Central line bloodstream infections

Abstract

Central line bloodstream infections have become a major concern for the healthcare sector key players. Studies conducted over last two decades have been of great importance in shedding light to the origin of these infections. The health care professional has thus turned their attention on reducing health exposure to these infectious agents. Previously, few infections and the associated additional costs brought about by these infections were considered an acceptable risk. Due to the frequent access, patients on a central line catheter are at an increased danger of contracting infections, than those with peripheral catheters.  In the 21st century, better practices have been introduced to reduce morbidity and mortality rates which had been earlier associated with the central venous catheter. However, non-compliance to these practices by some health professionals has posed a challenge in efforts to eradicate these infections.  Bundle care concept has been suggested by the Institute for Healthcare Improvement as a way of assisting in the reduction of central line infections. Bundle care comprises catheter site selection, hand hygiene, use of chlorhexidine skin antisepsis, and daily review of the central line. The aim of the paper is to educate on the importance of the bundle care practice by the medical professionals, to reduce central line-associated infections. 

Problem statement

Central line blood infections have been a challenge in the healthcare sector, with a mortality rate of up to 25 percent (MMWR). Various underlying factors contribute to the spread of the infection. The weak immune system of patients, especially those in the intensive care unit, and other underlying infections in the patient increase the risk of the patient to be infected. The pathogens enter the blood stream in many ways. These include; during the insertion of the catheter, when accessing the catheter when giving medication, or changing caps, or during hub manipulation (Hadaway).

Central line associated blood stream infections are bringing about additional expenses for the patient. The hospital stay of the patient is significantly lengthened increasing the other health care costs. An additional $33,500 to $75,000 cost is estimated for every infective episode (Jackson and Cooper). The patient’s quality of life is also significantly reduced, especially when the pathogen is unknown. Studies indicate that 5.3 central line infections are recorded for every 1000 catheters and an associated mortality of approximately 14,000 deaths annually. CDC reports suggest that if blood stream infections of all patients in the world can is almost 250,000 per year (Hadaway).

The increased workload to the nurses minimizes the quality of care they provide to the patients. The nurses lack enough time to provide holistic care to the patients, resulting in a reduced patient satisfaction. To mitigate these setbacks, the Institute for Healthcare Improvement suggests hygienic handling of the infected patients. Optimal catheter site selection, use of chlorhexidine skin antiseptics, and hand hygiene will in a long way reduce the instances of infections.

Bundle care practices applications in various hospitals have resulted in a notable reduction of cases of central line infections to patients. Use of these combined methods will bring about a better outcome compared to applying only one. Preparing a checklist while handling patients will ensure all procedures are compliant with the bundle care guidelines. 

Innovations in the healthcare sector have devised strategies for early detection of infections. Budgetary constraints, however, pose a challenge in developing and financing health care changes. Diseases brought about by use of invasive medical devices have been documented to cause severe complications with disabilities and even death.

Schears in a study in 2012 stated the primary reason for the poor protocol compliance by health care professional was staff shortage (Schears). There is limited time available for the staff to attend to many patients, pushing them to rush in their work ignoring protocol. Health care practitioners have constantly been reminded to follow the protocol even in the limited time frame. A suggestion by CDC to carry all necessary equipment required to provide care per bundle care protocol in one cart to reduce ignorance (Akridge). In a study by Hamage, it is seen that there is a reduction in the number of complications and infections related to catheter infection, when a continuous monitoring is conducted (Harnage).

The health care sector is a sensitive institution. Therefore for any changes or strategy to be introduced, evidence of its good outcome to patients should be evident. In this light, an education program to remind healthcare professionals of the importance of the following protocol should be introduced due to its many advantages, as shown by Jacoby (East and Jacoby). This should be coupled with constant staff evaluation to ensure all ethics and standards are followed, while at the same time observing patient safety.

Developing an implementation plan

Bloodstream infections are a significant medical hazard. The effort by stakeholders to eradicate this problem has not been successful, majorly due to non-compliance by professionals (Schears). Increased infections have been reported in various health care institutions, raising concerns over the quality of care given. The financial burden associated with the extra up to eight-day stay in the hospital and the mortality rate of 12-25% is a major worry. In this setting insisting on the following of protocol reduced the infection rates (McPeake, Cantwell, and Malcolm).

In another report by MMWR in 2011, a 58% reduction in disease was noted when bundle care practice are followed (MMWR). A total of $414 in medical cost was saved, together with 6,000 lives. These figures underline the importance of following the bundle care practice. A study conducted by Kaye et al. confirms this by attributing proper catheter insertion measures and following of maintenance bundles to a great reduction in central line infection rates. Implementation of the new policy will result in health care efficiencies in both cost and quality of care.

When comprehensive education has been given to the health care professionals regarding the need for practicing health care bundle in the system, the new policy can be successfully introduced to the current workflow. An in-service program will be presented in the health care institution and be used to educate the professionals on how to use the bundle care system. For comprehensive coverage of all the personnel in the hospital responsible for handling patients, a two day per week progressive to up to three weeks will be set.  The senior nursing officers will be tasked to ensure that all the health care professionals fully participate in the education program. They should further ensure all proposed changes are eventually incorporated into the system, and all staff members are complying with the protocols.

For the purpose of educating the staff, all relevant materials should be provided to them. These include pamphlets and PowerPoint presentations elaborating the current policy’s shortcomings and how these will be addressed by the new system being advocated. Information technology devices play an important function in this. A survey can be conducted after the sessions to test the personnel’s’ knowledge of using the system.

