Chapter II
Literature Review
The chapter is a review of past research evidence on the use of best practice training on central line dressing changes in central line care to prevent central line-associated bloodstream infections. Nine sources will be used in writing the literature review, which will be obtained from online databases.
Body of Evidence
The reviewed research indicate the importance of effective training for the nurses involved in central line dressing changes, in hospital settings, to reduce the prevalence of CLABSI. Pérez-Granda, et al. (2015) provides evidence of the effectiveness of training programs for nurses on venous lines care in achieving a reduction in CLABSI in the Intensive Care Unit. The focus of the study is the proper care of venous lines, which involves proper central line dressing changes. Cicolini, et al. (2014) in a multicenter survey highlights the importance of knowledge in nurses as training provides the necessary evidence based practice in preventing CLABSI.
Other researchers support the importance of evidence-based training on proper central line care procedures during the catheter use on critically ill patients (Longmate, et al., 2011). Stevens, et al. (2012) go further to suggest the importance of context and the culture of the unit in the implementation of central line care practices in preventing CRBSI. The research suggests the importance of providing continued training of the nurses within their practice settings and following the culture of the unit to achieve the reduction in CLABSI. Burden, et al. (2012) acknowledge that the prevention bundle is not enough and instead the policy makers should include simulation in training the nurses on how to properly take care of the patients using the catheter in the course of their treatment.
Nurses, being central to providing central line care, have been showed in research to be at the forefront in preventing CLABSI through evidence-based strategies. Marsteller, et al. (2012) implemented a training for nurses in intensive care unit, to establish the role of training in dressing change to reduce the cases of CLABSI. The training was effective towards this end. Implementation, according to the research involves proper training of the nurses on how to change properly the central line dressing. The study involved the input of the health care providers in implementing good practice in reducing the cases of CLABSI in the ICU.
Marschall et al. (2014) provide evidence of the effective role played by nurses in the care of patients within the ICU in preventing CRBSI. Such are nurses with proper knowledge of the basics such as safe central line dressing.
Generally, research provide evidence of best practice and effective management of central line by trained nurses in preventing CLABSI (Weingart, et al. 2014; Gupta, et al. 2015).
The State of Science
From the reviewed studies on best practice in reducing CLABSI there is consistency of the argument that best practice by well trained nurses has a role in reducing CLABSI. Thus, the studies advocate promoting best practice in preventing CLABSI, which involves proper training of the nurses in central line case such as proper central line dressing changes. Safe procedures during central venous catheter use, such as how to change the dressing without causing infections is a consistent topic in the reviewed studies. The majority of the reviewed studies and projects reveal the importance of training of the nurses in preventing the cases of CLABSI and more important training the nurses on how change central line dressing. The studies indicate that nurses have an important part in preventing the infections in the patients who are under their care, especially within the intensive care unit. The research is also consistent in support of prevention using the best practice as opposed to treatment, which is associated with high mortality rates. The researchers seem to focus on the value of effective training approaches for the nursing staff.
However, there are some inconsistencies in the reviewed studies. For instance, in the study by Burden, et al. (2012), there is an indication that training is not effective unless there is use of simulation. In the study, the researchers propose addition of the simulation to the usual training of nurses to improve practice. The other studies that focused on the implementation of best practice in the care settings which seem to have realized considerable decreases in the rates of CLABSI where they were properly implemented using well trained nurses. The inconsistencies are likely as a result of various factors. One of these is the design of the study. While some of the studies were primary studies (Longmate, et al. 2011; Marsteller, et al. 2012; Cicolini, et al. 2014; Gupta, et al. 2015), other studies, including Burden et al. (2012); Marschall, et al. (2014) and Bramesfeld et al. (2015) were reviews of the literature. Therefore, this means that their findings would be expected to differ. Another reason is the settings that were used in carrying out the study. Different units of the hospital were used in the different studies, which indicate that the different findings could be expected. However, most of the studies were carried out in the ICU.
It is worth noting that more research is necessary to close some of the gaps evident in the studies. Most of the studies that were reviewed focused on the use of evidence based training of the nurses on the proper central line care in general. Others focused on the general reduction of CLABSI. Thus, there is limited research that focuses on the training of nurses in best practice in relation to proper central line dressing changes in the reduction of CLABSI. More research is required to close this gap and promote best practice in the prevention of CLABSI using training on proper central line dressing changes.
Use of catheter in the treatment of hospitalized patients is necessary but limited by central line-associated bloodstream infections. Therefore, the research, which is providing evidence of effectiveness in preventing the infections, will be beneficial to hospitals and nurses as they will be able to use the catheters without being concerned about the possibility of infections. It will also be possible to save more lives that would otherwise be lost due to the infections. Under those premises, the cost-saving benefits will be achieved at the individual and organizational levels.
Conclusion
As highlighted in the discussion above, research provides evidence of major steps to take in preventing central line-associated bloodstream infections following the use of the catheter in the treatment of hospitalized patients. The review of research identifies some gaps that need to be filled in the current research project. Future research will also address some of the limitations that were evident in the past studies.
References
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Cicolini, G., Simonetti, V., Comparcini, D., Labeau, S., Blot, S., Pelusi, G., & Di Giovanni, P. (2014). Nurses’ knowledge of evidence-based guidelines on the prevention of peripheral venous catheter-related infections: a multicentre survey. Journal Of Clinical Nursing, 23(17/18), 2578-2588
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