Capstone: project planning
Introduction: Setting
In medical-surgical unit, the central line associated blood stream infection (CLABSIs) rate is high. They can be prevented through adoption of evidence-based practicessuch as the CLABSIs bundles.
Detail description of the problem
Central venous catheter or central lines are catheter tubes placed into a larger vein in groin, chest or neck with the aim of providing fluids or medication to patients or collection of blood for medical analysis. In outpatients and inpatients care, the vascular catheter use is very common. Over three million central line catheters are used each year in the United States. Central lines remain in place for a longer time and therefore can cause severe infection if left unchecked(Hebden, 2015, p. 1). Central line-associated bloodstream infections (CLABSI) are the infections associated with the entry of pathogenic bacteria or virus into the blood stream via the central line. In healthcare, infections of the blood stream are the main cause of increased mortality and morbidity in the world. Billions of dollars in the United States are spent on healthcare systems as a result of these infections, yet they can be prevented. The use central line use is the main factors of the infection of the blood stream. In the United States, more than a quarter million cases of the hospital- acquired infections of the bloodstream as a result of the use of the of central line are reported annually. In intensive care units (ICU) over 80,000 million cases are reported. Strict protocols that ensure sterility of the highest degree is required when inserting central line catheters to the patients(Hebden, 2015, p. 2). CLABSIs are prevented when evidenced based protocols are followed for maintenance and insertion of the central venous catheters.
Impact of the problem
The microorganism on the patients of the skins may enter the blood stream during the maintenance or insertion of the central line. If left unchecked, these could lead to sepsis. Central line infections prolong the patients stays at the hospital. The most affected are children. The mortality rate of neonatal with CLABSIs with bloodstream infection associated with the use of central venous line is extremely high(Oliver, Thomson, &Jardine, 2015, p. 1). This is because the immune system of the new bone is not fully developed to fight this kind of infections. One of the main problems when it comes to CLABSIs is blood stream infection with antibiotic resistance pathogenic bacteria. Infection with these types of bacteria also can spread to other patients (Ista et al., 2016, p. 2). Patients that are seriously ill are not able to overcome this nature of infections and these results in increased mortality rates in hospital settings.
Gravity of the problems
The patients and the health professionals have a role to play to ensure the prevention of CLABSIs. In United Stated as mentioned above, over 300 million central lines catheters are used every year in inpatients or outpatients settings.(Hebden, 2015, p. 1) Over eighty thousands cases of CLABLIs in intensive care units are reported each year. Additionally, the cost associated with these type of infection is also very high. The use of evidence-based practices will significantly assist in the reduction of these types of infections.
Solutions to the problem
Care bundles refer to evidence-based structured sets of practices that improve the outcome of the patients when applied together in a standard fashion. CLABSIs bundles enable preventions of blood stream infection significantly when applied in various health care settings (Ista et al., 2016, p. 2).
The CLABSIs bundles that should be observed during insertion of central line catheter include;
Decontamination of the hands using appropriates reagents after and before patients contacts
- The use of sterile protective barriers such as gown, gloves among others
- The use of chlorhexidine antiseptics of the skins to wipe the areas of insertions
- Suitable sterile catheter should be selected with no holes to prevent the occurrence of infections
- Sterile bandages should be applied when dressing the wounds of the patients or wiping
- Nurses and other healthcare professionals need to be educated on the importance of practicing CLABSIs with the aim of preventing these types of infections.
References
Hebden, J. N. (2015). Tackling central line-associated bloodstream infections in the ICU. Nursing Critical Care, 10(5), 34-39. doi:10.1097/01.ccn.0000471005.94331.6b
Ista, E., Van der Hoven, B., Kornelisse, R. F., Van der Starre, C., Vos, M. C., Boersma, E., &Helder, O. K. (2016). Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. The Lancet Infectious Diseases, 16(6), 724-734. doi:10.1016/s1473-3099(15)00409-0
Oliver, S., Thomson, P., &Jardine, A. (2015). Safe central venous catheter insertion practice must extend beyond simply measuring catheter-associated bloodstream infections. Journal of Hospital Infection, 90(1), 81. doi:10.1016/j.jhin.2014.11.021
Septimus, E. J. (n.d.). Faculty of 1000 evaluation for Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. F1000 – Post-publication peer review of the biomedical literature. doi:10.3410/f.726065775.793513067
