Summary of Clinical Issue (200-250 words): Central line associated infections can happen in the ICU setting and can lead to poor patient outcomes, longer complicated hospital stays, and increased cost in hospital stays.
Literature Evaluation Table
Student Name: Student Example
Summary of Clinical Issue (200-250 words): Central line associated infections can happen in the ICU setting and can lead to poor patient outcomes, longer complicated hospital stays, and increased cost in hospital stays. Education is a crucial way to inform frontline staff about how to prevent these infections. The creation of a bundle of ways for nurses to care for central lines and incorporating it into their protocols and daily routine can decrease the rate of infections. As a nurse in the ICU, it is helpful for staff to have direct and clear instructions to make sure their responsibilities and skills are being performed according to best practice and per protocol per facility. Nurses are at the bedside and are frequently interacting with central lines on a daily basis in the ICU. Making simple changes such as proper hand hygiene before and after use of a central line can have a very positive result on the rate of the infection. The Joint Commission has included central line-associated bloodstream infections (CLABSIs) in their National Patient Safety Goals. It is a problem that can cause critical issues for patients and event result in death. Nurses can have an impact on reducing CLABSIs by implementing evidence-based interventions, such as hand hygiene, proper education on central line care, visual reminders for staff in unit with key points, proper catheter access protocol, disinfecting caps, dressing changes, and frequent assessment of the continued need for the central line. As a nurse in the ICU, I want to establish a central line care bundle using evidence-based research that can reduce CLABSIs and improve patient outcomes.
PICOT Question: Does the implementation and use of a central line care bundle compared to a non-standardized routine reduce the rate of central line blood stream infections (CLABSIs) in adult ICU patients during their hospital stay?
In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?
In Adult Intensive Care Unit patients, what is the effect of central line care bundle on central line blood stream infections (CLABSIs) compared with non-standardized routine care during the hospital stay.
| Criteria | Article 1 | Article 2 | Article 3 |
| APA-Formatted Article Citation with Permalink | Scheck McAlearney, A., & Hefner, J. L. (2014). Facilitating central line-associated bloodstream infection prevention: A qualitative study comparing perspectives of infection control professionals and frontline staff. American Journal of Infection Control, 42(10), S216–S222. doi: https://doi.org/10.1016/j.ajic.2014.04.006
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Scheck, M. A. A., Hefner, J. L., Robbins, J., Harrison, M. I., & Garman, A. (2015). Preventing central line-associated bloodstream infections: a qualitative study of management practices. Infection Control Hospital Epidemiology, 36(5), 557–563. doi: 10.1017/ice.2015.27
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Damschroder, L. J., Banaszak-Holl, J., Kowalski, C. P., Forman, J., Saint, S., & Krein, S. L. (2009). The role of the “champion” in infection prevention: results from a multisite qualitative study. BMJ Quality and Safety, 18(6). doi: http://dx.doi.org/10.1136/qshc.2009.034199
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| How Does the Article Relate to the PICOT Question? | Reiterates how frontline staff are responsible for delivering direct and ongoing care for central lines. It helps discuss the different perspectives about challenges of central-line associated bloodstream infection prevention program successes. | It discusses how management and hospital-level differences can affect the outcome of patients who have central line-associated bloodstream infections. It gives me more of an idea of how my hospital performs due to their level of performing. I can recognize these barriers to help implement change to reduce infection rates. | It explores types and numbers of champions who lead efforts to implement best practices to prevent infections. It gives me ideas on how to implement practices to prevent CLABSIs and the characteristics is takes to promote change and improve patient outcomes. |
| Quantitative, Qualitative (How do you know?) | Correct Qualitative- it describes quality and characteristics of frontline staff through observation and interviews | Correct Qualitative- it interviews people and receives their nonnumeric data through descriptive characteristics. | Correct Qualitative- it gathers data about characteristics of people and observes behaviors not numeric type of data. |
| Purpose Statement | Infection control professionals play a critical role in implementing and managing healthcare-associated infection reduction interventions, whereas frontline staff are responsible for delivering direct and ongoing patient care. | To identify factors that may explain hospital-level differences in outcomes of programs to prevent central line-associated bloodstream infections. | Although 20% or more of healthcare-associated infections can be prevented, many hospitals have not implemented practices known to reduce infections. We explored the types and numbers of champions who lead efforts to implement best practices to prevent hospital-acquired infection in US hospitals. |
| Research Question | To determine if ICPs and frontline staff have different perspectives about the facilitators and challenges of central-line associated bloodstream infection prevention program success. | How can management practices reflect CLABSI rates and what can be implemented to streamline the reduction rate of CLABSIs with appropriate and effective central line care. | Observing how champions can promote and create change regarding CLABSIs or other hospital acquired infections/ |
