The Nurses Role in Prevention of Central Venous Line Infection - Research Proposal Example

The Nurses Role in Prevention of Central Venous Line Infection THE OF YOUR SCHOOL OR The Nurses Role inPrevention of Central Venous Line Infection Central venous line infection ("CVLI") is a serious issue faced by patients and staff in many medical facilities. Research needs to be conducted to understand the causes of CVLI, so that proactive training measures can be taken to reduce the frequency of incidence and provide a higher level of preventative and palliative care. CHAPTER ONE Purpose. The purpose of this research is to investigate the frequency of nurse contribution to CVLI and calculate the impact of training on the issues. The findings will be used to provide ways that medical staff can avoid contributing to the problem. Problem Statement. The problems identified for this research are that CVLI presents a serious health risk to patients, nurses are frequently in a position to contribute to the problem, and that training and prevention strategies should be employed to reduce the frequency and severity of CVLI. Significance of the Problem. The significance of CVLI cannot be overstated. It increases the morbidity and mortality rates of patients who suffer infection as a result of bacterial introduction and growth in what is often an immunosuppressed environment. This issue is important to nursing for two primary reasons; nurses are in a position to contribute to the frequency and severity of the problem, and they are also the first line of defense in prevention, detection, and resolution of CVLI. Theoretical Framework. A visual map of CVLI contributory issues is shown below: Figure 1: Visual Map of CVLI Incident Contribution Definition of Terms: Terms used in this research are defined as follows: Central Venous Lines - Lines, needles, or tubes inserted into a large vein to maintain or replace fluids. CVLI - A condition where the patient suffers a bacterial infection as a result of venous line insertion. Nurse - Any medical professional who is not a doctor, and has completed a prescribed course of study for state certification. Peripheral Catheters - Lines, needles, or other tubes inserted into a small vein to maintain or replace fluids. Research Hypothesis. The expectations for this research are that it will clearly demonstrate; that most cases of CVLI are preventable, the incidence of nurse contribution to the condition is high, a program of training and preventative strategies would reduce the frequency of infection, and that more research is needed to determine the protocols for a program of prevention. CHAPTER TWO Literature Review. There are several studies on the subject of CVLI and the contributory issues involved. While this body of literature is informative, it does not obviate the need for the research proposed herein. From Hadaway, we know that central venous lines are much more likely to increase the frequency, as well as the seriousness, of infections than are short peripheral catheters. She points out that two factors that contribute to this fact are that the patients themselves tend to be more vulnerable, and the exposure to microorganisms is increased due to the more frequent access required in maintaining central venous lines (Hadaway, 2006, p. 58) These infections, particularly those at the site of the intravascular device, are a major source of morbidity, occur frequently, and have the ability to increase both the length of a patient's stay at the hospital as well as the costs associated with that period of convalescence (Musher, el al., 2002, p. 769). The research of Dr. Oudiz and his co-authors has found that early detection of infection in such patients is crucial, though it can be difficult given the fact that the symptoms often present in a generalized way and do not initially appear as an acute infection (Oudiz, et al., 2004, p. 92). When those symptoms do present, however, it is often necessary to remove the central venous line in order to eradicate the infection (Brooks & Feldman, 2003, p. 214). There are things that nurses can do to assist in the prevention of infection when assisting with the insertion and maintenance of a central venous line; including cleaning their hands and the insertion site, applying alcohol and other sterilization fluids, maintaining a sterile field during the procedure, and using barrier precautions (Thomas-Masoorli, 1996, p. 28). There is a need for training, and some concern in the field that a regard for the importance of technical skill by specialists is not reflected in those who provide on-going care, such as nurses (Bogner, 