Reducing the Risk of Infections for Patients in the Intensive Care Ward - Research Paper Example

?  A study of using the central line prevention bundle for reducing the risk of infections for patients in the intensive care ward               In recent times, many medical facilities make constant efforts of making sure that their patients are safe, secure, comfortable and accommodated. Being confined in the hospital is normally not a wanted experience, but when a patient does go to a hospital, or when they are somehow required to stay there for a length of time, normally, patients expect a level of care from the medical staff as well as a level of sanitation and cleanliness that prevents complications or further issues from occurring. These hospitals not only keep their facilities and equipment clean and sterile but they also follow certain procedures or protocol that ensures that there are no further complications or infections for the patient.             One such infection-control procedure or protocol is the Central line bundle. This particular protocol was created in order to help prevent or control central-line infections in the intensive care unit. According to an article by nursezone.com “central lines” are the catheters inserted into major veins and are used to deliver medication or to replenish body fluids. These are great life support mechanisms; however the article also states that they “are also dangerous infection risks, responsible for as many as 28,000 deaths each year”. This figure is quite alarming, and this is also the same reason why this paper was created. It is meant to review the Central line bundle protocol and through medical data as well as articles, this paper will attempt to determine just how effective the Central line bundle is in terms of preventing infections for patients in the intensive care ward. This paper will use the PICO(T) method in trying to asses the Central line bundle’s effectiveness in preventing infections. It will try to break down the topics into discussions such as: Clinical Significance Formation of the PICO(T) Question Search for significant Literature Rapid Critical Appraisal Evidence Conclusion Clinical Significance             As previously mentioned, deaths resulting from central-line infections have a large effect on the medical practice. Any death on its own has a very alarming effect, but even more so for those deaths that come from the very equipment that were expected to help the patient out in the first place. It now becomes hard to imagine that the very thing that was meant to help alleviate your struggle could potentially cost you more than you bargained for.  This is why the process of making sure that the central line bundle is effective at preventing these types of issues and effective at controlling central-line infections. These steps that have been developed in order to control these types of issues may be the difference between life and death for most patients. This paper’s significance comes in its assessment of the protocol and its conclusion of weather it really is effective or if not doing the protocol will provide the same results. According to the same article by nursezone.com, this protocol is one result of some efforts to reduce central-line infections in the intensive care ward, as well as an effort to save 100,000 lives in American hospitals. This paper’s main purpose is to validate if the protocol is effective and in effect, also attempts to validate the efforts made towards saving 100,000 lives in American hospitals. This is one of the main driving forces behind the paper as well as to provide a positive image on the procedures ad effectiveness of hospitals and other intensive care facilities. This is because as we may already know, there are many negative connotations regarding confinement in a medical facility and if the protocol is assessed to be effective, this will shed a positive note on the protocols of medical institutions, as well as remove any negative connotations regarding these types of equipments or procedures. This is very significant to patient outcomes because if this is assessed to be effective, it could mean saving many lives, as well as promoting the effectivity of the healthcare industry as a whole. Formation of the PICO(T) Question             According to an article by ehow.com on writing a PICOT for evidence-based projects, it is “is a technique medical researchers use to develop a clinical research question.” Certain uses for the PICOT method are for funding proposals, or for experiments, or even trials. PICOT is an acronym. According to the same article, as well as from ncbi.nlm.nih.gov, PICOT means target Population (P), Intervention of interest (I), Comparator intervention (C), Outcomes (O), and timeframe (T). In terms of the target population (P), this paper will revolve around people who are admitted, or have been admitted into the intensive care unit and who require or have required the use of a central-line catheter, both past and present. This will limit the population of study to only those who are directly affected or have been directly affected by the level of effectivity of this protocol. This also provides the paper with a more focused group of study and therefore, the possibility of a more accurate outcome. For the Intervention of interest (I), this paper will focus on the use of the Central line bundle and how effective it was in terms of controlling or preventing infections. According to the article by nursezone.com, there are 5 steps to be followed for the Central line bundle. This gives the research a guideline to look for when checking instances of the bundle’s use. This also provides only 1 variable to look at and therefore has the possibility of more accurate results. In summary, the central line bundle consists of these 5 procedures: Hand hygiene: hand washing is a must in order to prevent transmitting of germs or dirt Maximal barrier precautions: Medical staff and caregivers are required to ware covering and the patient mush be draped in a sterile sheet. Chlorhexidine as antiseptic: The quick-dry formula ensures that bacteria are gone Appropriate catheter site selection and post-placement care: Choosing a catheter site depends on the benefit to the patient, and site care and cleanliness must be maintained Daily review of line necessity with prompt removal of