| Outcome | Study shows the need to include nurses in the implementation of infection control initiatives. Frontline staff contribute a critical real-world perspective that may facilitate the success of patient safety interventions. | A main theme that differentiated higher from lower performing hospitals was as distinctive framing of the goal of “getting to zero” infections. Although all sites reported this goal, at the higher performing sites the goal was explicitly stated, widely embraced, and aggressively pursued; in contrast, at the lower-performing hospitals the goal was more of an aspiration and not embraced as part of the strategy to prevent infections. | The types and numbers of champions varied with the type of practice implemented and effectiveness of champions was affected by the quality of organizational networks. For practices that require significant behavioral changes, however, a coalition of champions may be needed. |
| Setting
(Where did the study take place?) |
8 various sites in Ohio with approval of the Institutional Review board of Ohio State University | Eight US hospitals that had participated in the federally funded On the CUSP-Stop BSI initiatives. | 14 hospitals from all over the US were sent surveys, telephone interviews, sit down interviews, and some on-site visits. |
| Sample | Across the 8 sites in the study, they interviewed 194 key informants with different jobs and roles in the hospitals. Among these informants were 50 frontline nurses, and 26 ICPs. They focused on the comments from these 76 informants because their roles in the organizations are relevant to their research question focusing on the perspectives of ICPS and frontline staff. | 194 interviewees including administrative leaders, clinical leaders, professional staff, and frontline physicians and nurses. | Survey responses were used to select a stratified purposive sample of 14 hospitals for in-depth semistructured telephone interviews. These hospitals were selected for their potential to further our understanding of organizational barriers and facilitators in implementing infection prevention practices. |
| Method | They conducted interviews at 8 hospitals that participated in the Agency for Healthcare Research and Quality CLABSI prevention initiative called {On the CUSP: Stop BSI.” They analyzed interview data from 50 frontline nurses and 26 ICPs to identify common themes related to program facilitators and challenges. Interviews lasted 30-60 minutes, and the majority were conducted with at least 2 interviewers. | Extensive qualitative case study comparing higher and lower performing hospitals on the basis of reduction in the rate of central line-associated bloodstream infections. In-depth interviews were transcribed verbatim and analyzed to determine whether emergent themes differentiated higher from lower performing hospitals. | Qualitative analyses were conducted within a multisite, sequential mixed methods study of infection prevention practices in Veteran Affairs and no-Veteran Affairs hospitals in the USA. The first phase included telephone interviews conducted in 2005-2006 with 38 individuals at 14 purposively selected hospitals. The second phase used findings from phase 1 to select six hospitals for site visits and interviews with another 48 individuals in 2006-2007. |
| Key Findings of the Study | Identified 4 facilitators of the CLABSI program success: education, leadership, data, and consistency. We also identified 3 common challenges: lack of resources, competing priorities, and physician resistance. However, the perspectives of ICPs and frontline nurses differed. Whereas ICPs tended to focus on general descriptions, frontline staff noted program specifics and often discussed concrete examples. | Five additional management practices were nearly exclusively present in the higher-performing hospitals: 1) top-level commitment, 2) physician-nurse alignment, 3) systematic education, 4) meaningful use of data, and 5) rewards and recognition. They present these strategies for prevention of healthcare-associated infection as a management “bundle” with corresponding suggestion for implementation. | It was possible for a single well-placed champion to implement a new technology, but more than one champion was needed when an improvement required people to change behaviors. Although the behavioral change itself was often more complicated than changing technology because behavioral changes required interprofessional coalitions working together. |
| Recommendations of the Researcher | Their results suggest ICPs need to take into account the perspectives of staff nurses when implementing infection control and broader quality improvement initiatives. Further, the deliberate inclusion of frontline staff in the implementation of these programs may be critical to program success. | Adding a management practice bundle may provide critical guidance to physicians, clinical managers, and hospital leaders as they work to prevent CLABSIs. | Merely appointing champions is ineffective; rather, successful champions tended to be intrinsically motivated and enthusiastic about the practices they promoted. Create enthusiasm about the topic because champions can implement change within their own sphere of influence. |
| Criteria | Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink | Atilla, A., Doganay, Z., Kefeli Celik, H., Tomak, L., Gunal, O., & Kilic, S. S. (2016). Central line-associated bloodstream infections in the intensive care unit: importance of the care bundle. Korean Journal of Anesthesiology, 69(6), 599–603. doi: 10.4097/kjae.2016.69.6.599
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Berenholtz, S. M., Lubomski, L. H., Weeks, K., & Goeschel, C. A. (2014). Eliminating Central-Line Associated Bloodstream Infections: A National Patient Safety Imperative. Infection Control and Hospital Epidemiology, 35(1), 55–62. doi: https://doi.org/10.1086/674384
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Guerin, K., Rains, K., & Bessesen, M. (2010). Reduction in central-line associated bloodstream infections by implementation of a postinsertion care bundle. American Journal of Infection Control, 38(6), 430–433. Doi: https://doi.org/10.1016/j.ajic.2010.03.007
