Central Line-Associated Blood Stream Infections - Research Paper Example

? Central Line Associated Blood stream Infections Central Line Associated Blood Stream Infections A central line has been defined asan intravascular catheter terminating at the heart or close to it. The catheter may also be terminating in one of the “big“vessels that are used for purposes of infusion, hemodynamic monitoring and blood withdrawal (Moe, 2012). Some of the vessels used for central line insertion include the aorta, pulmonary artery, superior venacava, inferior venacava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins and common femoral veins (Moe, 2012). In neonates, the central line is the umbilical vessel. CLABSIs have been estimated to occur in the United States hospitals in the range of 250, 000-500, 000 cases annually. This has resulted in high costs of care for patients who have been hospitalized. The need to cut down the costs associated with CLABSIs resulted in research aimed at developing a feasible solution. Research has yielded a mechanism that will see nurses educated on best practices that will them take an active role in the prevention of CLABSIs. This paper will focus on implementation of a plan to prevent central line associated blood stream infections by way of educating nurses. Problem Identification and Importance According to the Center for Disease Control (CDC), every year an estimated 41,000 Central line associated blood stream infections occur in hospitals in U.S. The infections are typically serious and result in protracted stay in hospitals with increased costs. These infections also come with an increased risk of mortality (CDC, 2012). CLABSI (central line associated blood stream infections) are typically prevented by proper management of the central line. CLABSIs are considered to be part of healthcare associated infections (HAIs) and have been reported to responsible for mortality ranging from 12-15%. In a study conducted by CDC, the findings revealed that approximately 43,000 CLABSIs occurred in hospitalized patients in ICU in U.S hospitals. There was a reduction in the number of CLABSIs by approximately 18000 in the year 2009. CLABSIs resulting from Staphyloccocus aureus represented the greatest decrease than even the gram negative rods like Candida spp and Enterococcus spp. In the same year, 23,000 CLABSIs occurred among inpatient individuals in the inpatient wards of U.S hospitals. In the year 2008, approximately 37, 000 CLABSIs occurred in outpatient clients receiving outpatient hemodialysis (CDC, 2011). These statistics serve to underscore the importance of CLABSIs in U.S hospitals. CLABSIs have resulted in an increased cost of medical treatment. Hospitalized persons are paying huge amounts of money for their medical costs (Moe, 2012). It is this CLABSI associated costs that created a need for research activities that would see the CLABSIs kept to a minimum. The research activities have resulted in current evidence based guidelines that when executed, the incidence of CLABSIs will reduce. The mechanism requires that nurses be educated on prevention of CLABSIs. CLABSIs are not only responsible for high medical cost but are also responsible for morbidity and mortality in pediatric and neonatal intensive care units (Bizzarro, 2011). According to Bizzaro (2011), although implementation of evidence based catheter care bundles has reduced the infection rates, CLABSIs remain a fundamental problem in the pediatric and neonatal critical care units. CLABSIs are responsible for both pediatric, neonatal and adult morbidity and mortality in U.S citizens. Costs According to a study conducted by Shannon, et al (2006), the infections that are acquired while in hospital add considerable mortality and morbidity to patient care. A detailed economic analysis of the hospital expenses and revenues in 54 patient cases who had contracted central line associated blood stream infections over a period of three years in two intensive care units was conducted. The financial data was compared to data of other patients who were of a similar age, similar ailment severity as at the time of admission and the principal diagnosis. The average amount of money paid by a patient who had a CLABSI complication was found to be $ 64, 849. The average expense was $ 91, 733. The gross margin of the 54 cases was -$ 26, 894. The total loss that had been incurred due to the 54 cases was estimated to be $ 1, 449,306. The cost associated with CLABSIs was an average of 43 % of the whole cost of the care (Shannon, et al., 2006). In yet another study conducted by Anderson, et al., (2011) in a time span of 6 years from the year 2003 to 2009. The study’s aim was to investigate the outcome of healthcare associated infections across 24 community hospitals that participated in the Duke Infection Control Outreach Network (DICON). The study collected and analyzed data on the incidence of CLASBIs, VAPs (Ventilator Associated pneumonia), CAUTIs (Catheter Associated Urinary Tract Infections), those HAIs that are caused by Staphylococcus aureaus that is methicillin resistant, and EBBPs (Employee Exposure to Bloodborne Pathogens). The intervention resulted in prevention of a total of 312 VAP cases, 210 CLABISs, 1042 HAIs due to MRSA, 332 CAUTIs, 1016 employee EBBPs. This resulted in each of the participating hospitals saving approximately $100,000 for every single year they participated. The hospitals saved lives of 52-105 deaths from both VAP and CLASBIs. The two above studies reveal that preventing CLABSIs will not only result in a decrease in the costs incurred by patients but more importantly preventing CLABSIs result in the saving of lives and reduction of morbidity that is associated with CLABSIs. Safety Reducing the prevalence of organisms that cause CLABSIs will result in a decrease in CLABSIs and consequently result in an increase in safety. There are certain measures that can be taken that will result in a decrease in CLABSIs (Weinstein, 2012). Such measures include the use of a checklist while inserting a