The Use of Chlorhexidine Dressing in Critically Ill Patients - Term Paper Example

Subject Name Lecturer’s Name Management Due date Date Submitted Contents Keywords 2 Introduction 3 Discussion topic 4 LITERATURE REVIEW 5 Catheter-related infection 5 Preventive measures 6 Effectiveness of сhlоrhехidinе 7 Comparison between the uses of Сhlоrhехidinе dressing as compared with common practice 8 Ethical issues 9 Summary 10 Local action 11 Recommendations 12 Action plan 12 Conclusion 13 References 14 Keywords Catheter-related infection, evidence-based practice, сhlоrhехidinе, best practice, critically ill patients. Introduction Evidence-based practice is an important concept in the nursing and midwifery profession. The information collected from the ground is used to help improve the service delivery in the profession (Melnyk & Fineout-Overholt 2011). Evidence collected from the practice is incorporated into the practice to help improve the quality of the services delivered by nurses and midwives. The evidence so incorporated has helped reduce accidents and incidences that would have otherwise been avoided had some precautionary steps been taken. The information collected is also used in improving studies in the nursing and midwifery to ensure that the profession is improved regarding quality and service delivery. Collected information and evidence help make improvements, not from abstract ideas but the real situation on the ground (Melnyk & Fineout-Overholt 2011). The use of evidence has been used globally to ensure that the profession can adapt to new situations that would help save lives that would initially have not been possible. In Oman, the Evidence-based practice has been utilized to facilitate the improvement of the nursing profession. Like any other country, there are efforts to progress the use EBP in the profession to ensure that the healthcare provided is optimum. Discussions are ongoing on various topics such as the use of сhlоrhехidinе in Oman. The discussion is focussing on conducting research in the area and also evaluating the already conducted research on the topic to determine the effectiveness of its use. Oman needs to ensure that it aligns itself with the existing best practice. The best practice will be discussed later in the discussion through the consideration of research that has led to the development of such practice. The practice is usually developed from evidence supported by research on the ground (Raad , Hanna & Maki 2007). Mostly the nurses will make use of Randomized control trials to ensure that they establish what is best used under similar circumstances. Discussion topic Test the use of the Evidence-based practice in nursing will, in this discussion, against a controversial yet important topic. The topic to be discussed will be the use of сhlоrhехidinе dressing compared with current practice to prevent catheter-related infection in critically ill patients. The topic is important given the protracted debate around it and the ethical issues that surround it. LITERATURE REVIEW Catheter-related infection These are infections that are associated with the insertions of catheters in critically ill patients. The insertions are mostly urinary or intravascular; however, our focus shall be intravascular insertions. The inserts help critically ill patients survive situations that would have otherwise not been possible (Raad, Hanna & Maki 2007). The use of such technology is, therefore, invaluable in saving lives of a lot of patients. However, such technology does not come without effects especially in instances where the condition of the patient is highly fragile. Infections have been associated with the use of Catheter; it is therefore of paramount importance that practitioners get the right mode of preventing or reducing the chances of the infections occurring, especially with the consideration that the infections are occurring in patients with very fragile bodies (Ullman et al. 2015). The infections in question include biofilm formations. The biofilm formation mostly occurs at the surfaces of the catheters (Raad, Hanna & Maki 2007). The other infections include blood infections occur in intravascular insertions such as pathogens. The infections may result from contamination and other causes such as distant site infections, and also through the hands of those offering health care (Trautner & Darouiche 2010). Research has documented catheter-related infections in intensive care unit patients as the third highest rate of infection (Goudet et al. 2013). In that regard, it is a cause for alarm and preventive measures ought to be sought. The use of the catheter may lead to bacterial colonization. The bacterial infection results from the migration of the bacteria along the catheter .As such; preventive measures should be deployed to ensure that such incidences are reduced (Mermel et al. 2009). The use of antibiotics has been known to reduce the rate of infection. The use of antibiotics in the dressing has been said to increase the rate of resistance (World Health Organisation 2014). Children have also been affected (Levy et al. 2005). The resistance may help the patients from suffering from further infections in the future. More preventive measures will be discussed in the next topic. Preventive measures The occurrence of such infections warrants the search for preventive mechanisms. However, the solution sought should be evidence-based to ensure that there are some forms of proven tests. The evidence may be categorized into those that probably works, what might works and what works. It, therefore, means that some of the solutions employed have not been fully verified as working but the according to scientific deductions, such solution if applied should work, at the very least, probably work. The modes of reducing the infections have included the use of maximal sterile insertion barriers (Pronovost et al. 2006). The sterile barriers ensure that the catheter inserted does not result in infections or at the very least, there is a reduction in the infection cases that are reported (Frasca , Dahyot-Fizelier & Mimoz 2010). All the equipment used in the process must be sterilized. The sterilization has been proven through research to reduce the rate of infections considerably (Trautner & Darouiche 2010). The results may serve to indicate that a great of infections may have initially resulted from contaminated equipment. Сhlоrhехidinе has been accepted as a disinfectant that has been used in many countries to reduce the rate of