Use of eye protector while taking artirial blood sampling - Essay Example

? Infection Control Issues in the Intensive Care Unit: Arterial Line Sampling and the Use of Protective Eye Wear University Name Abstract Arterial line sampling is the process of drawing a blood sample from a previously placed arterial catheter. It is used for many reasons in the intensive care unit and can not be avoided when working with critically ill patients. These patients may be infected with all manner of potentially dangerous microbial agents. When dealing with potentially infected blood, it is important that safety with regards to infection control is kept as a top priority. Arterial line sampling carries with it the risk of infected blood splashing or spraying, and in this manner coming in contact with the face and eyes. Therefore, this proposal lays out a strategy for reducing this risk through the use of protective eye wear during the procedure. The change management strategy follows the intervention strategy model, which is based on systems theory. Possible issues with the change as well as solutions to these issues, especially that of compliance with the new policies, are laid out. These solutions include staff involvement in the change design, education on the suggested new policies and the reasoning behind these policies, and the placement of infection control personnel to perform use audits. Finally, future expansion of the use of this equipment for infection control is described. Arterial Line Sampling and the Use of Protective Eye Wear Background Information: Arterial lines are small, thin catheters placed in the peripheral arteries of a patient, usually placed in the radial or femoral artery, though they can be put in any major artery depending on the needs of the individual patient and the nature of that patient's injuries. These lines must not be used for delivery of medications due to a very high risk of tissue damage by such medications as sodium pentothal. Despite this restriction on their use, these arterial lines are often placed in critical care and intensive care patients, as they allow constant monitoring of blood pressure and other vital functions. This constant monitoring is a necessity in a severely injured or ill patient, and the use of these lines is nearly ubiquitous in the intensive care unit at any hospital (C. King et al. 2007). As an extension of this, arterial line sampling is the process of taking a blood sample through the arterial line, rather than through the use of a needle stick method that would be more common outside the intensive care unit. The use of an arterial line provides easier and faster access for taking such blood samples, which can then be used for many types of information gathering techniques as blood gas analysis, toxicology screens, and other tests. Use of an arterial line is safer for both the patient and the caregiver than the use of needles when repeated samples need to be taken, as is often the case in the intensive care unit. It reduces the risk of needle stick injury to the ward staff as well as reducing trauma by the repeated needle stick to the patient (Society of Critical Care Medicine 2008). This type of needle stick trauma is not to be taken lightly, as it can lead to oxygen de-saturation, which is especially common in paediatric and neonatal patients (C. King et al. 2007). Since the patients in the intensive care unit are already, by definition, in critical or severe condition, it is imperative that they are protected from such possible negative effects of what is supposed to be helpful treatment. Arterial line sampling is therefore clearly to their benefit, and with the patient's needs satisfied, hospital policy must now focus on protecting the interests and safety of the hospital staff. As was mentioned previously, the point of arterial line sampling is to collect blood samples for analysis. Whenever blood is being drawn or handled, there is always a high risk of infection from blood-borne pathogens if a nurse or other medical practitioner should come into contact with the fluids. These include such extremely dangerous and contagious pathogens as Human Immunodeficiency Virus, hepatitis B, hepatitis C, and many others too numerous to list here. Infection control by avoiding fluid exposure is especially of high concern in the intensive care unit setting, as studies show that the majority of bodily fluid exposures from splashes and needle stick injuries occur in nurses and in the intensive care unit. This then puts the intensive care unit nurses at even higher risk than other groups for infections acquired while working with patients, at the crossroads of these two risk factors (Murray et al. 2009). Description of Suggested Change: With these risks from exposure in mind, it is imperative that we analyze all methods of exposure to these pathogens that may occur when dealing with potentially infected blood, including those involved with the process of arterial line sampling. Current procedures require that nurses follow standard hygiene procedures and wear gloves when sampling from an arterial line in a patient. No facial or eye protection is currently required by hospital policy, even though there is a risk of splashing or spraying of blood during the procedure. If blood from the arterial line were to reach the eyes, the nurse could be exposed to blood-borne pathogens. As a result of these described risks, the obvious solution to this problem is to require the use of eye protection to be worn by the nursing staff when sampling an arterial line. The instigation for this solution is the previously mentioned risk of blood-borne pathogen infection from bodily fluid exposure, and the fact that it can be reduced or prevented by this simple