catheter. This would ensure that the healthcare provider adheres to the guidelines that have been stipulated in order to reduce infection transfers. The healthcare workers who are manipulating the vascular catheters use an alcohol based hand rub and or with antiseptic soap and water to perform hand hygiene regardless of whether they are wearing surgical or examination gloves. In adults, the healthcare workers should avoid using the femoral veins to access the vascular system. The healthcare workers should be encouraged to use kits that have complete equipment that is required for the aseptic insertion of a catheter (Weinstein, 2012). It is important that the healthcare personnel take maximal sterile barrier precautions while inserting the catheter. This involves covering the site of catheter introduction using a large drape that is sterile and also using the mask, sterile gloves, sterile gowns, and cup. Use of chlorhexidine based antiseptic is encouraged in patients older than 2 months old. Catheter hubs, injection ports of stopcocks, and needless connectors are to be disinfected using 70% alcohol or an alcohol chlorhexidine preparation in order to reduce contamination. The hub should be scrubbed for 10seconds. All catheters that are not being used should be removed. ICU patients who are older than 2 months old should have their skin cleaned using a no rinse chlorhexidine preparation on a daily basis. In adolescents and adults, in case of non tunneled CVC (Central Vascular Catheters), the transparent dressings are to be changed and site care performed every 5-7 days using chlorhexidine based antiseptic. The dressings are also to be changed when they are loose, damp or soiled. All these actions facilitate minimization of CLABSI causing organism being transferred to the patient and resulting in a CLABSI infection. In this way CLABSI infections are reduced and the patient safety is increased many fold with desirable outcomes being achieved (Weinstein, 2012). These actions make it hard for the organisms to thrive within the patient environment. This includes the patient’s body with particular reference to the area of insertion, the dressing used and the healthcare personnel’s personal hygiene. Chlorhexidine together with alcohol destroy the microorganisms responsible for CLABSI infections thereby increasing patient safety from the infection. Feasibility Providing education to nurses in order to prevent CLABSI through education is a feasible venture. According to Healthcare Associated Infections (2009), the preventive strategies are categorized into core strategies and Supplemental strategies. The core strategies are those strategies that have a high level of scientific evidence and have demonstrated feasibility. The supplemental strategies have got some scientific evidence but with varying feasibility levels. Some of the core preventive strategies include removal of unnecessary CL, adhering to proper insertion guidelines, complying with hygiene requirements, use of proper CL sites, adequate skin antisepsis, and adequate access/hub disinfection. These core strategies are easily transferred to the nursing fraternity through educative programs. It is possible to organize low cost forums where an expert in the core preventive strategies engages the nurses in educative forums where there id free flow of information both ways. The nurses will be allowed to air their thoughts and the expert will advise accordingly. Such forums are highly beneficial to the nurses and will be much cheaper compared to the benefits that would arise with application of the core preventive strategies. Weighing the cost versus benefits of having a nursing program that will educate the nurses and result in saving of man lives and funds, versus not having the program, the educative nursing program is by far the best choice. In conclusion, CLABSIs are responsible for deaths of many individuals and costs that run into millions of dollars per year. Developing a program that will educate the healthcare personnel on how to prevent these infections would be highly beneficial to all the parties that are involved. It would result in reduction in cots of treatment, saving of lives and a reduction in mortality rate. Such an educative program is feasible and should be undertaken in an effort to optimize the quality of care provided to a patient and the overall outcome of the patient’s treatment. Adoption of the core prevention strategies in hospitals is a good example of (EBP) evidence based practice and should be encouraged and adopted by all health personnel including nurses. References Anderson, D.J., et al. (2011). The network approach for prevention of healthcare associated infections: Long term effect of participation in the duke infection control outreach network. Infection Control and Hospital Epidemiology, 32(4), 315-322. Bizzarro, L.S. (2011). Prevention of central line associated bloodstream infections in critical care units. Current Opinion in Pediatrics, 23(1), 85-90. CDC (2011). Vital signs: central line associated blood stream infections. United States, 2001, 2008, and 2009. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm CDC (2012). Central line associated blood stream infection (CLABSI) event. Retrieved from: http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf Healthcare Associated Infections (2009). Central line associated bloodstream infections (CLABSI) in non-intensive care unit (non-ICU) settings tool kit. Retrieved from: http://www.cdc.gov/HAI/pdfs/toolkits/CLABSItoolkit_white020910_final.pdf Moe, P.(2012). Central line insertion practices (CLIP) data submission. Retrieved from: http://www.sdfmc.org/ClassLibrary/Page/Information/DataInstances/385/Files/2555/CLI P.pdf Shannon, R.P., et al. (2006). Economics of central line associated bloodstream infections. American Journal of Medical Quality, 21(6), 7S-16S. Weinstein, R.A.(2012). An evidence based approach to the prevention of central line associated bloodstream infections in hospitalized patients. 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