

Sample

5. Sample (and Location):

a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

b. Population: The population being sampled in the study is 120 adult ICU nurses (Elbilgahy, A. A. et al., 2015); 335 nurses were intrigued (Esposito, M. R. et al., 2017)

Define Variables

6. Define Variables:

a. Independent Variables: crystalloid fluids, hub hygiene and line changes

b. Dependent Variables: pedagogy

Methodology and Design

7. Methodology and Design:

The data tools were exploiting the practices of nurses in Adult ICU, questionnaire responses, and a review of the other related articles.

**The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues. The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews.

Purpose Statement

8. Purpose Statement:

The purpose of this quantitative project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff at hospitals in Webster, Texas for the prevention of CLABSIs.

Data Collection Approach

9. Data Collection Approach:

10. The primary instruments were nursing observations being done. The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues. The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews.

Data Analysis Approach

11. Data Analysis Approach:

The specific data analysis approach was chi-square and t-test are exploited for data analysis, and analysis was performed by using descriptive statistics through SPSS Statistics, Version 16.0. Also, The approach used for analysis of data will be thematic analysis as the data collected from interviews will be coded and these codes will further assist in the development of themes based on similarity in the content of interview data. Thematic analysis will facilitate in answering the clinical question developed.

Reference

Elbilgahy, A. A., Davidson, P. M., Sharps Mohamed, P. W., & Elassmy, M. (2015). Nursing Practice for Prevention of Central Line Associated Blood Stream Infection (CLABSI) in A Pediatric Intensive Care Unit. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 5(6), 150-154. Retrieved from www.iosrjournals.org

Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. doi:10.1371/journal.pone.0180473

Hentrich, M., Schalk, E., Schmidt-Hieber, M., Chaberny, I., Mousset, S., Buchheidt, D., … Karthaus, M. (2014). Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management, and prevention of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Annals of Oncology, 25(5), 936-947. doi:10.1093/annonc/mdt545