Abstract
Aims and Objectives: The principal determination 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.
Background: The use of central venous catheters (CVCs) 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, they have been revealed to cause a life-threatening problem, the central line-associated bloodstream infections (CLABSIs). Evidence of an increase in the infection is the basis for proposal of effective interventions, including evidence-based training for the nurses.
Design: A quasi-experimental study was carried out in the ICU of a mid-level hospital.
Methods: Quantitative data was collected from nurses (n=10), who took part in a weekly training program, founded on implementation of evidence-based strategies.
Results: Data was analyzed, comparing three phase: first period, second period and third period. The rates of LCBSI in the first period was 7.1, in the second period 4, and third period 1.7.
Conclusions: The results of the study are useful in 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.
Relevance: The findings have relevance in health care settings, among them, cutting the cost of treatment of CLABSI. Proper use of CVCS is also necessary in reducing the mortality rates relating to the infections.
Keywords: central line infection education, evidence-based, and nursing education
Introduction
Patients visit the health care system with the aim of getting treatment as well as manage their illnesses. However, the hope of proper care is affected by any dangers related to their care, one of the most critical being healthcare-associated infections. The critically ill patients, who have to depend on various devices to facilitate their care, including CVCs, are the most affected. As a result, infections contracted in the process of care are a major problem within the intensive care units (ICUs) (Seyman et al. 2014). The infections, including central-line associated bloodstream infection (CLABSI), are a cause of high level of morbidity and mortality. The infections have been showed to be major threats to the safety and quality of care for the patients within the ICU. Research has revealed that such infections can be prevented using effective and evidence-based strategies (Furuya et al. 2011, Seyman et al. 2014). The findings highlight the need for the implementation of evidence-based practices, including training for the nurses, an initiative aimed at preventing the infections.
Background
Contemporarily, the use of CVCs has become a vital aspect of health care in all the corners of the world. The use of CVCs has facilitated the medication, treatment plan, overall disease management, intravenous fluids and blood products, and parental nutrition for the critically ill patients (Banach & Calfee 2013). The catheters are tubes that are inserted into a vein like subclavian or peripherally inserted (PICC line). While these medical devices 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). CLABSI is a serious problem for healthcare facilities in the United States and globally. The risk for the development of the infections is based on various factors, including the kind of ICU, quality of patient care, suitable hospital infrastructure, and effective implementation of the strategies for preventing CLABSI.
CLABSI are linked to high mortality and morbidity rate. In the United States, for instance, more than 40,000 cases of CLABSI have been reported annually (Weber & Rutala 2011). The mortality rate is 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 US, resulting in the death of one out of five infected patients. In a hospital setting, many cases have been reported in the ICU where the patients are unable to perform some of the crucial activities required for treatment on their own precipitating the use of CVCs. Regardless of the prevalence and the seriousness of the problem, there are still inadequate findings on the most effective means of preventing these infections and saving the lives of the affected persons (Furuya et al. 2011).
Many deaths resulting from CLABSIs 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 of the CVCs (Miller & Maragakis 2012). Findings from various studies bring the conviction that the implementation of evidence-based education supports the overall measures for addressing cases of central line-associated bloodstream infection (Marschall et al. 2014). 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. Thus, the principal determination 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.
Methodology
Procedures/Methods
A quasi-experimental study project was carried out in an ICU of a mid-level hospital in the US. The purpose was to implement the use of evidence-based strategies by nurses that would achieve a reduction in CLABSIs within the ICU. The sample of nurses involved in the study was 10. The nurses providing services within the setting were used in implementing the monthly training program. As such, the nurses were trained on the use of diverse evidence-based strategies, including use of alcohol-impregnated caps, change of central line dressing in a timely and proper manner, use of chlorhexidine preparation for the daily baths of the patients, and assessment of the daily need changing CVCs (Marschall et al. 2014). In essence, major changes were made as the basis for implementing the strategies, including availing the alcohol-impregnated caps at the bedside of the patients using CVCs at the end and the 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 for the nurses on good care and maintenance, which include 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. Hospital records on the cases of CLABSI were used in collecting the quantitative data. The data was collected in three phases, for the first period, it was done before the implementation of the training program. The data indicated the rate of CLABSI before the program commenced. For the second period, data was collected one month following implementation of the program and again after the second month for the third period. The interviews for nurses were used in collecting the data before and after implementing the program to indicate the level of compliance with the strategies. In addition, the interview would provide important information on the changes that will have taken place within the setting after implementing the program.
Data Analysis
The data to be analyzed was obtained from the rates of CLABSI of three ICUs in the hospital. The preliminary data that was used suggested 8.07% rate of CLABSI. For the purpose of achieving a reduction in CLABSI with statistical significance with a 80% power, it was presumed that there would be a decrease in the infection rates of at least 30% from one period to the next. Indeed, to assess the changes over time in the rates of infection, Poisson regression was applied. Overall CVC days and patient days were used in calculating the total infection counts. The researchers used adjusted incidence rate ratios in reporting the results, accompanying confidence intervals of 95%. The analysis of the data was carried out with the use of SAS, version 9.2 (SAS Institute, Cary, NC, USA). For statistical significance, p values = 0.05 were d used. The analysis of the qualitative data was carried out using discourse analysis, indicating changes in the setting after implementing the evidence-based program.
Results
Table 1 shows the data on the characteristics of the study units, the types of ICU, the quantity of beds in the ICUs, the patient days and the figures of admissions in the ICUs.
