Central line-associated bloodstream infections

Central line-associated bloodstream infections (CLABSI) are healthcare infections that result in extended hospital admissions. This suggests that patients will suffer additional hospital charges as a result of their extended hospital stays. CLABSI occur in both critical care and non-intensive care units, yet both settings continue to receive unequal attention from the various interest groups. As a result of the improved central line insertion methods, the number of infections in ICU settings has decreased . Non-ICU patients are still experiencing the impact of CLABSI in large numbers since this setting has been neglected for a long time.

It is of paramount importance to advocate for central line’s best practices especially after insertion since this serves as a preventive measure for CLABSI. Besides, different organizations have commended the role played by central line maintenance as an effort of reducing CLABSI among patients (O’Neil, Caroline, Ball & Warren, 2016). They recommend that central line should be enforced across all organizations to ensure that the quality of service delivery in both settings is improved.

The article states that there exist certain catheter care requirements whose intention is to reduce the impact of CLABSI among ICU and non-ICU patients. Some of these recommendations include education to all healthcare personnel involved in the maintenance of catheter, disinfecting of hubs, proper prior preparation of skin antisepsis and the use of needleless connectors.

The main purpose of the study was to come up, implement and carry out an evaluation of a central line care system that was previously designed to enhance the operation of the central line practices in a bid to reduce CLABIS among patients. Furthermore, several studies have been conducted to establish the degree with which behavioral and educational interventions bundles have affected catheter practices and reduced incidences of CLABSI. This research is important since it focusses on non-ICU settings compared to most prior studies that focus on ICU settings where these infections have gradually reduced (O’Neil, Caroline, Ball & Warren, 2016).

Method of Study

The study uses sample a population of one thousand two hundred and fifty inpatients who were under central line for either one or two days. This study did not exclude any patient from the study as long as they had this practice within the specified period. A total of eight wards were selected to represent the whole population. Four of these wards were used for the study as the intervention wards whereas the other four were used as controlled experiments. Both the control and the intervention wards were in separate locations, leadership and the under different staffs. No worker was allowed to rotate during the period of the study.

This setting and design required the intervention wards to follow all the CLABSI prevention policies established to prevent these infections. For instance, workers including nurses were required to dress properly, disinfect hubs and use needleless connectors within the study period. There was a daily assessment of the central line to determine whether there was a need to continue using the practice. During this study period, staff were well trained and educated on everything about central line procedures and policies.

The intervention bundle was key for this study hence more attention and resources were used to facilitate nurses’ operations. This bundle required nurses to devote all their knowledge and attention to patients. For instance, it was a requirement to include photo slides that demonstrated procedures for proper catheter dressings.

The study uses different instruments of data collection in preparation for data analysis. First, data from the patients is collected using a hospital electronic system that collects the necessary medical records. Some of the data collected for analysis included gender, age, the start and end of the catheter. Other information collected during the study included pharmacy records in determining the extent with which patients used chemotherapy. Related infections were also investigated hence the need to collect data from patients suffering from neutropenia. This type of data was obtained from the laboratory. Data collected using Non-ICU CLABSI systems were shared among the intervention wards. This was part of the intervention bundle where wards learned about other wards and the combined outcome of all intervention wards.

Findings of the study

The study found out that the implementation of the central line was important in improving the health of both intervention and control wards’ patients. The study also found out that the level of CLABSI infections reduced in the intervention wards. However, this decline was not statistically significant compared to the decline in the control wards where significant changes were recorded. Observation data regarding the dressing practice showed that there was a gap in catheter from both the intervention and the control wards. Other studies have shown that poor dressing practices have resulted in poor care practices among patients.

In this study, most nurses complained that undated dressings were a big challenge to the achievement of the dressing changes required to reduce CLABSI cases among patients. Furthermore, significant changes witnessed in control wards were contributed by higher dressing practices in these control wards. The whole study showed that there was 78.8% compliance improvement in dressing among the intervention wards and 84.9% improvement control wards (O’Neil, Caroline, Ball & Warren, 2016).

Ethical Considerations

The study values the privacy of the patients and the staff members. First, patients’ details are obtained from the medical record system where all their information is stored. Despite the system having all the information regarding patient’s credentials, it does not reveal this information. The study uses a general perceptive to identify its potential sample population. It uses information such as age, genders and admission dates, but fails to use information such as patients’ name. The main objective of this feature is to safeguard patients’ privacy from leaking to the public. Furthermore, the study’s protocol was reviewed and approved by a recognized human research body. This sanction is significant since it shows that the study followed all the requirements of a good study.

Conclusion

It is important to ensure that all areas in the healthcare industry are treated equally to promote the equality of healthcare across the country. It is important that this study focusses on a non-ICU setting by observing catheter insertion practices which provide a more comprehensive microbiology perspective. Furthermore, the reduction of the CLABSI in intensive care units have proved to be effective in the United States. This implies that focusing on both ICU and non-ICU settings would be more effective in bringing the required changes in the medical industry. Therefore, it is important to carry to out extensive research to come up with an optimal strategy to reduce these infections.

Reference

O’Neil, Caroline, Ball, K. & Warren, D. (2016). A Central Line Care Maintenance Bundle for the Prevention of Catheter-Associated Bloodstream Infection in Non-ICU Settings. Infection Control and Hospital Epidemiology, 37(6): 692-698. doi: 10.1017/ice.2016.32