Introduction to the Project

Introduction to the Project

Revisions

Chapter 1: Introduction to the Project

Vascular catheters are commonly used for both in-patient and out-patient cases to administer blood products, intravenous fluids, parenteral nutrition, and other types of medications. The use of catheters is, however linked to the risk of developing infections mainly caused by microorganisms found on the external surface of the instrument or in the fluid pathway during insertion or in the course of use. Notably, central venous catheters have been cited as the most frequent and the costliest cause of bloodstream infections (Haddadin & Regunath., 2019). A central line-associated bloodstream infection (CLABSI) mainly occurs within 48 hours after a catheter is inserted and can be a major cause of morbidity and mortality besides increasing the cost of healthcare both for the individual and the healthcare system in general (Iliopoulou, Anderson & Day, 2015).

Most CLABSIs cases are recorded in the ICU, but there are some cases which occur outside the ICU. CLABSIs can be prevented with the use of evidence-based guidelines about the insertion and maintenance of catheters. Past research studies have been unable to successfully link CLABSIs with a mortality given that patient deaths occur as a result of multiple causes, and the effect of health associated infection may not be apparent. However, there is a general agreement that CLABSIs are a major cause of patient deaths in both developed and developing countries (Tomlinson, 2015). The fact that CLABSIs cases are a major cause of illnesses, deaths and longer stays in hospitals mean that it is highly costly, and there is a need to find a solution as soon as possible.

While there have been some improvements in reducing cases of CLABSIs, further efforts are required to prevent patients’ harm more so in non-critical care settings. Some of the measures which are in place to prevent CLABSI include ensuring procedural pause, aseptic techniques, hand hygiene, optimal site selection, use of chlorhexidine to protect the skin, and taking maximal sterile precautions. Other measures include education on appropriate indications for central lines, including antibiotics indications & durations. There is also clear escalation protocols for hard stick IV/phlebotomy patients and clear de-escalation protocols for central lines that are no longer medically necessary. Many nurses employ consistent bi-annual education on CVC dressings/maintenance by product reps. In addition to these measures, this project proposes consistent quarterly CVC dressing/maintenance checkoffs for all nursing staff on direct patient care units.

In this introductory chapter, the background of the project, problem statement, and the purpose of the project are given. Next, the clinical questions, criteria for advancing scientific knowledge, the significance of the project are provided. Lastly, the rationale for the methodology, nature of the project design, nature of the project design, as well as assumptions, limitations, and delimitations are given.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Introduction This section briefly overviews the project focus or practice problem, why this project is worth conducting, and how this project will be completed. (Three or four paragraphs or approximately one page)	2	2
Practice improvement project topic is introduced.	2	1	Develop what you’ll do in your project
Discussion provides an overview of what is contained in the chapter.	2	2
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	2
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Background of the Project

The use of central lines is increasingly becoming popular for both inpatients and outpatients to provide venous access. These lines upset the integrity of the skin, making bacterial and fungal infections possible. CLABSIs may spread in the bloodstream causing hemodynamic changes or organ dysfunction and ultimate death of the patient. It is estimated that 90 percent of CLABSIs occurs from central lines, with approximately 48 percent of cases taking place in ICU (Tomlinson, 2015). An estimated 82,000 CLABSIs cases and 28,000 attributable deaths occur every year (Tomlinson, 2015). In the U.S alone, it is estimated that 31,000 patients lose their lives annually due to CLABSIs (Tomlinson, 2015). A compendium of strategies has been developed to prevent CLABSIs. These include a guideline for hospitals and care professionals to use when placing a central line.