The rates of CLABSI are shown in Table II. From the analysis of the data, it was revealed that in first period, the rate was 7.1, in second period the figure was 4 and 1.7 in the third period. The results indicate a reduction in the rates of CLABSI of 43.7% from the first to the second period of the study. The results also indicated a relative risk (RR), 0.56. The confidence interval (CI) was at 95% 0.33 –0.94; p =0.03). From the second to the third periods of study, a reduction in the rate of CLABSI of 57.5% was achieved, 0.44 RR, CI, 95% and 0.28 – 0.69; p =0.001). The results revealed an interesting finding, which indicated that the reduction in the rate of CLABSI was highest from the first to the second period, marking the first month following implementation of the training program.
Discussion
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 an adequate implementation of the evidence-based strategies in the setting, and by the end of the third week, the nurses were already used to the adopted changes. The second objective, achieving a reduction of the infections following the implementation of the strategies was also achieved. Before implementation of the program, the cases were found to average at 7%, after one month of training, the rate went down to 4% and further down to 1.7 during the second month.
It was expected that following implementation of the program, the cases of CLABSI from one period to the next would decrease by 30%. Taylor, McDonald & Tan (2015) made a suitable proposal that by using evidence-based strategies, Centers for Disease Control and Prevention (CDC) and its guidelines shape the trajectory of addressing the cases of CLABSI. On the same breadth, Whited and Lowe (2013) captures the view that while there are successes on the compliance with the evidence-based guidelines, it emerges that the basis of poor infection outcomes is pegged on the inefficient compliance measures.
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 30% as anticipated. In fact, the reduction was greater than anticipated. Even one month of implementing the program, it was realized that the cases of infections were going down. After taking the cases of those who had acquired infections by the fourth week of the program, it was realized that a reduction to a rate of 4% 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 in the ICU.
Research carried out on central line-associated bloodstream infection touches on the non-ICU patients as well as the generalized intensive care setting. Essentially, some these studies pointed out the imperative need to reduce the prevalence of the infection by use of various strategic inputs. The nursing practitioners must understand that the rate of central line-associated bloodstream infection must be addressed within the evidence-based measures (Freixas et al. 2013, Taylor, McDonald & Tan 2015, Weingart et al. 2014, Pérez et al. 2015). However, the impact of these measures depends on the effective implementation framework that adheres to the evidence based principles.
Conclusion
From the study, it becomes evident that the two objectives were achieved. The nurses revealed a change in the ICUs to include use of evidence-based strategies in preventing the infections. Even one month into the program, the nurses had become accustomed to using the strategies, to such an extent that a greater level of reduction was achieved even compared to the second month. All the approaches were implemented in the first month of the program. The second objective was also achieved by surpassing the projected level of reduction. Clearly, the results revealed that use of evidence-based education and strategies is effective in preventing the prevalence of CLABSI in intensive care settings.
As it is palpable from the analysis, the study has indicated 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. In essence, such evidence will help the nurses to participate in preventing the problem of infections in hospitals.
Relevance to Clinical Practice
The findings have relevance in health care settings, among them, cutting the cost of treatment of CLABSI as is borne by individuals and the health care settings. The achievement is evident in reducing the complication of illnesses, and longer hospital stays due to the infections. Proper use of CVCS is also necessary in reducing the mortality rates relating to the infections. The health care system will also achieve safety and quality of care to the patients following the implementation of the strategies. Therefore, a change in the culture of the nurses to include the evidence-based strategies in their practice will achieve this goal. However, the study does not cover all the aspects of the reduction in CLABSI, highlighting implications for future studies. The factors that relate to the implementation have not been studied regardless the fact that they also determine success of lack thereof. Hence, future studies should focus on those factors and the role they play in the implementation process.
References
Banach DB & Calfee DP (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, 838-844.
Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D & Stone PW (2011) Central line bundle implementation in US intensive care units and impact on bloodstream infections. PloS one 6, e15452.
Marsteller JA, Sexton JB, Hsu YJ, Hsiao CJ, Holzmueller CG, Pronovost PJ & Thompson DA (2012) A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units. Critical care medicine 40, 2933-2939.
Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP … & Yokoe DS (2014) Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35, S89-S107.
McLaws ML & Burrell AR (2012) Zero risk for central line-associated bloodstream infection: are we there yet?. Critical care medicine 40, 388-393.
Miller MR, Niedner MF, Huskins WC, Colantuoni E, Yenokyan G, Moss M … & Brilli RJ (2011) Reducing PICU central line–associated bloodstream infections: 3-year results. Pediatrics 128, e1077-e1083.
Miller SE & Maragakis LL (2012) Central line-associated bloodstream infection prevention. Current opinion in infectious diseases 25, 412-422.
Pérez-Granda MJ, Guembe M, Rincón C, Muñoz P & Bouza E (2015) Effectiveness of a training program in compliance with recommendations for venous lines care. BMC Infectious Diseases 15, 1-5.
Seyman D, Oztoprak N, Berk H, Kizilates F & Emek M (2014) Weekly chlorhexidine douche: does it reduce healthcare-associated bloodstream infections?. Scandinavian Journal Of Infectious Diseases 46, 697-703.
Silow-Carroll S & Edwards JN (2011) Eliminating central line infections and spreading success at high-performing hospitals. The Commonwealth Fund 2, 15.
Taylor JE, McDonald SJ & Tan K (2015) Prevention of central venous catheter-related infection in the neonatal unit: a literature review, Journal of Maternal-Fetal & Neonatal Medicine 28, 1224-1230.
Weber DJ & Rutala WA (2011) Central line–associated bloodstream infections: prevention and management. Infectious disease clinics of North America 25, 77-102.
Weingart SN, Hsieh C, Lane S & Cleary AM (2014) Standardizing Central Venous Catheter Care by Using Observations From Patients With Cancer. Clinical Journal Of Oncology Nursing 18, 321-326.
Whited A & Lowe JM (2013) Central Line-Associated Bloodstream Infection: Not Just an Intensive Care Unit Problem, Clinical Journal of Oncology Nursing 17, 21-24.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