change. Additionally, this suggestion was inspired by the actual occurrences in this intensive care unit of splashes to the face when performing an arterial line sampling. Change Management Model, Procedures, and Strategy: The suggested change management model for this solution is the intervention strategy model. This management model proposes that every change situation, even highly complicated ones, can be resolved through the analysis of the problem to be solved and the solution to be implemented from the view-point of the system affected as a whole. The intervention strategy model has three major stages, although each stage has several sub-points. These major stages are, first, the definition stage; second, the evaluation and design stage; and, finally, the implementation stage. The definition stage is primarily focused on laying out the objectives of the change and analyzing the environment within which the change will take place. This information is the background necessary to perform the steps of the second stage. The evaluation stage involves analyzing the proposed solution and comparing it to designated performance indicators. This stage is the point at which to consider possible difficulties that could occur with implementation and to lay out the strategy to use in the final stage. The implementation stage is when the change is introduced to the system, and also when the effects of that change are monitored in the real-world environment, a result that is difficult to predict during the evaluation phase (Paton & McCalman 2000). The objectives of this proposed change are obvious: to reduce the risk of infection by blood borne pathogens from splashes to the face and eyes during arterial line sampling. A secondary objective, which is needed in order to achieve this primary goal, is to ensure that the staff makes use of the new protective eye wear that is being provided for their safety. If they do not use the new equipment, putting it in place will benefit no one. While the environment of a hospital would seem to encourage high levels of hygienic and infection control practices, studies have shown that healthcare workers already do not comply fully with current universal safety precautions, even such simple practices as regular hand-washing or the the use of gloves (Gammon et al. 2008). This is a clear example of why an understanding of the environment is crucial to creating a change management strategy; more education and use audits are required for any new infection control technique if it is suspected that staff is already not following universal hygiene and infection control practices. It is already recommended that nursing staff wear protective eye wear when performing any procedures that could result in blood spraying onto the staff, and this does include the original placement of the arterial line (C. King et al. 2007). Additionally, some hospitals and governmental policies already require the use of protective eye wear when performing arterial line sampling (New South Wales Department of Health 1998). Using the environmental analysis and objectives of the descriptive stage, the evaluation stage can now lay out the strategy and possible issues for implementation. The first step in the strategy is to re-educate staff on the dangers of blood-borne pathogens, to encourage the use of current infection control procedures, as well as use audits for those practices. Secondly, education on the use of the equipment should begin before the equipment is actually put into place, so that the staff is prepared when the change does come into effect. Staff should be educated on when to use the new protective eye wear, how it should be used to best protect them, and also on the after care of the equipment so that it lasts longer and continues to work properly. This also allows for the management to take suggestions and complaints as to the nature of the implementation stage, so that changes can be made to the implementation strategy before problems occur. One way to avoid the issue of staff not using the equipment is to include nursing staff in the selection of equipment. Studies have shown that involving staff in the selection process for new equipment decreases negative incidents and increases compliance of the staff with safety practices. It also encourages them to follow proper procedures for the use of the equipment, since they themselves selected the equipment and know in advance how and when they are expected to use it (Baker 2008). Another portion of strategy to encourage use is to make sure that that the protective eye wear is placed at each patient bed side or in each patient room in the intensive care unit. If the equipment is readily available, there will less excuse for staff not to make use of it, reducing their risk of infection in this manner. This would also reduce the cost of purchasing equipment, since the protective eye wear would be needed per patient with an arterial line, rather than per member of the intensive care unit nursing staff. Another option for avoiding splashes and sprays during arterial line sampling is to change the procedure so that the face and eyes of the nurse are not directly over the patient's line while the sampling takes place. This positioning would put them further away from any possible spray during sampling. However, given the delicate nature of the procedure and the risk of adverse events if care is not taken with the handling of the line, this would be difficult to accomplish (C. King et al. 2007). The use of protective equipment to provide a barrier between the infected patient and the medical practitioner is the only true method of preventing exposure to bodily fluids. If they were worn properly, protective eye wear would reduce the