1994, p. 24). Finally, it is obvious that a program of prevention strategies is needed to reduce the frequency of infection, as well as specific guidelines that support those strategies, but so far the impact of such a combination approach in ICU's is not known (Eggimann, et al., 2000, p. 1864). Thus, the urgency of the problem and the lack of conclusively effective methodologies make the case for further research. CHAPTER THREE Research Design and Methodology. I propose to utilize an intervention study with a pre-test, post-test, single group design. The experimental group's sensitivity to preventing, monitoring, detecting, and resolving CVLI, along with the number of infections in the unit, will be audited over an eight week period prior to training. Data collection (pre-test) will be conducted on field sterility, insertion site monitoring, detection of infection, response to infections symptoms, and rate of infection through the combined use of volunteer reporting and auditor oversight. A course of training in the four procedural categories will then be implemented by a certified instructor, followed by an eight week audit period (post-test) using the same measures. Subjects. Ten volunteers will be recruited from five area hospitals that have a sufficient volume of central venous line insertions. The study group will all be Registered Nurses with at least one year of experience in general patient care and at lease six months experience in central venous line maintenance. Data Analysis. For each participant, the adherence to proper sterility procedures, frequency of site monitoring, rate of infection detection, and adherence to proper infection response procedures will be calculated, as well as the rate of infection in the units where they work. These will be calculated for each of the audit periods. From the data collected, the efficacy rate in each category will be determined for each participant so that individual and group means can be obtained. A paired t-test will be used to determine if there is a statistical difference between the pre-test and post-test audits. A 0.05 level of significance will be used as the determining level. Cost/Feasibility Analysis. A chart of expected costs is shown below: Research Activity Cost Protocol Compliance Check $ 1,000.00 Audit 1 $ 3,000.00 Training $ 7,000.00 Audit 2 $ 3,000.00 Analysis and Final Report $ 1,000.00 TOTAL $ 15,000.00 Figure 2: Table of Anticipated Costs Assumptions/Limitations. While this research can be conducted with confidence, there are some potential difficulties. Limitations identified in this research are; the small sample size, the subjective nature of site monitoring and timely infection detection, data integrity from self-reporting activities, and efficacy of training. Conclusion. The research proposed herein will calculate and compare the incidence and frequency of CVLI, pre- and post-training. It will allow researchers to quantify the contributions nurses make to both the problem itself, as well as its prevention after being trained in a course of instruction. Based on the research, an effective method of prevention can be set forth and additional research can be conducted to refine the processes with the intent of significantly reducing CVLI in patients. References Bogner, M. S. (1994). Human Error in Medicine. Hillsdale, NJ: Lawrence Erlbaum Associates. Brooks, T. & Feldman, S. (2003). Central Venous Catheter Infection in a Child: Case Report and Review of Kluyvera Infection in Children. Southern Medical Journal, 96, (2), 214-217. Eggiman, P., Harbarth, S., Constantin, M., Touveneau, S., Chevrolet, J., & Pittet, D. (2000). Impact of a Prevention Strategy Targeted at Vascular-Access Care on Incidence of Infections Acquired in Intensive Care. The Lancet, 355, 1864-1868. Hadaway, L. C. (2006). Keeping Central Line Infection at Bay. Nursing 2006, 36 (4), 58-63. Musher, D., Goldsmith, E., Dunbar, S., Tilney, G., Darouiche, R., Qinghua, Y., Lopez, J. A., & Dongl, J. (2002). Association of Hypercoagulable States and Increased Platelet Adhesion and Aggregation with Bacterial Colonization of Intravenous Catheters. The Journal of Infections Diseases, 186, 769-773. Oudiz, R. J., Widlitz, A., Beckmann, J., Camanga, D., Alfie, J., Brundage, B. H., & Barst, R. J. (2004). Clinical Investigations: Micrococcus-Associated Central Venous Catheter Infection in Patients with Pulmonary Arterial Hypertension. CHEST (American College of Chest Physicians, 126, (1), 90-94. Thomas-Masoorli, S. (1996). Combating Infection: Questions and Answers about CVC's and How to Minimize Infection Risks. Nursing96, November, 28-29. Read More