Reduce Catheter-Related Infections In Hospitalized Patients
Restate your practice issue. Why is this a problem? Give statistics and information to back the scope of the problem at your facility/work area. How does this problem impact healthcare on a broader scale?
You will be the leader of the team since this is your project. Who will you also include in your team? Make sure you choose relevant stakeholders. You should have no more than eight members. Do not list your team members by name but instead by position (pharmacists, charge nurse, etc.)Reduce Catheter-Related Infections In Hospitalized Patients.
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Why are the members chosen important to your project? What are their roles?
Conduct internal/ external search for evidence. What type of evidence did you find in addition to you Evidence Summary? EBP guidelines? Quality improvement data? Position statements? Clinical Practice Guidelines? Briefly discuss the strength of this research. This is not where you describe the results of your studies. This is done in the following steps.
In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.
Develop Recommendations for Change Based on Evidence
What is your recommendation based on the research? Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program.
You have not implemented your project yet, therefore, this section will be hypothetical. Develop your plan for implementation. What are the specific steps you will take to implement your pilot study? What is the timeline for your plan? Make sure you include a plan for evaluation of outcomes and method to report the results.
What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders?
How will you implement the plan on a larger scale? Will this be applicable to other units or the facility as a whole? What will you do to ensure that the implementation becomes permanent?
How will you communicate your findings internally (within your organization) and externally (to others outside of your organization)?
Provide a clear and concise summary. Review the key aspects of the problem as well as the change model. Be sure to include important aspects of the five points of the ACE Star change model EBP process and ways to maintain the change plan.
Scope Of The EBP
The hospital acquired diseases are prevalent in health care sector, which is significantly reducing the health outcomes of patients. One of the key hospital acquired disease is catheter associated infection. The central venous catheter is a common device, which is being used for several functions in hospitalized patients, which develops a high risk of developing infection at the site of catheterization, which ultimately enhances the mortality and morbidity rates (Regagnin et al., 2016).. Although several previous literatures have shown potential ways to reduce the mortality and morbidity rates associates with catheter-related infections. Within these interventions, use of skin antiseptics and assessment of skin antisepsis. However, the key issue is great uncertainties in those estimates due to underpowered analysis and low quality of evidences (Bouk et al., 2016)Reduce Catheter-Related Infections In Hospitalized Patients. Thus, in this context, there is a potential need for assessing and reviewing the pre-existing evidences related to the issues and identifying the potential solutions from those evidences, in order to develop an action plan that will address the issue effectively. Here, an action plan would be proposed for addressing the issue.
The ACE STAR model of knowledge transformation is a framework that helps to integrate evidences into practice through a systematic approach. The model includes five major stages including knowledge discovery, evidence summary, translation into practice recommendations, integration into practice and evaluation. In order to address the current issue, it is important to review what have already been done regarding this issue and what are left to be done, in order to improve the situation. For doing this, ACE STAR model is one of the best models that can be explored to integrate evidences into practice, leading to the integration of the best possible changes (Bondmass, 2012).
According to the study by Lai et al., (2016) there is significantly low evidence related to the best antiseptic medications related to catheter associated infection prevention. On the other hand, outcomes of those small scale interventions were also poorly reported. Thus, based on only this information, it is not relevant to administer interventions to the patients. Therefore, there is a need for an in-depth review of relevant literatures and an action plan for reducing the catheter-related infections. It has been estimated that the risk of central venous catheter associated infections is significantly high with the incident rate of 2 to 7 episodes within 1000 catheter days in hospital ward (Deatherage, 2016). As a result, the issue is significantly affecting the health care sector by enhancing the rate of mortality and morbidity rate of patients. In ICU patients, the net cost for infected patient is estimated to be from $34,508 to $56,000 per episode, which is significantly posing burden on health care sector (Lai et al., 2015)Reduce Catheter-Related Infections In Hospitalized Patients.
Stakeholders
There is a need for selecting the team members and defining their roles, prior delegating tasks for developing the action plan based on reviewed literature. In this context, the current project team would include a team leader, pharmacist, skin specialist, registered nurse, charge nurse practioner, GP, HSC staff and financial analyst.
The team leader would disseminate tasks within the team members, while continuously monitoring their roles. For instance, the pharmacist will search the most appropriate skin remedies for reducing catheter-associated infections. On the other hand, the skin specialist and registered nurse would review the incidences of catheter related infections among hospital patients. The nurse practitioner, GP and skin specialist physician would search and review relevant literatures. The HSC staff would search the right method of conducting and developing the action plan (Walters, 2016). The financial analysis will develop the budget plan. All the team members will take part in developing the action plan.
The central venous catheter is one of the devices that help to monitor the hemodynamic indicators as well as administer the intravenous medications. This can include the blood products, parental nutrition, and fluids. It may lead to the catheter- related blood stream infection as the micro- organisms colonize this foreign substance. As a result, it can increase the morbidity, health care loss, and mortality rate. However, for the research, there was no language barrier and some specific databases are used to find the data and only the randomized controlled trial articles are included. As the evidence- based practice is the standard of the health care practice; hence, it is followed in the review. The clinical practice guideline as well as the quality improvement data is added in the research. The evidence- based interventions include the staff education, hand hygiene, at insertion site effective skin antisepsis (Lai et al., 2016)Reduce Catheter-Related Infections In Hospitalized Patients. Moreover, it states about the quality assurance that is monitoring the compliances systematically to the set up guidelines as well as evaluate the issues, which is related to the compliance. Another information that is gained from it is aseptic techniques are use while insertion as well as using the CVCs. It is necessary to maintain the maximum sterile barrier precautions by using the sterile gloves, masks, cap, using large sterile drape, and sterile gown. The skin antisepsis can prevent the microbial contamination at the time of catheter. In such way, the risk of the catheter can be prevented or reduced.
