Central Line Clinical Practice Guideline & Rational
Central venous catheters (CVCs) are frequently used in intensive care units (ICUs) for a number of reasons (measure central venous pressure, when peripheral veins are unable to be accessed, administration of medications/therapies and aspiration of blood samples) (Conroy, 2006, p. 98). Patients in this environment already have an increased risk of infection because of their treatments. Patient treatments commonly involve invasive devices or interventions (major surgery), antibiotic therapy (raises the risk of bacterial resistance) while steroid, chemotherapy and radiation therapy all suppress the immune system (Hatler, Hebden, Kaler, & Zack, 2010).
NSWHealth (2005) found that 20-40% of all healthcare associated bloodstream infections may be linked to an inserted CVC. These incidences of central line associated bloodstream infections (CLABSIs) have a negative impact on the patient, whose hospital stay is increased, further exposing them to potential complications while significantly contributing to hospital costs (Soufir et al., 1999). Therefore clinical practices associated with CVC management are integral to nursing practice in high acuity areas too ensure patient safety and minimising costs to health care providers.
Sarah Dobinson is a patient at increased risk of infection she is an older patient in a hyper metabolic state secondary to trauma. To ensure Sarah’s safety a set of CVC guidelines have been developed using the most recent primary sources. These guidelines will focus on nursing interventions post insertion in an adult ICU setting they have been developed under four sections addressing the importance of hand hygiene and aseptic technique, changing of administra...
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...ter-Related Infections in Critically Ill Adults. The Journal of the American Medical Association, 301(12), 1231-1241. doi: 10.1001/jama.2009.376
Timsit, J.-F., Schwebel, C., Bouadma, L., Geffroy, A., Garrouste-Orgeas, M. t., Pease, S., . . . Lucet, J.-C. (2009). Chlorhexidine-Impregnated Sponges and Less Frequent Dressing Changes for Prevention of Catheter-Related Infections in Critically Ill Adults: A Randomized Controlled Trial. The Journal of the American Medical Association, 301(12), 1231-1241. doi: 10.1001/jama.2009.376
Ye-benes, J., Vidaur, L., Serra-Prat, M., Sirvent, J., Batlle, J., Motje, M., . . . Palomar, M. (2004). Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: A randomized controlled trial. American Journal of Infection Control, 32(5), 291-295. doi: 10.1016/j.ajic.2003.12.004
Antimicrobial therapy is the cornerstone sepsis treatment, and the therapeutic goal should be centered around administration of effective IV antibiotics within 60 minutes of septic shock or severe sepsis (without shock) recognition. The initial antimicrobial therapy should be empiric and focused on having activity against all expected pathogens (bacterial, fungal, viral), based on each individual patient situation. Daily reassessment of antimicrobial therapy should be performed, with de escalation in mind; procalcitonin levels can be of use to direct discontinuation in patients with no evidence of infection following initial septic
However, increasing antibiotic resistance patterns among intensive care unit pathogens, cultivated by empiric-broad spectrum antibiotic regimens, characterizes the variable concerns. Recent literature point that antibiotic use before the development of VAP is associated with increased risk for potentially resistant gran-negative infections and Methcillin-resistant Staphylococcus auereus (MRSA)
Catheter Acquired Urinary Tract Infections (CAUTIs) has become to be classified as one among the leading infections which most individuals end up being susceptible to acquire while at the hospital. Healthcare-associated or acquired infections (HAIs) are a significant cause of illness, death, and more often than not, have resulted to cost the tax payers potentially high medical expenses in most health care settings. ("Agency for Healthcare Research and Quality," para. 1) Due to this, 1 out of every 20 patients will end up with CAUTI within the US hospitals and this has caused Agency for healthcare research and quality (AHRQ) to embark on nationwide plans to help in the eradication and control of CAUTI incidences. ("Agency
Capriotti & Frizzell (2016) explain that sepsis is often seen in those who have a weak immune system. These individuals are at an increased risk of developing sepsis from microorganisms that a healthy immune system would normally fight off (Capriotti et al. 2016). The elderly, infants, and immunosuppressed patients are the most at risk for developing the condition (Capriotti et al. 2016). Sepsis can be caused by any microbe, but is most often caused by bacteria (Capriotti et al. 2016). Since sepsis has such a broad reach and can develop as a secondary infection after an initial injury or illness, Capriotti & Frizzell (2016) further explain the di...
Clinical Infectious Diseases, 49(3), 438-443. Doi:10.1086/600391. See full address and map. Medicare.gov/Hospital Compare - The Official U.S. Government Site for Medicare (n.d).