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| How Does the Article Relate to the PICOT Question? | Explains the importance and efficacy of a care bundle for preventing central line-associated blood stream infections in the Intensive Care Unit. Also reinforces why central lines should be assessed daily if they are essentially needed for care. | It shows how the implementation of the “On the CUSP: Stop BSI” program with uniform and appropriate central line care can reduce the rate of CLABSIs. | Studied how a post insertion bundle was effective in decreasing rates of infection. It also gives ideas of what post insertion interventions help prevent infections for nursing care. |
| Quantitative, Qualitative (How do you know?) | Correct Quantitative- it evaluates numbers that result in measurable data | Correct Quantitative- it evaluates using numbers and concludes with measurable data | Correct Quantitative- they did measurable methods to gather data and evaluated using numbers. |
| Purpose Statement | The importance and efficacy of a care bundle for preventing central line-associated bloodstream infections and infections complications related to placing a central venous catheter in the patients in the intensive care unit. | Several studies demonstrating that central line-associated bloodstream infections are preventable prompted a national initiative to reduce the incidence of these infections. | Central line-associated bloodstream infections cause substantial morbidity and incur excess costs. The use of a central line insertion and postinsertion bundle has been shown to reduce the incidence of CLABSI. |
| Research Question | What is the effect of a central line care bundle in association with central line-associated bloodstream infections in the ICU. | How can implementing a national program help decrease the rates of CLABSIs. | Post insertion bundles need to be consistent and uniform to be effective. |
| Outcome | The catherization duration was longer and femoral access was more frequently observed in patients with CLABSIs. CLABSI rates decreased with use of the care bundle. | The overall mean CLABSI rate significantly decreased from 1.96 cases per 1000 catheter-days at baseline to 1.15 at 16-18 months after implementation. | During the preintervention period, there were 4415 documented catheter-days and 25 CLABSIs, for an incidence density of 5.7 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 2825 catheter-days and 3 CLABSIs, for an incidence density of 1.1 per 1000 catheter-days. |
| Setting
(Where did the study take place?) |
In a medical ICU and a surgical ICU | Adult ICU patients in a total of 44 states, the District of Columbia, and Puerto Rico. Collectively more than 1000 hospitals and 1800 hospital units participated | DVAMC-Denver is a university-affiliated acute care teaching hospital which includes a 10-bed medical intensive care unit and a 13-bed surgical intensive care unit. |
| Sample | In total, 114 patients who had CVCs placed in a 22-bed medical ICU and a 12-bed surgical ICU from July 2013 to June 2014 were enrolled. | Adult ICU patients in a total of 44 states, the District of Columbia, and Puerto Rico. Collectively more than 1000 hospitals and 1800 hospital units participated | All ICU patients in both the medical and surgical ICU from October 1, 2006 to September 30, 2009 with a preintervention and a postintervention study completed. |
| Method | A care bundle was implemented from July 2013 to June 2014 in a medical and surgical ICU. Data were divided into three periods and a post intervention period. A care bundle consisting of optimal hand hygiene, skin antisepsis with chlorhexidine (2%) allowing the skin to dry, maximal barrier precautions for inserting a catheter, choice of optimal insertion site, prompt catheter removal and daily evaluation of the need for the CVC was introduced. | They conducted a collaborative cohort study to evaluate the impact of the national “On the CUSP: Stop BSI” program on CLABSI rates among participating adult intensive care units. The program goal as to achieve a unit-level mean CLABSI rate of less than 1 case per 1000 catheter days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented. | Surveillance for CLABSI was conducted by trained infection preventionists using National Health Safety Network case definitions and device-day measurement methods. During the intervention period, nursing staff used a postinsertion care bundle consisting of daily inspection of the insertion site; site care if the dressing was wet, soiled, or had not been changed for 7 days; documentation of ongoing need for the catheter; proper application of a chlorohexidine gluconate-impregnated sponge at the insertion site; performance of hand hygiene before handling the intravenous system; and application of an alcohol scrub to the infusion hub for 15 seconds before each entry. |
| Key Findings of the Study | Infection rate increased when catheters remained in place longer than needed, when healthcare workers did not follow the care bundle practices, and when the catheter was placed via a femoral route. During first 6 months, there were difficulty complying with care bundle practices improved with regular coordination meetings. | Coincident with the implementation of the national “On the CUSP: Stop BSI” program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the US can achieve additional reductions in the CLABSI rates | Findings demonstrate that implementation of a CVC postinsertion care bundle was associated with a significant reduction in CLABSIs. This study demonstrates that interventions developed by front-line nursing staff can be a highly effective response to a problem. |
| Recommendations of the Researcher | Use of all barrier precautions and removal of catheters when they are no longer needed are essential to decrease the CLABSI rate. | Have well-defined, evidence-based interventions. Build a solid implementation structure and project plan. Collect and use timely, accurate, and actionable data to improve performance. Tailor national program for local and unit audiences. Evolves project strategies and emphases over time. | Staff education and reinforcement of proper CVC care after insertion, along with careful cleaning of the hub before access, might reduce the incidence of infection. |
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