Determining The Responsibility Of Team Members
However, the contamination can lead to the colonisation of the external catheter infection and the skin antisepsis can reduce the BSIs. This can be done with the short- term CVCs. As mentioned by Galeon and Romero (2014), the antisepsis is the infection prevention by the help of the inhibition of the growing micro- organism. The antiseptic agent starts its working instantly after injected in the living tissues. This can include the presences f the small blood and is very much effective against the pathogenic bacteria. However, Chen et al., (2015) stated that it needs to be non- toxic for the living cells and can be used safely on the all body parts repetitively. The mechanical actions of washing hands with soaps, and water can reduce the risk of the catheter and the residential flora can tend to be inhibited in the deeper layer of skin. As the resident as well as the transient flora implicate in pathogenesis of the CVC that is Associated with the infection can be effective for the skin antisepsis. Moreover, it requires the mechanical removal as well as the chemical killing. On the other hand, Cheung et al., (2015) mentioned that the inhibition of the resident as well as transient flora is included. The evaluation strategies are identified in accessing the baseline data, data result of pilot implementation, and interim data. The CAUTI program can help to reduce the problem. Hence, before implanting the plan, it is necessary to check the strength and weakness of the project.
Initially, based on the reviewed evidences and knowledge base of the team members, the goals for the action plan will be developed.
| Goal | Actions | Time |
| Reduce catheter-associated infections | Introducing skin assessment; evidences have revealed that the risk of catheter-associated infections is embedded in skin density of microbiota and to the risk of thrombophlebitis. Thus, it is important to assess these parameters prior selecting an area to insert the catheter (Chen et al., 2015). Aligning hospital procedures for catheter-associated patient’s care with CDC guidelines, constant surveillance, use of femoral vein, avoiding unnecessary catheterization, introducing advance stage sterilization of patient’s room or ward to prevent infection colonization, | The time required for achieving this goal is 3 months |
Developing efficient workforce
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Advance training of staffs related to catheter associated infection control, changing position of patients frequently, removing catheter as soon as it is not needed, changing the location of catheter as soon as any kinds of inflammation or sign of infection is observed, using proper antiseptic solutions, training for hand hygiene
Conducting hand hygiene workshop for nursing staffs, staff education for catheter insertion and prevention strategies for blood stream infection; hiring experienced staffs (Deatherage, 2016) |
The time required for achieving this goal is 6 months |
| Providing best medication remedy to patients | Reviewing the literature, the best medication, i.e. the best skin antisepsis should be selected on the basis of the status of the infection and the skin type of the patient. In this context, as there is poor evidences related to the most effective skin antiseptic medication for reducing catheter-associated infection, aqueous chlorhexidine, povidone-iodine and alcohol and the combination of these medications would be tested for finding the most appropriate solution (Denny & Munro, 2017) | The time required for achieving this goal is 3 months |
The desired outcomes of the above action plan are reduced incidents of catheter associated infections among patients and reduced mortality rate in the hospital. The outcomes would be measured after exceeding the timeline, by estimating the total number of catheter associated infection and fatal cases in the hospital and the reports would be disseminated within the stakeholders through meetings, emails and publishing the report in hospital website (Fasugba et al., 2016). Based on the outcomes of this pilot study, the applicability of the interventions in major scale would be decided.
Conclusion
In conclusion, it can be said that the central venous catheter associated infection is one of the most common issues identified in hospital, which significantly affects patient’s well being. There is significantly little evidences related to the best antiseptic solutions for the issue. With the help of ACE STAR model, the current project proposed a change plan for resolving the issue Reduce Catheter-Related Infections In Hospitalized Patients.
Reference List
Bondmass, M. D. (2012). Application of the ACE Star Model and Essential Competencies in a DNP Program.
Bouk, M., Mutterer, M., Schore, M., & Alper, P. (2016). Use of an electronic hand hygiene compliance system to improve hand hygiene, reduce MRSA, and improve financial performance. American Journal of Infection Control, 44(6), S100-S101.
Chen, W. T., Wang, C. Y., Huang, H. R., Tseng, H. C., & Shih, C. C. (2015). Reducing catheter-related bloodstream infection by implementing hospital-wide central venous catheter bundle at a cancer hospital. Journal of Microbiology, Immunology and Infection, 48(2), S155-S156.
Cheung, C. W. Y., Wong, Y. Y., Lau, S. S., Ching, P. T. Y., Li, K. H., & Seto, W. H. (2015). Implementation of the catheter associated urinary tract infection (cauti) bundle with the help of infection control link nurses and infection control practice auditors. Journal of Microbiology, Immunology and Infection, 48(2), S95.
Deatherage, N. (2016). Impact of Reduced Isolation and Contact Precaution Procedures on Infection Rates and Facility Costs at a Non-Profit Acute Care Hospital. American Journal of Infection Control, 44(6), S101-S102.
Denny, J., & Munro, C. L. (2017). Chlorhexidine Bathing Effects on Health-Care-Associated Infections. Biological research for nursing, 19(2), 123-136 Reduce Catheter-Related Infections In Hospitalized Patients