Central line-associated blood stream infections (CLABSI) are among the top hospital-acquired infections and directly associated with mortality and morbidity, extended length of stay, and increased cost of care (Kellie et al., 2014). CLABSI is exponentially important for the intensive care patient. Results of decreased incidence of infection are directly attributed by bundle interventions, improving patient outcomes. Bundle care interventions outside of critical care has not widely been reported (Klintworth et al., 2014). Placement of central lines are necessary for measuring right arterial pressure as well as fluid administration (Hinkle & Cheever, 2014). Collaborative efforts are needed in order to prevent occurrence. Bundle care is implemented …show more content…
(2014) conducted a retrospective data review to determine whether current interventions were effective in preventing central line-associated blood stream infections (CLABSI). The study included sequential patients admitted to the medical intensive care unit at University of Louisville Hospital from 2009 to 2010. This facility is a level I trauma center consisting of 404 beds in a large metropolitan area. The current interventions studied included implementation of care bundles, use of chlorhexadine, fully sterile procedures and improved adherence to existing policies. During this study, in addition to current interventions, critical care educators were required to conduct in-services on CLABSI, attend staff meetings, and also require nursing staff to complete a checklist during central line insertion. During the completion of this checklist, the nursing staff must also require the physician to sign the document acknowledging of the assessment of adherence to standards during the procedure (Kellie et al., …show more content…
(2014), focuses on determining if proper preventative care bundling reduced the rate of CLABSI. The study involved a multimodal CLABSI risk reduction strategy which was implemented over a 20 month period from April 2009 to March 2011. The facility involved was a 700 bed tertiary referral center located in Australia. Before the study, the use of preventative interventions were examined. These included hand hygiene promotion, auditing, use of chlorhexadine gluconate, avoidance of the femoral site, proper sterile technique. The study was a quality-improvement initiative introduced to evaluate effectiveness of proper implementation of interventions to reduce CLABSI incidence. Additional measures were introduced step-wise from April 2011 to December 2012. These included monthly surveillance reports and education involving infection prevention. A Poisson distribution with P < .05 deemed statistically significant were assumed when comparing CLABSI rates before and after the interventions (Klintworth et al.,
According to an article by Timsit, J., et al. an estimated 5 million central venous catheters are inserted in patients each year. CBIs, most of which are associated with central venous catheters, account for more than 11% of all health-care associated infections. Additionally, more than 250,000 central-line associated blood stream infections also occur annually, with an estimated mortality rate of 12-25%. For patients within the intensive care unit, the numbers were even higher. Each episode significantly increases the patient’s hospital stay, as well as increasing costs from $4,000 to $56,000 per episode.
This unit has the highest identified CLASBI rate. Correction of the rate in this unit may have the greatest impact on the total hospital rate. In addition it has a limited number of staff as compared to the total hospital. This unit likely represents the highest number of central line use at any single time interval. By beginning the CPG in this unit, the PDSA cycles can be utilized to optimize the process for Baptist before the attempt is made to move it the rest of the hospital. By beginning the process in the ICU, there will be a group of line care experts and champions to move the process out the rest of the hospital. The use of central lines is ubiquitous through out the hospital and so should the care
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
Bloodborne Pathogens are pathogenic microorganisms that can eventually cause disease. They are found in human blood and other bodily fluids such as synovial fluid, semen, vaginal secretions, cerebrospinal fluid and any other fluid that mixes or has contact with blood. The bloodborne pathogens are pathogenic, which means they are disease causing, and they are also microorganisms, which means that they are very small so the human eye cannot see them.
5), many hospitals in conjunction with the Joint Commission's 2012 National Patient Safety Goals has been rallying for hospitals to use evidenced-based practices (EBP) to the prevention of CAUTIs because evidence is growing showing that many are avoidable. Such practices such as utilizing a nurse-driven protocol to assess and evaluate the appropriateness and use of urethral catheter to determine how long a patient should have an indwelling catheter and when to discontinue it. Several factors have been identified that pose as risk factors to CAUTI which include but not limited to drainage bag not being below the level of the bladder, healthcare personnel not practicing standard precautions and utilizing aseptic techniques during insertion of catheters, unsterile equipment, and unnecessary placement of urinary
“Early Recognition and Treatment of Sepsis in the Medical-Surgical Setting,” focuses on the nurse’s role in being able to identify early signs of sepsis and initiating the sepsis bundle quickly. In the article, “Nurses’ Critical Role in Identifying Sepsis and Implementing Early Goal-Directed Therapy,” it explains how the interventions in the sepsis bundle have decreased mortality from 37% to 30.8% in a two year study conducted in 165 different health care sites. This article also details clinical guidelines and timelines for implementing the sepsis bundle. Early stages of sepsis and clinical manifestations are discussed in the article, “Helping Patients Survive Sepsis,” with emphasis on the i...