A central line bundle consisting of five components has been established to improve patient’s outcomes (Iliopoulou, Anderson & Day, 2015). These components give better outcomes when implemented together as opposed to individually. They include hand hygiene, chlorhexidine antisepsis, maximal barrier precautions, optimal site selection and daily reviews and prompt removal. It is important to note that this is not a comprehensive selection of all the care elements that should go together with central lines. On the central line, the bundle is intended to enhance collaboration and teamwork among healthcare professionals. Other elements may be recommended depending on the patient and the purpose of the central line (Olsen, Schwehm & Campbell, 2015). In essence, the use of the central line bundle has helped reduce cases of CLABSIs by about 66 percent (Olsen, Schwehm & Campbell, 2015). A multidisciplinary approach is always recommended when taking care of patients in the ICU. Such teams should be heterogeneous in composition but homogenous when it comes to the mindset. It is important to offer encouragement and commitment to such teams if the end goal is to be met. This way, cases of CLABSIs can be reduced if not eliminated, and deaths occurring due to hospital-related infections prevented.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Background of the Project The background section explains both the history and the present state of the problem and project focus. This section summarizes the Background section from Chapter 2. (Two or three paragraphs)	2	2
This section provides an overview of the history of and present state of the problem and project focus.	2	2
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	1	Citations needed for statistics
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Problem Statement

There is limited research on CLABSIs, especially regarding developing countries. Existing studies indicate that the rates of CLABSIs are higher for developing countries as compared with developed ones. Still, the latter countries also have worrying rates even though there are established guidelines to prevent, control, and reduce incidences of infections (Iliopoulou, Anderson & Day, 2015). Even though studies have substantiated CLABSIs as a significant health concern, the degree of efficacy of CVC maintenance during and after catheter insertion needs improvement. This is even though guidelines have been established to help reduce cases of CLABSIs. More specifically there is an alarming trend that indicates that caregivers do not adhere completely to established guidelines which is one of the causes of CLABSIs (Duane, Ramanathan, Leavell, Mays & Ober, 2016). Also, poor training for nurses about hand hygiene and skin aseptic techniques has been a contributing factor to microbial infections as a result of CLABSI. This has, in turn, increased mortality rates for CVCs patients besides prolonging hospital stays and increasing the cost of care (Duane, Ramanathan, Leavell, Mays & Ober, 2016). While there are many guidelines in the literature regarding proper handling of vascular catheters, cases of CLABSI infections seem to remain high. This calls for the need for teaching proper CVC maintenance as the intervention to prevent CLABSI.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Problem Statement This section includes the problem statement, the population affected, and how the project will contribute to solving the problem. (Two or three paragraphs)	2	2
This section states the specific problem for investigation by presenting a clear declarative statement that begins with “It is not known if and to what degree/extent…,” or “It is not known how/why and….”	2	2
This section identifies the need for the project.	2	2
This section identifies the broad population affected by the problem.	2	2
This section suggests how the project may contribute to solving the problem.	2	2
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	1	Add citations where needed
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Purpose of the Project

The purpose of this study is to explore the problem of CLABSIs and examine available measures to prevent, control, and reduce incidences. More importantly, the study examines the role of training both in school and on the job in helping to reduce associated health infections such as CLABSIs. In this context, the researchers realize that nurses are poorly trained on how to maintain hand hygiene which coupled by factors such as lack of support from the management increases cases of CLABSIs (Al Hammadi et al. 2018). In this study, the role of training in reducing CLABSIs is investigated. Further, what various stakeholders are doing to ensure that nurses are conversant with evidence-based practices for preventing CLABSIs is looked at.

In particular, this project proposes teaching proper CVC maintenance as an intervention to prevent CLABSI. It is expected that increasing the number and quality of training sessions about CVC maintenance would lead to a reduction in cases of CLABSI infections. The research will focus on nurses working in acute care sections of public health facilities in Webster, Texas.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Purpose of the Project The purpose statement section provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the project will contribute to the field. (Two or three paragraphs)	2	2
This section presents a declarative statement: “The purpose of this project is….” that identifies the project design, population, variables (quantitative) or phenomena (qualitative) to be investigated, and geographic location.	2	2
This section identifies project method as qualitative, quantitative, or mixed, and identifies the specific design.	2	0	Specify components in text
This section describes the specific population group and geographic location for the project.	2	1	Develop population demographics
This section defines the dependent and independent variables, relationship of variables, or comparison of groups (quantitative). Describes the nature of the phenomena to be explored (qualitative).	2	1	Specifics are needed
This section explains how the project will contribute to the field.	2	1	develop
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	2
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Clinical Question