risk of exposure through this method nearly to zero. At this point, there are few other obvious possible issues with the use of this equipment except for the added time stress on the nursing staff. This time stress can be alleviated first by making the educational interventions as unobtrusive and accessible as possible, such as by having video lectures available on nursing station computers to be viewed at the leisure of the staff, rather than requiring such lectures to be attended when it is convenient for the teacher. Second, the education itself can reduce the time stress put on the nursing staff, as familiarity with the equipment would mean that the time needed to put on, use, remove, and perform the required after care on the protective eye wear would be drastically reduced. Once the change is implemented according to the described strategy, the effect of the change and compliance with the new policy must be monitored and controlled. This is done through use audits, which are done to measure the actual usage of the new equipment, and continuing education on the new policy and the use methods of the new equipment. Compliance with safety policies is improved by having infection control personnel on staff for sufficient hours per full-time employee providing patient care. Such staff need to be physically in place to monitor usage (Vaughn et al. 2004). This is due to the fact that personal interaction with an infection control physician and a personal pledge to follow guidelines have best effect on compliance with infection control practices when compared to passive methods such as newsletters or posters (Salemi et al. 2002). Other usage audits should measure management and supervisor attitudes toward proper safety procedures. If management stresses speed and completion of work duties over patient and employee safety, new equipment such as protective eye wear will not be used; safety audits should take this into account instead of simply blaming employees for their actions (Vaughn et al. 2004). Educational intervention has been shown to increase compliance with universal hygiene and infection control practices (Gammon et al. 2008). Continuing education on new and old policies and equipment must take place with relative frequency, as infrequent re-education seems to have little effect on compliance with procedures (Vaughn et al. 2004). An easy way to ensure the education on arterial line sampling procedures is distributed is to give such education in combination with the education for the original placement of the arterial line. This information should be distributed through direct presentations, such as live lectures or video, as these have been shown to be much more effective at increasing compliance than posted notices or even letters sent by e-mail or on paper (Salemi et al. 2002). As mentioned during the evaluation phase, the educational classes need to cover the proper use of the protective eye wear, during which procedures the nurses need to wear the new protective equipment, and the proper care of the equipment. Future Expansion of Equipment Use: While the impetus for the protective eye wear suggested in this proposal is the risk of exposure to blood-borne pathogens specifically from splashes due to arterial line sampling, the risks of this procedure would not be the only reason to provide protective eye wear to the nursing staff of the intensive care unit. When working in close proximity to critically ill patients, there is always a high risk of exposure to many types of bodily fluids that may be contaminated with infectious agents. Eye wear could protect the care staff from exposure to saliva or vomit to the eyes, for example, both of which can carry dangerous pathogens such as the previously mentioned HIV and hepatitis in the same way that blood exposure can. Once the staff is comfortable and familiar with the use of protective eye wear when doing arterial line sampling, perhaps the use of the equipment could be expanded into other areas that are of lesser risk than currently require eye wear but still have the possibility of bodily fluid exposure. Examples of such procedures could be the placement of a IV line or any activity that requires the nurse to be within a few inches of the patient's face or any other bodily opening that could produce infected fluids. Conclusions: Arterial lines and arterial line sampling are used commonly enough in the intensive care unit that all precautions should be in place to protect the staff from possible harm arising from the procedure. Since there is a risk of splashing occurring to the face when sampling from an arterial line, it is proposed that protective eye wear be used whenever sampling is performed. The change management strategy proposed for this change in policy is the intervention strategy model, which is based on systems theory. Possible issues and strategies for solution implementation have been discussed, as well as the need for continuing use audits and education on the equipment. The placement of personnel to monitor the use of equipment and to perform the use audits for this and other infection control policies is absolutely vital if staff compliance with these new policies is to be assured. Future possible expansions of the use of this equipment were also suggested, to protect intensive care unit staff from other bodily fluid exposures besides blood spray from arterial line sampling. REFERENCES Baker, B., 2008. Improving Safety for Nurses Providing IV Therapy. Journal of the Association for Vascular Access, 13(4), pp.188-189. Available at: http://www.ingentaconnect.com/content/ava/javac/2008/00000013/00000004/art00005. Gammon, J., Morgan?Samuel, H. & Gould, D., 2008. 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