Prevention of Central line Associated Blood Stream Infection
The Capstone Project in the RN to BSN Program is the culmination of learning experiences guided by the baccalaureate program’s student learner outcomes. This project is focused on integration of concepts, theories, and principles related to the professional nursing role as articulated in AACN’s BSN Essentials. According to Melnyk and Fineout-Overholt (2019), changing clinical practice is complex and challenging. As a result many models have been developed to systematically guide the implementation of EBP. The models used in the capstone project are designed to assist clinicians in changing practices on the basis of evidence in their organizations (p. 379). The Iowa Model, the Stetler Model and the Model for Evidence-based Practice Change are three evidence-based models that will be used to propose a practice change and promote quality care. These models are covered in detail on pages 383-398 of the 2019 edition of the book Evidence-based practice in nursing and healthcare by Melnyk and Fineout-Overholt.
A. The student will prepare a written proposal for a project of which the focus is resolution of a selected issue or problem significant to professional nursing practice (with potential for application in a work or community setting). While the proposal may not actually be implemented, it will be submitted to pertinent administrators in a workplace or community setting (*) with a request to present the proposal to a relevant committee, council, or staff. (*) Options other than work place are: Nursing Homes, Home Health Agencies, Public Health Units, or Community Healthcare Clinics. Other possibilities will require advanced faculty approval.
B. The student will select one of three evidence-based nursing practice models as the foundation for the Capstone Project (Stetler Model, Iowa Model and the Model for Evidence-based Practice Change). All elements of the model must be addressed, as indicated. The elements will be used as headings within the written paper to ensure they are used to structure the project.
C. This project should address one or more of the following Essentials of Baccalaureate Education for Professional Nursing Practice and/or Quality and Safety Education for Nurses’ (QSEN) elements at a minimum, as applicable to the student’s specific project. As an aside, please notice the Baccalaureate Program Graduate Outcomes and Competencies for the College of Nursing and Allied Health Professions are based upon these two pivotal documents.
1. Patient safety
2. Patient-centered care (patient involvement in care decisions such as cultural considerations, patient values, etcetera)
3. Professional values (altruism, human dignity, ethics, et cetera)
4. Quality improvement
5. Nursing informatics
6. Opportunities for teamwork and interdisciplinary collaboration
7. Leadership and Management (healthcare regulations translated into practice, healthcare policies, environment of care issues, communication strategies, ethical and legal implications, financial resources, et cetera)
D. This Capstone Project must include an analysis and synthesis of recent, scholarly, peer-reviewed journal articles in order to validate the usefulness of the project to facilitate evidence-based change that meets an identified need. This need can ‘NOT’ be a change that is currently taking place in your facility. Words in red indicate to have minimal direct quoting! Please seek the articles through our University Library, using a wide database search. Our Distance Learning service in the University Library also includes the ability to do a Google Scholar search. Articles should mostly be published within the United States. Be sure to include mostly nursing articles.
(It is acceptable to use other discipline’s articles to ensure a collaborative effort between the disciplines however; nursing should be the majority of the articles.) Recall from earlier classes, articles from magazines and non-peer reviewed journals are NOT acceptable sources of information.
E. The written paper should include data from A, B, C, and D above. The total length should fall between 5-7 pages not including the title page, abstract, and reference list. The paper must strictly adhere to APA format in all elements.
Central line-associated bloodstream infections (CLABSIs) occur when micro-organisms enter a patient’s blood following the insertion of the central line catheter. They mainly occur in intensive care units, where most patients require intubation for hydration, nutrition, and disease diagnosis. CLABSIs pose a significant risk to the patient’s health and even increase their likelihood of dying. The infections occur due to a combination of caregiver-related, patient-associated, and environmental factors. This complexity means that slight mishaps can cause major CLABSI-related challenges to patients and a healthcare facility. Therefore, the current paper develops a four-part protocol to reduce the incidence and severity of CLABSIs in intensive care. The proposal utilizes the Stetler Model to outline and evaluate the protocol in clinical practice. Finally, it presents an elegant approach to disseminating the intervention’s outcomes to enhance continued competence in eradicating CLABSIs.
Keywords: CLABSIs, evidence-based, Stetler
Prevention of Central Line-Associated Blood Stream Infection in the Intensive Care Unit
Central Line-Associated Blood Stream Infections (CLABSIs) occur when bacteria, viruses, or other pathogens enter the blood within forty-eight hours of a central line insertion. Central lines are crucial to medical processes, especially in the intensive care setting, since they allow medical professionals to maintain the flow of substances in and out of a patient’s bloodstream. Their purpose includes administering medication and fluids, as well as collecting blood for various tests. Unlike intravenous catheters, central lines access a major vein, usually close to the heart. Also, they remain in place for longer, usually weeks or months. Therefore, the invasive nature of the central line warrants diligence from the professional inserting it. In some cases, the healthcare provider may think that they have done all that is necessary to prevent CLABSIs. Sometimes, the insertion is an emergency, and there is inadequate preparation and insufficient precaution to avoid the infection. Hence, there is the need to develop an evidence-based approach to systematically reduce CLABSIs’ prevalence in the intensive care unit (ICU).