unnecessary lines: Patient must be reviewed daily and the catheter be removed as soon as it is deemed safe. In terms of the Comparator intervention (C), the paper will look at those who’s medical caregivers did not observe the central line bundle and what collective effects this may have had on the patients. This provides the research with a mode of comparison. This gives the research a point to compare its positive results in order to provide a more accurate conclusion. For this paper’s Outcomes (O), it aims to determine weather or not the central-line bundle is actually effective at lessening infections in patients in the intensive care ward that require catheters. This paper aims to definitively assess this protocols effectiveness and create a conclusion based on the study's outcome. Search for significant Literature In this portion of the paper, there will be literature presented that is very much significant to this issue. These literature pieces were taken from reliable medical data base sources as well as peer-reviewed articles regarding the issue. After some comments and quotes are presented form the literature and articles, this paper will also present some comments and analysis regarding the information presented. A paper from baylor.edu called “Central Line Associated Blood Stream Infection Prevention” provides us with some information regarding other uses of the central-line bundle in other locations, specifically, the Johns Hopkins Hospital and Dr. Peter Pronovost who developed the best practice guidelines that are used to prevent Central line associated blood stream infections (CLABSIs). The paper also provides us some information regarding the hospital where the guidelines have been developed and that although CLABSI rates fluctuate and differ at this location each month, the paper found that the reason for the fluctuation in occurrence of CLABSI is due to a low compliance rate for the CL insertion checklist. The paper also gave recommendations regarding the improvement of the compliance rate to the said checklist in order to lessen the occurrence of CLABSI in the institution. The recommendations stated the expectation of 100% compliance to the checklist. This provides the paper an idea regarding the effectvity of the protocol. When the protocol or checklist is not followed, or is followed inconsistently, the occurrence of CLABSI in this institution fluctuates. Another thing to consider is that the recommendation that was made in this literature was to have 100% compliance. This gives us the impression that the people who created this literature supported the idea that the protocol lessened the occurrence of CLABSI. This can be said because their recommendation was to continue the protocol and improve compliance to 100% rather than removing the protocol and replacing it with another one. One more study, this time, by ncbi.nlm.nih.gov called “Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy” focuses on looking at the effects of implementing a policy in order to reduce CLABSI in their institution. The study recommended The CLUE insertion bundle, which is another term for our central-line bundle, as an effective method of reducing CLABSI occurrences. The study focused on patients undergoing central venous catheter placement and were observed “per 1,000 line days during the 12 months before and after implementation of the policy”. According to the conclusions in the literature, as well as the data presented, the implementation of the policy was associated with reduction on CLABSI rates. This also gives us great insight into the definitive effectiveness of the central line bundle in reducing CLABSI rates because not only was it recommended in the study as an effective method of CLABSI rate reduction, but the study its self concluded that these types of policies were associated with institution-wide reductions of CLABSI occurrences once they were implemented. This gives this paper a great reference point in concluding weather the central line bundle really is effective. The final literature that this paper looks at is one from patientsafetyauthority.org. This article also looks at the central-line bundle and tries to determine if it is an effective method of preventing or controlling CLABSI occurrences. This study recognizes that CVC is a very important part of medicine, but it does have its set backs. It puts the patient at risk of CLABSI. This is also why The Association for Professionals in Infection Control and Epidemiology has a zero tolerance outlook on healthcare-associated infections (HAI). The checklist presented in this article is similar to this paper’s own bundle. The paper concluded that CLABSI occurrences will continue to rise if prevention strategies are not effectively implemented. This means that without procedures such as the central line bundle, CLABSI issues will continue to be a threat to patients. This final article gives us a good look at the consequences of not properly implementing an effective policy such as the central line bundle. It lets us know what will happen if this policy is not followed and is not complied with at 100%. Rapid Critical Appraisal For the rapid critical appraisal of the articles used above, this paper will follow 2 separate checklists, one for quantitative information and one for qualitative information, in order to determine and make sure that the articles and information above is both usable, valid, and helpful to this research. The checklists and answers are as follows: Quantitative checklist: 1. Are the study findings valid? There are several subtopics of concern for this particular line item which the paper addressed for each individual article or research paper used. For the first main research article used, which is from baylor.edu, the participants were patients that required a central line catheter the ones that were included into the study were the ones that included in the study were the ones that used the Sunrise ClinDoc electronic patient record system. The study was conducted in 3 separate audits with ample amounts of time in each audit in order to make sure that the results were as accurate as possible. All of the subjects completed the study as none of them were mentioned to have been removed from the study in the literature. The control group was very appropriate to the study as they are the ones that are affected directly by the issue. The measurements that were used in the study were both reliable and valid because the one measurement is weather or not the protocol was followed. As for the second study conducted by ncbi.nlm.nih.gov, the participants were patients that required central line catheters through the tenure of their stay. The scope was limited to the number of catheter insertions instead of the number of patients. The study counted the rate of infections for every 1,000 line days for a period of 12 months before and 12 months after the implementation of the study. The study looked at the total occurrence of CLABSI occurrences for the 1,000 line in days in the 12 month periods. 