Introduction
In the United States, millions of catheters are purchased annually. Intravascular catheters make an indispensable part of modern-day nursing practice, particularly in oncology units. The use of catheters has its inarguable benefits: it provides necessary vascular access for the administration of treatment. However, exposure to intravascular catheterization makes patients vulnerable to local and systemic infectious complications. The said complications include but are not limited to local site infection, catheter-related bloodstream infection (CRBSI), endocarditis, and septic thrombophlebitis. The incidence of each of the conditions is contingent on a variety of factors. For instance, for CRBSI, the contributing factors include the type of catheter, frequency of use, and patient-related factors. Local or bloodstream infections (BSIs) are often associated with peripheral venous catheters that are most commonly used for intravascular access. It is argued that yet another important factor shaping patient outcomes is nursing education on the subject matter.
Problem Statement
Statistically, in the United States, patients are exposed to the central venous catheter (CVC) 15 million days annually. The average rate of CVC-related bloodstream infections (BSIs) is roughly five per 1,000 catheter days (Rupp & Karnatak, 2018). Therefore, one can approximate that there are about 80,000 CVC-related BSIs happening in the US each year. At present, there is no consensus on the mortality rate associated with BSIs: research reports figures ranging from zero to 35% in mortality (Rupp & Karnatak, 2018). Regardless, CVC-associated infections create a nationwide financial burden with an attributable cost per infection of $34,508–$56,000 and the total cost ranging from $296 million to$2.3 billion (Rupp & Karnatak, 2018). Oncology units have their peculiarities when it comes to hospital-acquired infections: See et al. (2016) report that antimicrobial-resistant E. coli and E. faecium are now serious pathogens in oncology. Reducing the infection rate will mean a lesser financial burden, better patient outcomes, and an increase in the quality of life for patients.
PICOT Question Explanation of Each Component
Population of Interest
The population of interest for this study project consists of oncology nurses. Today, oncology nurses are experiencing an unusually high workload due to the soaring cancer rates in North America. Cummings et al. (2018) predict that 45% of North American women and 49% of North American men will experience cancer during their lifetime with one-fourth of all cases being lethal. Cummings et al. (2018) reason that the role of oncology nurses will continue to evolve and likely include specialization and advanced training. On top of that, oncology nurses are expected to take on leadership roles and develop the field. For the reasons stated above, it is only reasonable to provide oncology nurses with better education on catheter use in oncology units.
Intervention of Interest
The intervention of interest is a short-term educational course in a hospital setting for nurses employed in oncology units. The course should cover all important topics and problems related to catheter and port use and be evidence-based. Some of the topics to be addressed may include but are not limited to the choice of catheter, insertion technique, disinfection, catheter dressing and maintenance, and guidance. Special attention should be paid to infections in oncology units since, as mentioned before, some aspects such as pathogens may vary. Gao et al. (2015) also warn about the delayed onset of infectious complications for oncology patients with an average time of 98.26 days after the use of a catheter. There is evidence suggesting the effectiveness of education in reducing the rates of BSIs in hospitals. For instance, Bell and O’Grady (2018) report that the use of multiple strategies and adherence to evidence-based guidelines results in a drop in the infection rate (both CRBSI and CLABSI).
Comparison of Interest
The current study project will focus on the same sample of nurses and will compare their pre-training knowledge to their post-training knowledge in the form of a multiple-choice test or open-ended questions. It would not be exactly reasonable to divide the sample into the intervention and control groups because it would not prioritize current healthcare needs. As many nurses as possible should be educated on the subject matter simultaneously.
Outcome of Interest
As mentioned before, the current research seeks to bring down the CVC-associated infections rates in oncology units through continuing education of nurses. The goal is to lower the incidence rate for a given hospital and keep it lower than statewide or nationwide metrics. Eventually, research might also address the financial aspect of the problem and look into the cost efficiency of training.
Timeframe
The proposed timeframe for the current study is from eight to 16 weeks.
Conclusion
Hospital-acquired infections associated with catheter and port use are common complications in American hospitals. Every year, they take the lives of patients, decrease the quality of life for others, and contribute to the financial burden of the healthcare system. Oncology units deserve special attention in this discussion as they have their unique characteristics when it comes to CVC-associated complications. The current research project seeks to determine the effectiveness of nurse training on the evidence-based use of catheters and ports in oncology patients. The desired outcome is a reduction in the infection rate at eight to 16 weeks post-training.
References
Bell, T., & O’Grady, N. P. (2017). Prevention of central line-associated bloodstream infections. Infectious Disease Clinics of North America, 31(3), 551–559.
Cummings, G. G., Lee, S. D., & Tate, K. C. (2018). The evolution of oncology nursing: Leading the path to change. Canadian Oncology Nursing Journal = Revue Canadienne de Nursing Oncologique, 28(4), 314–317.
Gao, Y., Liu, Y., Ma, X., Wei, L., Chen, W., & Song, L. (2015). The incidence and risk factors of peripherally inserted central catheter-related infection among cancer patients. Therapeutics and Clinical Risk Management, 11, 863–871.
Rupp, M. E., & Karnatak, R. (2018). Intravascular catheter-related bloodstream infections. Infectious Disease Clinics, 32(4), 765-787.
See, I., Freifeld, A. G., & Magill, S. S. (2016). Causative organisms and associated antimicrobial resistance in healthcare-associated, central line–associated bloodstream infections from oncology settings, 2009–2012. Clinical Infectious Diseases, 62(10), 1203-1209.