CLABSIs are the most common complication in ICUs. Different facilities report varying infection rates. Chi et al. (2020) noted that CLABSIs increase the risk of hospital death by a factor of 2.75. Additionally, treating CLABSIs is expensive. Each case accrues an additional 46000 dollars, according to (Chi et al., 2020). Hence, it is in the healthcare facilities’’ interest to ensure that such cases are as few as possible.
CLABSIs occur due to a combination of the healthcare worker’s hygiene conduct and several confounding factors. If the professional inserting the catheter fails to sterilize their hands (with gloves on) effectively, they risk transferring micro-organisms into the patient’s blood. Sterilization is also essential to eliminate the patient’s skin flora on the insertion site. The infection can also occur if the caregiver who routinely accesses the central line introduces the pathogens while adding fluid/medicine or drawing blood. In rare instances, the IV set may have been pre-contaminated. This scenario is likely due to poor medical equipment handling during transport or storage. Finally, if the dressing on the insertion site is loose, micro-organisms could find their way into the patient’s bloodstream, causing an infection. The environment enhances the potency of these risk factors. For instance, insertion hygiene errors are more likely to occur during an emergency. Similarly, the physical conditions in the ICU ward, such as dusty air, may increase the infection risk.
Other risk factors are patient-related. For instance, active immunosuppression lowers the individual’s ability to fight off pathogens. Similarly, comorbidities such as diabetes and cardiovascular disease increase the risk and severity of the infection. A patient who has also had a lengthy hospital stay before the insertion is more likely to develop a CLABSI than one who undergoes the procedure immediately after admission. Therefore, reducing CLABSIs’ prevalence requires that healthcare professionals explore these risk factors to determine which ones apply to their facility.
The evidence-based practice protocol to reduce CLABSIs’ prevalence in the ICU will consist of four main resolutions: enhanced barrier precautions, central line insertion integrity, safe handling and storage of central lines, and comorbidity management. Enhanced barrier precautions are practices that effectively eliminate the risk of pathogen transfer between various entities in the care setting. Therefore, the change process will require that all caregivers in the ICU sterilize thoroughly before they attend to a new patient. They will also disinfect the reusable equipment before using them to insert or handle a central line. The facility will promote the execution of this resolution by increasing the number of sanitation booths and sinks within the ICU. Thus, there will little chance for the transfer of microorganisms from the healthcare workers/ other patients to the patient with or receiving the central line.
Next, central line insertion integrity will address the risk of infection during the insertion process. This will include diligent sterilization of the insertion site to prevent inadvertent entry of skin flora into the patient’s blood stream. The healthcare workers must also ensure that there are is no gap left after insertion by securing and dressing the site.
The third resolution involves comorbidity management. The ICU unit must assess the patient for comorbidities that would increase CLABSI severity. For instance, they must determine if the patient has diabetes mellitus. If the diagnosis is positive, they will provide the relevant medical interventions to control blood sugar. A similar approach will also be necessary to preventing CLABSI complications due to cardiovascular disease.
Finally, it is necessary to improve central line handling. The facility must ensure that the central line stocks are safely stored in the warehouse. The warehouse management personnel will verify there are no sharp edges that can puncture or compromise the packaging. They will also seek to eliminate dust and pathogen components at the facility, thereby reducing the contamination risk before usage.
The CLABSIs prevention resolutions will systematically change the facility. Therefore, the healthcare workers must undergo a training and education program to enhance their competence in implementing the protocol. First, the clinical staff will attend sessions where the change agents will explore and explain the concepts of enhanced barrier precautions and effective insertion site preparation and dressing. The educators will also highlight the common comorbidities that the caregivers should test and manage to reduce patients’ vulnerability to CLABSIs. Meanwhile, the warehouse management team will receive training on how to properly store central lines. The educators will also conduct practical sessions where they will demonstrate proper disinfection, insertion, handling, and comorbidity management techniques. The healthcare team will also attempt implementing the protocols with the educators guiding and assessing their competence. Thus, the education-based implementation approached will prepare the ICU and ICU-affiliated staff members to implement the four-part evidence-based protocol by improving their knowledge and skill levels.