Abstract
Background: The use of central venous catheters facilitates the medication, treatment plan, overall disease management, intravenous fluids and blood products, and parental nutrition in hospitalized and critically ill persons. While the CVCs are critical to the treatment and management of patients who are critically ill, they have been revealed to cause a life-threatening problem, bloodstream infections, commonly known as the central line-associated bloodstream infections (CLABSIs). Evidence of increase in the infection is the basis for proposal of effective interventions, including evidence-based training for the nurses.
Aims and Objectives: The primary purpose of the current study is to find out whether evidence-based nursing education for nurses is operational in reducing central-line associated bloodstream infection. The objectives of the study are: 1) to find out if implementing evidence-based nursing education program has been done within the acute care setting, and 2) to establish whether the evidence-based nursing education program attained the objective of reducing the cases of CLABSI in the ICU.
Design: A quasi-experimental study was carried out in the ICU of a mid-level hospital, where data was collected from nurses (n=10). The nurses took part in a weekly training program, founded on implementation of evidence-based strategies, implemented to achieve reduction in CLABSI in the ICU.
The results: From the analysis of the data collected before and after reduction, it was revealed that the evidence-based training program reducing the cases of CLABSI by 40%.
Conclusions: The results of the study are useful following implementation of evidence-based nursing education program to achieve reduction in the cases of CLABSI in the ICU. Proper implementation and compliance are the basis for achievement of the objective of decreasing the cases of the CLABSI in hospital settings.
Relevance: The findings have relevance in health care settings, among them cutting the cost of treatment of CLABSI as borne by individuals and the health care settings. Proper use of CVCS is also necessary in reducing the mortality rates relating to the infections.
Central Line Infection Reduction through Evidence Based Nursing Education
Introduction
Contemporarily, the use of central venous catheters (CVCs) has become a vital aspect of health care in all the corners of the world. The use of central venous catheters has facilitated the medication, treatment plan, overall disease management, intravenous fluids and blood products and parental nutrition (Banach & Calfee, 2013). The central venous catheters are tubes that are inserted into a vein like subclavain or peripherally inserted (PICC line). While the central venous catheters are critical to the treatment and management of patients who are critically ill, they have been revealed to cause a life-threatening problem, bloodstream infections originating from microorganisms prevalent on the external surface of the CVCs devices or the fluid pathway when the CVCs devices are inserted (Miller, et al. 2011). “Central-line associated bloodstream infection” (CLABSIs) are a serious problem for health care facilities globally.
Central-line associated bloodstream infections are associated with high mortality rate, approximated at between 4% and 20% based on the setting (McLaws & Burrell, 2012). Silow-Carroll & Edwards (2011) revealed that in 2009, about 43,000 CLABSIs occurred in hospitals across the United States, resulting in the death of one out of five infected patients. Regardless of the prevalence of the problem, there are still inadequate findings on the most effective means of preventing these infections and saving the lives of the many affected persons (Furuya et al., 2011). In the United States for instance, more than 40,000 cases of central line-associated blood stream infections have been reported annually (Weber & Rutala, 2011). In a hospital setting, many cases have been reported in the Intensive Care Unit (ICU) where the patients are unable to perform some of the crucial activities required for treatment on their own precipitating the use of CVCs.
Many deaths resulting from central line infections have been attributed to late detection of the infections, suggesting inadequacy in the prevention measures and lack of proper training among medical practitioners involved in the insertion and changing the CVCs (Miller & Maragakis, 2012). The majority of the research on central line-associated bloodstream infection has been carried out in the different clinical settings, including the intensive care settings and even on non-ICU patients (Freixas et al. 2013; Taylor, McDonald & Tan, 2015). Most of the studies have pointed the need to reduce the prevalence of the infections using various strategies that should be implemented by the nurses. It is evident from research that the rate of central line-associated bloodstream infection is reduced following proper implementation of evidence-based measures (Weingart et al., 2014; Pérez et al., 2015). However, the impact depends on the successful implementation of the intervention and adherence to the evidence-based strategies.
Whited and Lowe (2013) indicate that while success can be achieved, it is not always the case based on the poor compliance with the evidence-based practices. In fact, the low adherence is the basis of poor infection outcomes. In essence, such results from previous studies highlight the need for further studies on the implementation of evidence-based education supported by the nurses, to reduce the incidence of central line-associated bloodstream infection in intensive care and other clinical settings.
Methodology
Procedures/Methods
The research project was carried out in an Intensive Care Unit of a mid-level hospital in the United States. The purpose was to implement use of evidence-based strategies by nurses that would achieve a reduction in CLABSIs within the ICU. The nurses providing services within the setting were used in implementing the monthly training program. The nurses were trained on the use of diverse evidence-based strategies, including “alcohol-impregnated caps (green caps), proper and timely central line dressing changes, bathing patients using a chlorhexidine preparation every day, and evaluating the need for the CVCs changes daily” (Marschall et al., 2014, S90). Major changes were made as the basis for implanting the strategies including availing the alcohol-impregnated caps at the bedside of the patients using CVCs at the end and beginning of each shift, ensuring that the ICUs have enough chlorhexidine bath soap supplies as well as CVC dressing change kits, and offering evidence-based education to nurses on good care and maintenance, including proper and timely dressing changes, of CVCs (Marschall et al., 2014).