Engaging healthcare professionals to adopt hygienic practices is crucial in the fight against CLABSIs. However, it is even more important to ensure that nurses are well trained and conversant with the general guidelines of patient handling to eliminate cases of health-related infections. Training ensures that best practices are followed during the insertion of catheters, dressing, assessment, and removal. While training especially on-the-job training may take time and adoption of practices prolonged, hospitals should ensure that nurses and other care professionals are informed on the best practices to avoid cases of CLABSIs. Staff training in CVC site care and maintenance will help reduce infections (Owings et al. 2017). Hospitals should, in this case, assess nurses’ understanding and competence when it comes to maintenance of CVC sites. Empowering nurses is also important to ensure commitment and willingness to communicate issues relating to patient care. The following clinical question guide this quantitative project:

Q: How does staff training of proper CVC maintenance reduce the incidence of CLABSIs?

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Clinical Question(s) This section narrows the focus of the project and specifies the clinical questions to address the problem statement. Based on the clinical questions, it describes the variables or groups for a quantitative project or the phenomena under investigation for a qualitative project. (Two or three paragraphs)	2	1	Use PICO format compared to what? What is proper? Evidence base best practice standards? What period of time? Name population- newborns?
This section states the clinical questions the project will answer, identifies the variables, and predictive statements using the format appropriate for the specific design.	2	1	Develop variables
This section includes a discussion of the clinical questions, relating them to the problem statement.	2	1	Grow one paragraph to three overall1
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	1	Develop citations as development of section occurs
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Advancing Scientific Knowledge

Upon completion, this project is set to add to existing knowledge in the field of nursing and specifically the management and prevention of CLABSI. Nurses working in all settings requiring the use of vascular catheters already have varying knowledge regarding guidelines and safety measures to avoid central line blood infections. Given that the rates of CLABSI infections are still relatively high, it can be tentatively concluded that adding more knowledge in CVC maintenance will help. The proposed project seeks to add to this knowledge skills on proper CVC maintenance as the intervention to prevent CLABSI. This project will also contribute to the existing scientific knowledge in form of implementation of educational interventions regarding CVC maintenance for CLABSI prevention.

The theoretical foundation upon which this project is based is the Quality Health Outcomes Model (QHOM). This framework is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. The project seeks to bridge the gap existing in the literature regarding teaching proper CVC maintenance as the intervention to prevent CLABSI. This will be achieved by training a few nurses and observing if there is any improvement in how they handle CVC procedures.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Advancing Scientific Knowledge This section specifically describes how the project will advance population health outcomes on the topic. It can be a small step forward in a line of current project, but it must add to the current body of knowledge in the literature. It identifies the gap or need based on the current literature and discusses how the project will address that gap or need. This section summarizes the Theoretical Foundations section from Chapter 2. (Two or three paragraphs)	2	1	Justify why project is needed in this setting. Develop- This section summarizes the Theoretical Foundations
This section clearly identifies the gap or need in the literature that was used to define the problem statement and develop the clinical questions.	2	1
This section describes how the project will address the gap or identified need in the literature.	.2	1
This section identifies the theory or model upon which the project is built.	2	2	good
This section describes how the project will advance the theory or model upon which the project is built.	2	1	Develop tis component
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	2
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Significance of the Project

This study seeks to add to existing knowledge about CVC maintenance and how it can be used to ensure safety of patients with catheter insertions. As noted earlier, there are established guidelines that nurses are required to follow to ensure that patients are not exposed to microbial infections when undergoing treatment in the hospital (Al Hammadi et al. 2018). Arguably, these guidelines are, at times, not adhered to completely, which exposes patients to the risk of infections (Rosenblatt et al. 2017). According to a study by Valencia et al. (2016), poor adherence to the guidelines for CLABSI prevention are the key causes of infections. This study is backed by studies by Pronovost et al. (2010); Umscheid et al. (2011); Blot et al. (2005); and Marschall et al. (2014).

