Hospital-Acquired Infections and Guidelines Study

Practice Issue

The topic

The following PICOT question has been formulated to guide this project: In adult patients within medical-surgical settings who are at risk of having a hospital-acquired infection caused by central lines (P), can the proper use of hospital approved guidelines when taking care of central lines (I) verse not following the guidelines (C) decrease the frequency of hospital-acquired infection (O) over a three-month period. A similar topic is discussed in the article by Flodgren et al. (2013).

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The nursing practice issue related to the topic

Central line-associated bloodstream infections (CLABSIs) are among the main factors that lead to high rates of infestation and deaths. The severity of the consequence depends on several aspects, such as underlying conditions, diagnosis, and the quality of interventions. However, one of the most critical factors related to CLABSIs is nursing management. It includes several factors. These are the evaluation of the patient’s risks of developing an infection, preventive measures, and management of central lines.

The scope of the practice issue

The problem of CLABSIs is one of the significant issues in health care. According to official statistics, 30,100 CLABSIs are recorded in Intensive Care Units in the United States annually (“Central Line-Associated Blood Stream Infections (CLABSI),” 2016). They have an enormously harmful effect on the entire country. Other statistics show that “patient mortality rates associated with CLABSI range from 12-25 percent” and “the cost of CLABSIs per episode of care ranges from $3,700 to $36,000 per episode” (“Central Line-Associated Blood Stream Infections (CLABSI),” 2016, p. 2). However, this problem is successfully addressed in several states. For example, it was recorded that the application of evidence-based practices resulted in a reduction in the CLABSIs rates by 46 percent (“Central Line-Associated Blood Stream Infections (CLABSI),” 2016).

The practice area

  • Clinical
  • Education

How the practice issue was identified

  • Safety/risk management concerns
  • Unsatisfactory patient outcomes
  • Significant financial concerns
  • Clinical practice issue is a concern

Infections are one of the main concerns of safety management. This discipline is focused on the prevention of medical-related infections. Its approaches are applied to all people in medical settings, including patients, personnel, and visitors. Constant monitoring of the occurrence of infestation and infectious illnesses helped to identify the issue. Two other pertinent factors were unsatisfactory patient outcomes and financial concerns. The above-mentioned statistics revealed that infections are one of the significant threats to patient safety. Moreover, these data showed that CLABSIs have a considerably negative financial effect. Finally, reports of medical personnel also contributed to the identification of the issue. Infections affect not only patients but also other people who come into contact with them. Therefore, multiple clinicians develop infectious diseases when delivering care.

Evidence that must be gathered

  • Literature search
  • Guidelines
  • Clinical Expertise
  • Financial Analysis

To address the PICOT question, it is necessary to review the relevant literature. There are various studies that cover this topic. The problem is widespread, and specialists throughout the country need to use only effective approaches. Therefore, prior to application, all guidelines should be tested. Such studies are conducted in different settings. Hence, they can provide essential data for analysis. The existing guidelines should be examined as well. Methods offered by different guidelines need to be carefully analyzed and compared to assess their effectiveness. Also, important information might be obtained from the clinical expertise. The experience of clinical practitioners is highly valuable and should be taken into account. Finally, financial analysis is also a pertinent source. Economic reasoning can form the foundation for implications for clinical practice.

Evidence Summary

The practice problem with reference to the identified population, setting, and magnitude of the problem in measurable terms

CLABSIs are one of the main causes of high morbidity and death rates among adult patients receiving care in medical-surgical settings. Statistics demonstrate that such infections are associated with mortality rates that vary from 5 to 35 percent (Flodgren et al., 2013). Therefore, it is necessary to follow the existing guidelines more closely to settle the problem.

Identify the objectives of the systematic review article

The main objective of this article is to evaluate the impact of several interventions on the improvement of infection control within medical settings. The authors focused on the methods to enhance the adherence of clinicians to the existing guidelines.

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The questions being addressed in the work and how these relate to the practice issue

The authors address the question about the main risk factors. They state that these are the application of invasive medical instruments and inaccurate performance of infection prevention activities. This question is pertinent to the practice issue that I discuss in this work. The PICOT question has been formulated to analyze the effectiveness of the established hospital guidelines in reducing the frequency of hospital-acquired infection.

The interventions the author(s) suggest to improve patient outcomes

The authors state that the evidence presented in the review is not sufficient to prove the effectiveness of a particular intervention (Flodgren et al., 2013). Nonetheless, they suggest that educational interventions that consist of several active components and are delivered several times during a certain period are deserved to be examined more closely. They also highlight the importance of interventions delivered by specialists who support care by evidence.

The main findings by the authors of the systematic review, including the strength of evidence for each main outcome

In a work by Flodgren et al. (2013), the authors state that the strongest effect on ventilator-associated pneumonia rates was a decrease of 7.36 cases per 1000 ventilator days. The data was collected from five studies in fifteen cities (strong evidence). The next finding is that interventions that led to the reduction in infection rates included several active interventions. Six studies documented post-intervention adherence scores that varied from 14 to 98 percent (weak evidence).

The main findings of another study include the positive effect of infection prevention guidelines. They reduced the occurrence of CLABSIs by 40% and saved approximately $15,181,000 (“Central Line-Associated Blood Stream Infections (CLABSI),” 2016). The AHA/HRET Hospital Engagement Network provided the data (strong evidence).

These findings are relevant for my project as they demonstrate the effect of different interventions on patient outcomes. Therefore, these data might be used in the Milestone 2 project paper.

Evidence-based solutions to consider for the project

The reviewed interventions include an indication for a central venous catheter, sterile precautions, hand hygiene, skillful insertion, and an aseptic technique.

Limitations to the studies that impact the ability to utilize the research in your project

Insufficient evidence presented in the study by Flodgren et al. (2013) is the major limitation for my project. The authors state that further research is required to make any reasonable conclusions regarding the effectiveness of the discussed in the study interventions.

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References

Central Line-Associated Blood Stream Infections (CLABSI). (2016). Web.

Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device‐related infections. The Cochrane Database of Systematic Reviews, 28(3), 1-106.

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