Summary: In this journal Deborah Ward speaks about how hand washing is only the first step in infection prevention and that there are many other steps that must be taken such as the use of sterile gloves. Mrs. Ward talks about client home care and how with these clients it is not always easy to keep a sterile environment. Deborah Ward explains how when using alcohol rubs is that they need to be used just as thoroughly as soap and water. While alcohol rubs are handy hand washing should still be taking place every time a nurse enters a patient's room. Mrs. Ward explains how as the nurse you should always be doing risk assessments for what form of personal protective equipment you should be utilizing while working with clients. She also explains
Zawistowski, C. A. (2013). The management of sepsis. Current Problems in Pediatric and Adolescent Health Care, 43(10), 285. doi:10.1016/j.cppeds.2013.10.005
practitioner and patient decisions about appropriate health care for specific clinical circumstances". Their purpose is "to make explicit recommendations with a definite intent to influence what clinicians do". Additionally, guidelines have an important role in standardization care and health policy formation such as health promotion, screening etc.
This literature review will analyze and critically explore four studies that have been conducted on hand hygiene compliance rates by Healthcare workers (HCWs). Firstly, it will look at compliance rates for HCWs in the intensive care units (ICU) and then explore the different factors that contribute to low hand hygiene compliance. Hospital Acquired infections (HAI) or Nosocomial Infections appear worldwide, affecting both developed and poor countries. HAIs represent a major source of morbidity and mortality, especially for patients in the ICU (Hugonnet, Perneger, & Pittet, 2002). Hand hygiene can be defined as any method that destroys or removes microorganisms on hands (Centers for Disease Control and Prevention, 2009). According to the World Health Organization (2002), a HAI can be defined as an infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. The hands of HCWs transmit majority of the endemic infections. As
The initial cause of all further problems is the infection. This can occur anywhere in the body. The most common sites of infection that can lead to sepsis include: urinary tract, skin, abdominal, and respiratory. These infections can occur at any time, in any population; however, there are some groups of people who are at a higher risk. These include individuals who have been diagnosed with: diabetes mellitus, renal failure, heart failure, and chronic obstructive pulmonary disease (Leon, Hoyos, Barrera, De La Rosa, Dennis, Duenas, Granados, Londono, Rodriguez, Molina, Ortiz, Jaimes, 2013). The infection is the first step in patients who go into septic shock. Performing cultures and treating this infection e...
Hospital data on specific NSI impacts the outcomes of care within the whole institution. Being aware of the data regarding the prevalence of a problem can lead to resolution or at the very least minimizing the risk factors. For example, if the data shows that infection levels with Foley catheter insertion have increased, then that knowledge should lead to new guidelines to decrease this incidence. The data demonstrating this change, if showing a decrease in incidence, is a reflection of the effect that competent nursing care can have on the outcome
Central lines (CL) are used frequently in hospitals throughout the world. They are placed by trained health care providers, many times nurses, using sterile technique but nosocomial central line catheter associated blood stream infections (CLABSI) have been a dangerous issue. This is a problem that nurses need to pay particular attention to, and is a quality assurance issue, because CLABSI’s “are associated with increased morbidity, mortality, and health care costs” (The Joint Commission, 2012). There have been numerous studies conducted, with the objective to determine steps to take to decrease CLABSI infection rate, and research continues to be ongoing today. The problem is prevalent on many nursing units, with some patients at great risk than others, but some studies have shown if health care providers follow the current literature, or evidence based guidelines, CLABSIs can be prevented (The Joint Commission, 2012). The purpose of this paper is to summarize current findings related to this topic, and establish a quality assurance (QA) change plan nurses can implement for CL placement and maintenance, leading to decreased risk of nosocomial CLABSIs.
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.
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
(2014) shed light on two key components for infection control, which includes protecting patients from acquiring infections and protecting health care workers from becoming infected (Curchoe et al., 2014). The techniques that are used to protect patients also provide protection for nurses and other health care workers alike. In order to prevent the spread of infections, it is important for health care workers to be meticulous and attentive when providing care to already vulnerable patients (Curchoe et al., 2014). If a health care worker is aware they may contaminate the surroundings of a patient, they must properly clean, disinfect, and sterilize any contaminated objects in order to reduce or eliminate microorganisms (Curchoe et al., 2014). It is also ideal to change gloves after contact with contaminated secretions and before leaving a patient’s room (Curchoe, 2014). Research suggests that due to standard precaution, gloves must be worn as a single-use item for each invasive procedure, contact with sterile sites, and non-intact skin or mucous membranes (Curchoe et al., 2014). Hence, it is critical that health care workers change gloves during any activity that has been assessed as carrying a risk of exposure to body substances, secretions, excretions, and blood (Curchoe et al.,