infections (Safdar et al. 2014). In most, it has been the most trusted disinfectant. It is available in two forms, alcoholic and aqueous formulations. Other solutions have included the use of heparin or Gentamicin lock solution as antibiotic lock solutions (Abad & Safdar 2011). Of the two, when a random controlled test was conducted, the use of Gentamicin proved to be better than the use of heparin alone. The use of Gentamicin increased the survival rate in the patients (Zhang 2009). The solutions available therefore are many (Jaffer et al. 2008). The use depends on the country in question. However, the use of Сhlоrhехidinе has been cited as the best practice in controlling the catheter-related infection. However, not all countries make use of it. A need arises to make sure that such countries align themselves to the common practice or rather, the best practice in the nursing and midwifery profession. Effectiveness of сhlоrhехidinе The effectiveness of сhlоrhехidinе cannot be established without conducting due research. No product or procedure should be used without having established that it is effective and that its use will not lead to any undesired effect. The side effects may be present although the same should be mild. The research has been conducted on the effectiveness of сhlоrhехidinе. The test shows that the use of сhlоrhехidinе in dressing has resulted in no deaths (Pedrolo, Danski & Vayego, 2013). The dressing using сhlоrhехidinе showed proximity in the reaction in comparison with gauze. In the research, however, one critical case was reported (Pedrolo, Danski & Vayego, 2013). The use of сhlоrhехidinе as stated earlier has been cited as one of the most effective disinfectants. However, it also has some side effects. It has been associated with hypersensitivity in patients. The hypersensitivity is mostly in the areas where there is contact between the dressing and the skin (Pedrolo, Danski & Vayego, 2013). This side effect would mean that the use of сhlоrhехidinе dressing in a patient may not be as widely used; instead, it would be prudent to recommend it only to patients without issues of hypersensitivity to сhlоrhехidinе. The research would mean that it should not be used in all patients. This aspect poses a dilemma to healthcare providers since some patients may not have a recorded incidence and yet could have a hypersensitivity reaction to сhlоrhехidinе. At such a point, the health care provider may find that they have used it on a patient with no medical record only for such patient to have a reaction. Comparison between the uses of Сhlоrhехidinе dressing as compared with common practice Other products are available in the dressing of catheters. One such product is the povidone iodine. However, when a test was conducted on the two; that is the povidone iodine and the сhlоrhехidinе, chlorhexidine was found to be more superior. The research conducted indicated that the povidone reduced the catheter- related infection by only 10% while сhlоrhехidinе reduced the infection by 50% (Goudet et al. 2013). The statistics from the research indicate that under such performance, сhlоrhехidinе would be more preferred in dressing considering that it would reduce the catheter- related infections to a greater extent. Furthermore, povidone has been attributed to bacterial activity. It has also been linked to long-term antimicrobial suppression. Such results would render the use of povidone less appropriate as compared to сhlоrhехidinе. The form that registers the best result is the use of alcoholic сhlоrhехidinе. Another comparison that has been done has been between Nonchlorhexidine Dressings and Сhlоrhехidinе dressing of which infections in Сhlоrhехidinе dressing have been found to be lesser (Jean-Francois et al. 2012). Ethical issues The use of evidence-based practice is a challenge to some extent. According to the ethical guidelines of nurses and midwifery in Oman, there should be informed consent (Oman Nursing & Midwifery Council 2013). That means that whatever procedure is to be applied to the patient, he or she has been informed of everything about it. It also follows, therefore, that the use of drugs or running tests on the patients should also be done with the consent of the patient in question. Such an ethical requirement raises an issue with the use of evidence-based practice. Since the patient has to be informed of everyone and that they have to give consent, running tests might be difficult. What is to happen in an incidence where the patient is strongly against being the subjected of a controlled test? Another challenge with consent would be that the patients in question will mostly be those that are critically ill. Such persons would not have the capacity to give consent (Lemaire, Bion & Blanco 2005). A challenge would arise where the person who is supposed to give consent under such circumstances cannot be easily reached. A dilemma would arise where the nurse or the midwife would want to conduct a procedure that would save the life of the patient but on the other hand, no consent has been given. On confidentiality, the use of evidence-based practice may be applied without contravening the ethical requirements (Oman Nursing & Midwifery Council 2013). The statistics collected do not indicate the names of the patients but rather, just numbers. However, the health status, the signs and possibly location may be disclosed. Such information, though not intended to disclose the identity of the patient may serve to do exactly that. It is, therefore, not absolute that the use of evidence-based practice does not lead to ethical issues. On the issue of the use of сhlоrhехidinе dressing in catheter-related infections, the nurses will be under the obligation to disclose to the patients that despite its approval rate around the globe, some side effects might arise. The problem would arise where the patient does not wish to be subjected to its use. The nurses and midwives will find themselves at crossroads. They have an obligation to offer the best available care, but again they cannot do so without the consent of their patients. Another problem would arise where the nurse or the midwife inquire from the patient's record on the possibility of them being hypersensitive to сhlоrhехidinе. If such record is not available or the patient is not aware that they have such a reaction, the nurse or the midwife would end up using сhlоrhехidinе. Such a step would be against the risk reduction ethical requirement. Although the same would have been