Also, nurses lack enough knowhow when it comes to implementation of these guidelines, which coupled with lack of support and commitment on the side of the administration hinders the effort to ensure the safety of CVC patients. For instance, in a study, Ferrara and Albano (2018) found out that nurses lacked evidence-based knowledge and practices concerning the management of CVC. Other studies with similar findings include the ones carried out by Septimus and Moody (2016); Magill et al. (2014); Ider et al. (2012); and Bonnal et al. (2010). By examining how training and nurse empowerment contributes towards the reduction of cases of CLABSIs, this study seeks to identify ways in which hospitals and care providers can work collaboratively to ensure the safety of the patient by proposing proper CVC maintenance practices.

An important implication of this study is that CLABSI cases will significantly reduce owing to the training. It is hoped that if the recommendations drawn from this study are applied across health facilities, cases of CLABSI will decline. This project fits within and will contribute to the current literature, and the clinical site practice since proper maintenance of CVC is nurse driven. The skills gained from the proposed teaching will be directly applied in the hospital when performing vascular catheter operations.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)
Significance of the Project This section identifies and describes the significance of the project and the implications of the potential results based on the clinical questions and problem statement. It describes how the project fits within and will contribute to the current literature or the clinical site practice. It describes potential practical applications from the project. (Three or four paragraphs)	2
This section provides overview of how the project fits within other current literature in the field, relating it specifically to other studies.	2	Specifics needed
This section describes how addressing the problem will impact and add value to the population, community, or society.	2	Supportive evidence is suggested
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2
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Rationale for Methodology

The current study will apply a mixed methods approach where elements of both qualitative and quantitative techniques will be used in data collection and analysis. In mixed research design, a combination of at least one quantitative and one qualitative component is used in the processes of data collection and analysis (Johnson and Christensen, 2017; Onwuegbuzie and Johnson, 2006; Schoonenboom & Johnson, 2017). In this project, a CVC maintenance bundle checklist will be used to observe various nurses in the ICUs of an acute care hospital in Webster, Texas. The observation will involve comparing what the nurses are doing regarding CVC maintenance versus the guidelines on the maintenance bundle and will be done for a period of three months. The parallel qualitative design will involve interviewing various nurses in hospitals to explain barriers to proper application of CVC maintenance bundle. The mixed methods research approach has been successfully used by Ider et al. (2012) to identify barriers to compliance with evidence-based guidelines for central line management. The main objective of using this approach is to strengthen and/or expand conclusions thereby contributing to existing knowledge. The approach helps to heighten knowledge and increase the validity of the results. A mixed approach will also help to ensure convergence, correspondence, and corroboration of results (Guetterman, Fetters & Creswell, 2015). Further, it will help in ensuring complementarity besides expanding the range and breadth of inquiry.

The clinical question posed in this study is: How does staff training of proper CVC maintenance reduce the incidence of CLABSIs? From this question, the independent and dependent variables are “training of proper CVC maintenance” and “reduction in the incidence of CLABSI.” It is predicted that introducing the training will reduce CLABSI incidences. Thus, the two variables are expected to be negatively correlated.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Rationale for Methodology This section clearly justifies the methodology the investigator plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the clinical questions and address the problem statement. It uses citations from textbooks and articles on DPI project methodology or articles on related studies. (Two or three paragraphs)	2	1	Relate to actual interventions you’ll include in the project
This section identifies the specific project method for the project.	2	1	Develop methodology
This section justifies the method to be used for the project by discussing why it is the best approach for answering the clinical question and addressing the problem statement.	2	1	“
This section uses citations from textbooks or literature on the DPI project methodology to justify the use of the selected methodology.	2	1	Develop citations as other parts are developed
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	2
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Nature of the Project Design