2 periods were used in order to have a valid comparison or to see an effect before and after the implementation of the policy. The time given was long enough in order to observe changes and to confirm validity. The patients finished their needed line in days and the total of 1,000 line-in days was counted. For the final literature by patientsafetyauthority.org is a reference article that tries to look at historical evidence and recommendations by other overseeing bodies in order to make its own recommendations. It then tries to present some known strategies of CLABSI reduction strategies based the information gathered as well as from historical evidence. Although there are no direct participants for this study, we can consider the participants of the surveys and studies that were analyzed and used in this research. The lengths of time that were used in the research’s resources but all of them were significant in the sense that the different lengths of time still get similar results and they are all long enough to be able to get constant results. 2. What are the results of the study? In terms of the study results, they can be seen as both useful and valid. The 3 main articles or researches used differ in the sense that 2 of them used direct research methods and direct observations in order to come up with recommendations while the other research used analysis of other references and articles in order to come up with recommendations, however, all 3 of them had very similar conclusions despite the fact that they had different styles of research. They also differ in size or scope of study as well as scope of affected patients however, they do provide similar results. The demographic of participants are also similar since they are patients that require central line catheters. The interventions used in the research literature by both baylor.edu and ncbi.nlm.nih.gov, the effect of the intervention were felt though out the institution. An example of this is that in the study by baylor.edu, the effect of implementing the protocol was aimed to improve CLABSI occurrences for the institution as a whole. The interventions suggested in the literature should be considered precise since they were based on evidence already present in current literature as well as evidence seen in their independent studies. For the 2 researches that used direct methods of research namely baylor.edu and ncbi.nlm.nih.gov, they experienced the results of their intervention first hand while for the research literature, it was able to compare several sources and researches before creating an intervention and recommendation. Although independent and done in different timeframes, years, as well as different methods, it must be noted that they have very similar results which would support their validity as well as the effectiveness of the intervention. 3. How are the results applicable to your patients? The information regarding all 3 of the research literatures were clearly noted and documented. It presented factors and information that were very useful in the conclusion of this own paper. All of the outcomes were properly documented and measured as well as used in the recommendations made in the researches that this paper has used. The 3 papers recommend the central line bundle to be followed strictly in order to control and avoid central line infections and based on these researches and information, the steps that they have taken are quite doable in any and most clinical settings. This has enormous value to patients, specially to those patients that require the use of a central line catheter. This means that the risk factor that used to loom over their heads can be considered either lifted, or lightened. This also have enormous value for the medical community as this is able to lessen the cost associated with CLABSI occurrences. Qualitative checklist: 1. Are the study findings Valid (credible)? A. Research purpose The linking factor of the 3 main research papers used is that their purpose statements were clear, precise and were stated in a manner that not only provided a clear direction but also, in a way, delimited the scope of study. The 3 researches approached the issue in 3 unique ways such as A. Direct observation of patients over a period of time, B. Observation of the line hours of the inserted central line catheters over a set period of time, and C. Analysis of current information and research on the topic provided. All 3 approaches were appropriate and effective in the end aim of the study. B. Participants The participants used for the 2 researches were chosen based on their need for a central line catheter. They were not forced into using the catheter as they were on a need-to-have basis. None of the participants used the catheter without the need for it. Outside of this, they were merely observed and the only variable is weather or not the protocol was followed, or the difference seen when the protocol was implemented. No violation of rights occurred and the participants were protected. As for the research with an analysis method, it did not use any direct participants. There was no bias involved since, for the researches that used direct observation, their participants were not hand picked but instead came up based on occurrence of need from existing patients and were only observed. As for the research with an analytical method, it used current articles and used more than one resource to avoid bias. C. Sample: Was the sampling strategy clearly defined and justified? The sampling methods used were different for each research but despite that, they were definitely clear, and appropriate for the uses. The researches that used direct