Before commencing of policy change, it is necessary to seek approval from the top management, and for a smooth flow, from fellow staff members. In a health care setting, a new policy has to be approved by the board of directors of the institution. The chief nursing officer then presents the policy to the board, although the officer is typically a member of the board of trustees. In this way, all the stakeholders of the health care facilities participate in providing better and customer outcomes and overall satisfaction.

Incorporating the germ theory

Theories are concepts that are interrelated and provide a systemic view of a concept that is observable and is explanatory and predictive in nature. The nursing profession is supported by various theories that govern how the nurse assesses and dictate how to handle the patient depending on the specific needs of the patient. The Germ theory states that specific microorganisms are responsible for certain diseases (Nursing planet). The theory is perceived to be the pillar of modern medicine, explaining the mode of disease transmission and possible intervention interventions for preventing disease transmission.

Organisms that cause central line infections can enter the body of the patient in various instances including catheter insertion or through contaminated fluid and medication. Health care personnel actively in contact with the patients are also at a risk of picking microorganisms including Klebsiella species. This underlines the importance of hygiene in the health sector by patients and health personnel to reduce central line infections. Chlorhexidine has been recommended by CDC, as an effective catheter cleaning agent.

Nurses should primarily be educated on the importance of hygiene when dealing with patients with central line catheter, together with other components of bundled care. Decontaminating the fingertips when handling the catheters, proper cleaning and disinfection of the insertion site and use of maximal barrier precautions should always be used. Education sessions will thus be introduced to educate nurses on the importance of these, and follow-up peer reviewing conducted to ensure the proposed changes are implemented.

Developing an evaluation plan

An evaluation consists of a formal and systematic procedure used to evaluate how well a procedure or policy is operating, flaws arising from the system and possible ways to deal with the problems. Evaluation of a policy is conducted continuously on a random basis, and modifications did when required. This consistent approach in the health sector due to the need of evidence-based practice required while introducing new technologies in the sector. This paper digs into the benefits of the use of bundle care concepts in the reduction of central line infections in central line catheter patients.

Evaluating the effectiveness of new policy

To determine the efficiency of the bundle care system in the health sector, in the reduction of central catheter infections, a primary health center will be studied. Audits of reports before and after implementation of the concepts will be compared. The start will also be independent with the approval of the plan by the board as aforementioned. There will be provision of PowerPoint presentation to participants who have accepted to participate in the study. Forms of pre and post evaluation will also be available for the participants to evaluate their knowledge level, attitude, response to the program and possible suggestions concerning the program.

Assessment of variables

To achieve comprehensive benefits of the bundled care, all concepts must be practiced together. Proper hand hygiene, use of maximum precaution barriers, regular central line review, proper catheter insertion point selection, and use of chlorhexidine for cleansing, are the core concepts to be followed in the theory. Close adherence to the protocols by the professional health care providers will significantly reduce incidences of central line catheter infections. The study results will, therefore, be affected by the level of compliance with the principles.

Assessment tool to evaluate the success of the new policy

The audit tool will be used to test for the success of the bundle care concept within a time interval of six months. Patients review will be done to compare with other audit results obtained from analysis of the nurses. Information gathered could also be used to identify the shortcomings of the bundle care concepts and modify areas which are failing.

Dissemination

Research finding from the study can be disseminated to health care stakeholders to push for the incorporation of the bundle care plan in health institutions that are yet to take them. Evidence-based findings will be a greater motivation to the stakeholders compared to technical data. Publishing of the data in renowned journals and medical pamphlets will further spread the evidence to the wider community (Oermann, Shaw-Kokot, and Knafl).

Conclusion

Advancement in science and technology has considerably contributed to advancement in the health care center. The emergence technologies have enabled reduction and mitigation of previously acute infections. This achievement has been possible due to evidence-based practice, with information technology playing a vital role in the dissemination of this information.

Central line-associated blood stream infections, though lethal, can be effectively managed if proper precautions are taken to prevent the disease. Hygiene of both patients and the handling health care professionals is the primary driving force in this change. In order to achieve zero cases of central line blood infections, best nursing practices should be strictly followed, with bundle care concepts being adhered to.

Works cited

Akridge, J. “Preparation and dedication prevent central line infection.” Healthcare Purchasing News 2011: 36-44.

East, D. and K. Jacoby. “The effect of a nursing staff education program compliance with central line care policy in the Cardiac Intensive Care Unit.” Pediatric Nursing 31.3 (2005): 182.

Hadaway, L. “Keeping central line infection at bay.” Nursing 36.4 (2006): 58-64.

Harnage, S. “Achieving zero catheter-related bloodstream infections: 15 months success in a community based medical center.” Journal of the Association for Vascular Access 12.4 (2007): 218-224.

Jackson, A and S Cooper. “Zero central-line infections in a 550-bedded district general hospital.” British Journal of Nursing (2012): 24-28.

McPeake, J., et al. “Central line insertion bundle: Experiences and challenges in an adult ICU.” Nursing in Critical Care 17.3 (2012): 123-129.

MMWR. “Vital signs: central line- associated blood stream infections.” 2011.Nursing planet. Nursing planet. 14 October 2011.

Oermann, M., et al. “Dissemination of research into clinical nursing literature.” Journal of Clinical Nursing 19.23 (2010): 3435-3442.

Schears, G. J. “Online surveys: A potential weapon against clinician non-compliance.” Journal of the Association for Vascular Access 17.1 (2012): 38-41.

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