In this project, a CVC maintenance bundle checklist will be used to observe various nurses in the ICUs of an acute care hospital in Webster, Texas. The observation will involve comparing what the nurses are doing regarding CVC maintenance versus the guidelines on the maintenance bundle and will be done for a period of three months. The parallel qualitative design will involve interviewing various nurses in hospitals to explain barriers to proper application of CVC maintenance bundle. The mixed methods research approach has been successfully used by Ider et al. (2012) to identify barriers to compliance with evidence-based guidelines for central line management. Closed-ended questionnaires will be administered to the sampled nurse supervisors. This type of questionnaires will ensure that data analysis is not overwhelming because the respondents are tied to specific answers. The questionnaires will be formulated based on a closed questionnaire format on the basis of a Yes or No responses. As a validation process, the interview questionnaires will be acquired from the previous literature that handles the same issues in the study.

For evidence-based practice in a healthcare setting, it is proper to ask nurses questions about the particular practices in relation with the staff training, reinforcement of the central line catheter hub hygiene once it has been inserted, the cleansing of the site and cases of Central Line-Associated Blood-stream Infections. The process will assist in acquiring the observational, additional, and basic data that is targeted. A sample of 120 nurses will then be picked randomly from the facility whose supervisors will have been interviewed and taken through a short training on CVC maintenance. Their likelihood of causing CLABSI will be determined by comparing the number of infections caused in their care before and after the training.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Nature of the Project This section describes the specific project design to answer the clinical questions and why this approach was selected. It describes the project sample as well as the process that will be used to collect the data on the sample.	2	1
This section describes the selected design for the project.	2	1
This section discusses why the selected design is the best design to address the problem statement and clinical questions as compared to other designs.	2	1
This section briefly describes the specific sample and the data collection procedure to collect information on the sample. Briefly describes how the design supports the intervention and solution to the practice problem.	2	1
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	2
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Definition of Terms

The following terms are used operationally in this project:

CLABSI (Central Line-associated Bloodstream Infection). This is a primary laboratory-confirmed bloodstream infection in a patient with a central line at the time of (or within 48-hours before) the onset of symptoms, and the infection is not related to an infection from another site (California Department of Public Health, 2017).

Central Venous Catheters (CVCs). “A central venous catheter is a catheter with a tip that lies within the proximal third of the superior vena cava, the right atrium, or the inferior vena cava. Catheters can be inserted through a peripheral vein or a proximal central vein, most commonly the internal jugular, subclavian, or femoral vein” (Smith & Nolan, 2013).

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Definitions of Terms This section defines the project constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and sundry terminology used within the scope of the project. Terms are defined in lay terms and in the context in which they are used within the project. (Each definition may be a few sentences to a paragraph in length.)	2	2
This section Defines any words that may be unknown to a lay person (words with unusual or ambiguous means or technical terms) from the evidence or literature.	2	2
This section defines the variables for a quantitative project.	2	0	develop
Definitions are supported with citations from scholarly sources.	2	2
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	2
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Assumptions

1. It is assumed that survey participants in this project do not give misleading information through their answers. Participants are expected to provide answers which are honest and to the best of their ability. This assumption is based on the fact that the participants are professionals working under oath to adhere to professional ethics at all times.

1. It is assumed that this project is an accurate representation of the current situation in many hospitals across the world, and specifically in adult wards in Phoenix, Arizona. The assumption is especially about those patients who have already undergone a CVC procedure.

Limitations and Delimitations

 

 

1. This project is limited by the possibility that some participants may give biased, false, or inaccurate information. The researcher does not have a way of knowing if the information collected is true, unbiased, or accurate. Further, the project is limited by funds and other resources because it is solely funded by the researcher.