involuntary, it may lead to adverse effects. The nurses and midwives will be required to act with competence (Oman Nursing & Midwifery Council 2013). The same can only be possible if the nurses and midwives have accumulated the required skills and knowledge in сhlоrhехidinе dressing. The existence of research that support the effectiveness of its use would not be enough; proper training must be done to ensure that the procedures are conducted properly and with the least number of side effects by the risk reduction ethical requirement. Training has been cited as an important aspect of the nursing profession regarding any concept no matter how minute it might seem (Prakash, Vinod Arora, and Geethanjali 2011). The adoption of this mechanism would, therefore, call for financial support to ensure that proper training is effected so as to ensure the highest rate of life conservation (Blot et al. 200). Summary The evidence available point to the existence of various modes of preventing the catheter-related infection. However, the most popular has been cited as the use of сhlоrhехidinе dressing to prevent such infection. It has been seen as superior as compared with other remedies such as the use of povidone. The alcoholic formulation of сhlоrhехidinе has been preferred from the aqueous formulation; this is because the alcoholic formulation delivers the best results. However, the use of сhlоrhехidinе is not free of side effects. Its use may be limited since those with hypersensitive reactions to сhlоrhехidinе should not use it. The reaction in hypersensitive patients may be chronic. Local action In Oman, the practice has been to use antibiotics in the catheter insertions. The profession has not yet adopted the best practice as the common practice in the country. There is also the adoption of the best practice in the handling of the catheter by ensuring the use of sterile equipment. The use of such equipment including sterile disposable gloves ensures that the infection is not transferred from the healthcare provider to the patient. In cases where infection has been reported, the health care providers have opted to replace the catheter. Best practice calls for the use of сhlоrhехidinе in maintenance to prevent further infections in the future around the catheter. Replacements are to be made in instances where the infection is severe (Jean-Franc¸ois et al. 2009). However, the health of the patient must be considered to ensure that the procedure for replacement does not result in negative effects on the patient. Such a move, especially in the critically ill patients, may serve to risk the lives of the patients the more (Panduranga & Al-Mukhaini 2013). As such, the preventive mechanisms should be more emphasized. In Oman, the infection in end-stage renal disease has been cited as the second leading cause of deaths. The statistics, therefore, call for speedy implementation of available preventive measures. Research regarding the use of сhlоrhехidinе has been conducted in the country. What remains is the nationwide acceptance of its use in the country. However, proper guidelines need to be established in the use of сhlоrhехidinе to ensure that the given solution does not result in unwarranted side effects. Recommendations Oman is still in the process of testing the efficacy of the use of сhlоrhехidinе dressing in the prevention of catheter-related infections. The most advanced nations, however, have adopted the use of сhlоrhехidinе as the best practice. The research that has been conducted in such countries has shown that the use of сhlоrhехidinе is more superior to other forms of dressing available. The use of dressing is important in reducing the prevalent infections that have been shown to the third in infections that occur in critically ill patients. There is, therefore, a need to ensure that such infections are prevented from occurring. In Oman, the use of сhlоrhехidinе should be adopted since its use has shown to be more effective than most of the other remedies available. Action plan The research done and adopted by other countries should also be implemented by Oman. More research should be conducted to reduce the negative effects of the use of сhlоrhехidinе. The research should be done by the institutions of higher learning as well as the health facilities. The government should chip in the implementation process. As such, the government should ensure that сhlоrhехidinе is readily available in the government healthcare facilities under the government. Furthermore, it should help in financing the research in the country to ensure that better solutions are discovered through the research. On the ethical issues raised by the previous topic, the government should legislate on the issue to ensure that there are proper guidelines on seeking consent from the critically ill patients. The same should adopt a hierarchy of individuals such that, in the absence of one, the next person in the hierarchy should be consulted. Furthermore, the regulatory body in the nursing and midwifery profession should indulge itself in the search for solutions to the questions of confidentiality and the training to ensure that the ethical requirement of competence is achieved in the given area. The regulatory body should also venture to answer on what should be done given various scenarios that might pose a dilemma to the healthcare providers. Such detailed guidelines would help in reducing incidences of breach of ethics by the nurses and midwives. Conclusion The use of Evidence Based Practice is important in the nursing and midwifery profession. The best practice is mostly adapted from scientific research. The research in the nursing profession is mostly conducted in the form of Randomized Control Trials. Such trials put two or more tests side by side to ensure that the results are monitored and outcomes correctly recorded. On the issue of the use of сhlоrhехidinе dressing in critically ill patients to prevent catheter-related infection, the evidence-based practice. Evidence has indicated that its use yields more superior results when put side by side with other preventive solutions such as the use of povidone. Other forms of antibiotics and sterilization of equipment have also been held to reduce the rate of catheter-related infections. In Oman, the use of antibiotics to prevent the infections has been adapted. However, the country ought to put to use сhlоrhехidinе as widely accepted form of prevention of the infection. 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