Data Collection and Analysis
Critical data was collected and analyzed to establish the effectiveness of the evidence-based training for nurses in reducing the cases of CLABSI. The hospital records and interview of the nurses was used in collecting the data before and after implementing the program. The records would indicate the cases of the infections before and after the program. Also, the interview would provide important information on the changes that will have taken place within the setting after implementing the program. The cases of CLABSI prior to the program was taken and recorded and the same was done one month following the implementation of the program. the data was analyzed quantitatively and also using discourse analysis, indicating changes in the setting after implementing the evidence-based program.
Results
In the quasi-experimental study, which measured the rate of infection before and after the intervention, the research revealed that the use of evidence-based practices has a significant impact in reducing the rate of infections. The focus is on the use of evidence-based strategies in ensuring patient safety through evidence-based training (Freixas et al., 2013). The two objectives of the study were achieved. There was adequate implementation of the evidence-based strategies in the setting and the nurses were used to using them by the end of the third week. The second objective, achieving a reduction of the infections following the implementation of the strategies was also achieved. Prior to implementation of the program, the cases were found to be about five cases every month. It was expected that following implementation of the program, the cases of CLABSI would go down by about 50 percent.
After implementing the program, and after one month of effective training of the nurses, it was realized that the second objective was achieved. However, the reduction in the cases of CLABSI was not by 50 percent, but the reduction was achieved all the same. Even one week of implementing the program, it was realized that the cases of infections was going down. After taking the cases of those who had acquired infections by the third week of the program, it was realized that a reduction to three cases from five a month was achieved. Marsteller et al., (2012) revealed that implementation of training for nurses in ICU works in reducing the case of all kinds of infections in health care settings. Thus, the study proved successful in reducing the cases of CLABSI by 40% in the ICU.
Discussion and Conclusion
The two objectives, which were being tested in the study, were achieved, including finding out if the strategies were implemented as well as whether the strategies achieved a reduction in the cases of CLABSIs. All the strategies were implemented in the first month of the program. Three weeks following the weekly training, the nurses agreed to have become used to using the evidence-based practices. Also, following implementation, and after the one month, it was found out that the cases of CLABSI went down considerably. Clearly, the results revealed that use of evidence-based education and strategies is effective in preventing the prevalence of CLABSI in intensive care settings. Taylor, McDonald & Tan (2015) propose the use of the strategies indicated within the guidelines that the Centers for Disease Control and Prevention (CDC) publish to reduce the cases of CLABSI.
The study has pointed the need to reduce the prevalence of the infections using the different strategies in an evidence-based training. It is evident from research that the rate of central line-associated bloodstream infection is reduced following proper implementation of evidence-based measures. However, the impact depends on the successful implementation of the intervention and adherence to the evidence-based strategies. Whited and Lowe (2013) indicate that while success can be achieved, it is not always the case based on the poor compliance with the evidence-based practices. In fact, the low adherence is the basis of poor infection outcomes. In essence, such results from previous studies highlight the need for further studies on the implementation of evidence-based education supported by the nurses, to reduce the incidence of central line-associated bloodstream infection in intensive care and other clinical settings. Such evidence will help the nurses to participate in preventing the problem of infections in hospitals.
References
Banach, D. B., & Calfee, D. P. (2013). Central Line-Associated Bloodstream Infection. Healthcare Associated Infections: A Case-based Approach to Diagnosis and Management.
Freixas, N., Bella, F., Limón, E., Pujol, M., Almirante, B. &Gudiol, F. (2013). Impact of a multimodal intervention to reduce bloodstream infections related to vascular catheters in non-ICU wards: a multicentre study, Clinical Microbiology & Infection, 19(9), 838-844.
Furuya, E. Y., Dick, A., Perencevich, E. N., Pogorzelska, M., Goldmann, D., & Stone, P. W. (2011). Central line bundle implementation in US intensive care units and impact on bloodstream infections. PloS one, 6(1), e15452.
Marsteller, J. A., Sexton, J. B., Hsu, Y. J., Hsiao, C. J., Holzmueller, C. G., Pronovost, P. J., & Thompson, D. A. (2012). A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units. Critical care medicine, 40(11), 2933-2939.
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Weingart, S. N., Hsieh, C., Lane, S., & Cleary, A. M. (2014). Standardizing Central Venous Catheter Care by Using Observations From Patients With Cancer. Clinical Journal Of Oncology Nursing, 18(3), 321-326.
Whited, A. & Lowe, J.M. (2013). Central Line-Associated Bloodstream Infection: Not Just an Intensive Care Unit Problem, Clinical Journal of Oncology Nursing, 17(1), 21-24.
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