observation had their settings in medical facilities where in the participants were those that required central line catheters, and these are the only settings that would be appropriate for this function. The research that used analysis used resources that were directly involved in the issue and had data directly related to the issue. All sampling methods were dedicated, as precise as possible and thorough. The research data was also able to represent their intended participants accurately. D. Data Collection: What methods did the researcher use to collect and analyze the data? The researches used similar data collection methods such as observation, notation and education of staff. Data was analyzed differently as well as, for the 2 researches that used direct observation, one collected information in time intervals over a set amount of time while the other had a set time and an over all result, while for the research that used analysis, the information used was as current and as relevant as possible in order to make its recommendations as accurate and as relevant as it could be. The information gathered was able to indicate consistent information from all main researches used and the samples and methods were as concise as possible. 2. What are the results of the study and are they important (reliable)? In terms of the provided results, conclusions and recommendations of the research literature and articles above, despite them having different methods, different years done, different sampling others, they have consistent results. Their results match and complement each other. The descriptions and findings were discussed and detailed in a clear, concise and logical manner, and that they were build to match the information that gathered from their respective researches. The papers and researches conducted their methods in real world environments, and for the one paper that analyzed information from other articles, the information it made use of was very recent and appropriate. This makes the information logical, believable and plausible. These 3 articles tackled the issue in different ways and also presented their results and recommendations in different approaches but they still provided consistent information. 3. Will the results help me in caring for my patients? Are the results transferable to a wider population (transferable)? In terms of the significance of this study and how they directly translate to caring for patients, this has huge value. The results and recommendations provided in the study provide definite support for the validity and effectivity of the central-line bundle. This means that there is valid support for the use of the central-line bundle which translates to better care for patients. These studies and their conclusion and recommendations validate the use of the bundle as an effective way of avoiding central-line infections which also means better care and security for patients. Since the bundle is applicable in any situation where the patient requires the use of a central line catheter, the bundle can be used I any facility in any state or country. This means that the affected population is very much expandable. Evidence Conclusion Base don the information provided by the articles that have been used and reviewed in this article, this paper definitively concludes that the use of the central-line bundle is definitely directly related to reductions of Central line associated blood stream infections (CLABSI). This means that the central-line bundle reduces the occurrence of CLABSI in patients that require a central line catheter in their time spent in the intensive care unit, This directly translates to the central line bundle being very effective at reducing the risk of infections in the said patients in the intensive care ward. This paper has not only looked at 3 different studies in 3 different medical locations regarding the effectivity if the central line bundle, but also has looked at other articles that support the validity of the bundle in reducing as well as controlling CLABSI. The final conclusion of this paper is that the central line bundle is definitely effective at reducing the risk of infections related to central line catheters for patients in the intensive care ward due to the fact that this process has been studied and tested to be directly responsible for lessening the occurrences of CLABSI in more than one medical institution. References Anaesth, C. J. (Jan 2010) Posing the research question: not so simple. ncbi.nlm.nih.gov retrieved Nov 15, 2011. http://www.ncbi.nlm.nih.gov/pubmed/19247780 Beyond the Bundle: Reducing the Risk of Central Line-Associated Bloodstream Infections, (Mar 18, 2010) patientsafetyauthority.org retrieved Nov 15, 2011, http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2010/mar18_7(suppl1)/Pages/01.aspx Central Line Associated Blood Stream Infection Prevention (2010) baylor.edu retrieved Nov 15, 2011, www.baylor.edu/content/services/document.php/146657.docx Cherry, R. West, C. Hamilton, M. C. Rafferty, C. M. Hollenbeak, C. S. Caputo, G. M. (Dec 17, 2010) Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy ncbi.nlm.nih.gov retrieved Nov 15, 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123176/ Gulliver, T. (Dec, 27, 2010) How to Write a PICOT for Your Evidence-Based Practice Project ehow.com, retrieved Nov 15, 2011. http://www.ehow.com/how_7696012_write-picot-evidencebased-practice-project.html Lowes, R. (June 7, 2011) High Central-Line Infection Rates at Many Teaching Hospitals, New Consumer Reports Study Gives Poor Marks to 67 Institutions medscape.com, retrieved Nov 15, 2011, http://www.medscape.com/viewarticle/744131 Orlovsky, C (2006) Hospitals Follow Bundle Protocol to Reduce Central Line Infections nursezone.com, retrieved Nov 15, 2011. http://www.nursezone.com/nursing-news-events/more-news/Hospitals-Follow-Bundle-Protocol-to-Reduce-Central-Line-Infections_25740.aspx Rapid Critical Appraisal of Chosen Articles (limit to 3 pages) Apply the RCA criteria you used in the DB to summarize the findings in each article. Explain how the research articles answered your PICO(T) question. Discuss the overall strength of the evidence in terms of: level of, validity of (based on criteria used in your rapid critical appraisal) and confidence to act (or change your nursing practice) based on the evidence you found.  Read More