Pathogens are a type of microorganism that spreads viral and bacterial diseases. These diseases when present in human blood and body fluids are known as blood borne pathogens, and can spread from one person to another. (Worcester polytechnic institute) The most serious types of blood borne diseases are the hepatitis B virus (HBV) and hepatitis C virus (HCV), which can cause liver damage; and HIV (human immunodeficiency virus), which is responsible for causing AIDS (acquired immune deficiency syndrome). The blood borne pathogens can be spread when the blood or body fluids (semen, vaginal fluid, breast milk, and amniotic fluid) of an infected individual comes into contact with mucous membranes or an open sore or cut on the skin of another person. Mucus membranes are located in the eyes, nose, mouth, and other areas as well. ("Bloodborne pathogens: MedlinePlus Medical Encyclopedia") Two of the most common ways that pathogens are transmitted is through the exchange of fluids during sexual intercourse or by sharing infected IV needles. (Worcester polytechnic institute)
Each year the number of health care associated infections (HAI) increases and has been estimated to be in the hundreds of millions of people around the world. In the United States this accounts for approximately 1 in 25 patients ("Hand Hygiene Basics," 2014). Health care associated infections are considered to be the most persistant adverse event in health care. Hand washing is considered to be one of the best methods for preventing the spread of infection and that poor hand hygiene places patients at high risk ("The Evidence for Clean," n.d.). Patients receiving care in hospitals, long term care facilities, and nursing homes are especially at high risk for developing infections while being cared for. Most health care associated infections
CLABSIs are not confined to one unit of nursing care and there are many precipitating factors that may contribute to the development of a CLABSI. Often times these lines are placed in emergent situations in the emergency department (ED) and there may be a break in sterile technique. However a study conducted by Smith, Egger, Franklin, Harbrecht, and Richardson (2011) found a higher incidence of CLABSIs among intensive care unit (ICU) patients compared to those patients whose CLs were placed either in the ED or operating room (OR). This indicates further education for ICU s...
Prevention of hospital-acquired infections: review of non-pharmacological interventions. Journal of Hospital Infection, 69(3), 204-219. Revised 01/20 Haugen, N., Galura, S., & Ulrich, S. P. (2011). Ulrich & Canale's nursing care planning guides: Prioritization, delegation, and critical thinking. Maryland Heights, Mo. : Saunders/Elsevier.
This essay critically examines the relationship between interventions and the dubious increase in hand hygiene compliance by healthcare professionals by using the framework of evidence-based practice to evaluate previous literature, identify barriers, and note mechanisms used to measure effectiveness of interventions. The systematic review, Interventions to improve hand hygiene compliance in patient care, conducted by the Cochrane Collaboration investigated innovations to improve hand hygiene compliance within patient care. The review included 2 original studies with an additional two new studies (Gould & Moralejo et al., 2010). Throughout the review, it was affirmed that while hand hygiene is an indispensable method in the prevention of hospital-acquired infections (HAI), the compliance among nurses’ is inadequate. Nurses are identified within the public as dependable and trustworthy in a time of vulnerability due to their specialised education and skills (Hughes, 2008).
Patient safety must be the first priority in the health care system, and it is widely accepta-ble that unnecessary harm to a patient must be controlled.Two million babies and mother die due to preventable medical errors annually worldwide due to pregnancy related complications and there is worldwide increase in nosocomial infections, which is almost equal to 5-10% of total admissions occurring in the hospitals. (WHO Patient Safety Research, 2009). Total 1.4 million patients are victims of hospital-acquired infection. (WHO Patient Safety Research, 2009). Unsafe infection practice leads to 1.3 million death word wide and loss of 26 millions of life while ad-verse drug events are increasing in health care and 10% of total admitted patients are facing ad-verse drug events. (WHO Patient Safety Re...
The Infection Prevention and Control (IPC) Program is an essential force maximizing quality, patient centered care, and safety throughout the Veterans Affairs North Texas Health Care System (VANTHCS). The VANTHCS “... is a progressive health care provider in the heart of Texas ... we serve more than 117,000 Veterans and deliver 1.4 million outpatient episodes of care each year to Veterans in 38 Texas counties and two counties in southern Oklahoma” (“VA North Texas,” 2016, para. 1). The purpose of the IPC Program is to guide a facility-wide approach toward identifying, preventing, controlling, and eliminating healthcare-associated infections (HAIs). This approach is facilitated through infection control (IC) practitioner’s role-modeling behaviors of assessing, supporting, guiding, and/or directing healthcare providers (HCPs) in the application of evidence-based practices (EBPs) to prevent HAIs. According to the Centers for Disease Control and Prevention (CDC), HAIs are often preventable adverse events that pose a major threat to patient safety (“Centers for Disease,” 2016). As a result, IC practitioners recognize the importance of preparing nurse faculty to engage clinical staff in the application of EBPs to prevent infections.
One day, this writer happened to see another nurse changing a Peripherally Inserted Central Catheter Line dressing. As a nurse leader, this writer asked the nurse why she is changing the dressing. The caregiver explained dressing changes can prevent infection to the site and there are lot of patients readmitted because of central line infections and subsequent complications. This nurse demonstrated good kn...