1. The survey of nursing supervisors is delimited to only public urban hospitals in Webster, Texas, limiting the demographic sample. It would be practically impossible to survey a wider region with the resources and time available.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Assumptions, Limitations, and Delimitations This section identifies the assumptions and specifies the limitations, as well as the delimitations, of the project. (3-4 paragraphs)	2	1	Review resources to add to this section
This section states the assumptions being accepted for the project (methodological, theoretical, and topic-specific).	2	1	Develop theoretical assumptions
This section provides rationale for each assumption, incorporating multiple perspectives, when appropriate.	2	1
This section identifies limitations and delimitations of the project design.	2	1
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	2
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Summary and Organization of the Remainder of the Project

In the first chapter of this project, the background of the project, problem statement, and the purpose of the project are given. Next, the clinical questions, criteria for advancing scientific knowledge, the significance of the project are provided. Lastly, the rationale for the methodology, nature of the project design, nature of the project design, as well as assumptions, limitations, and delimitations are given. Chapter 2 will present a review of current evidence on the centrality of the practice improvement project literature review in research preparation. Chapter 3 will describe the methodology, design, and procedures for this investigation. Chapter 4 details how the data was analyzed and provided both a written and graphic summary of the results. Chapter 5 is an interpretation and discussion of the results, as they relate to the existing body of research related to the practice improvement project topic.

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Organization of the Remainder of the Project This section summarizes the key points of Chapter 1 and provides supporting citations for those key points. It then provides a transition discussion to Chapter 2, followed by a description of the remaining chapters.	2	1	Ok, talk specifically about your project
This section summarizes key points presented in Chapter 1.	2	1
This section provides citations to support key points.	2	0
Chapter 1 summary ends with transition discussion to Chapter 2.	2	1
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	1
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References

Advani, S. D., Lee, R. A., Long, M., Schmitz, M., & Camins, B. C. (2018). The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center. Infection Control & Hospital Epidemiology, 39(07), 878-880. doi:10.1017/ice.2018.78

Al Hammadi, A., et al. (2018, November). Accuracy of the NHSN central line-associated bloodstream infection (CLABSI) definition. In Open Forum Infectious Diseases (Vol. 5, No. Suppl 1, p. S3). Oxford University Press.

Anderson, S.F., Kelley, K., & Maxwell, S.E. (2017). Sample-size planning for more accurate statistical power: A method adjusting sample effect sizes for publication bias and uncertainty. Psychological Science, 28(11), 1547-1562. doi:10.1177/095679761772372428(11)

Arkkelin, D. (2014). Using SPSS to understand research and data analysis. Psychology Curricular Materials, 1-100. Retrieved from http://scholar.valpo.edu/psych_oer/1?utm_source=scholar.valpo.edu%2Fpsych_oer%2F1&utm_medium=PDF&utm_campaign=PDFCoverPages

Beverly, A. L., Hill, M. M., Camins, B. C., & Lee, R. A. (2018). Decreasing CLABSI Incidence Associated with Decreasing MRSA Bacteremia LabID Incidence. American Journal of Infection Control, 46(6), S82. doi:10.1016/j.ajic.2018.04.160

Blot SI, Depuydt P, Annemans L, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis. 2005;41:1591–1598. doi: 10.1086/497833.

Bonnal C, Mourvillier B, Bronchard R, de Paula D, Armand-Lefevre L, L’heriteau F, et al. Prospective assessment of hospital-acquired bloodstream infections: how many may be preventable? Qual Saf Health Care. 2010;19:e30.

California Department of Public Health. (2017, April 21). Healthcare Associated Infections (HAI) Program. Retrieved from California Department of Public Health: https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/CentralLine-associated Bloodstream Infection (CLABSI).aspx

Carpenter, A. D., McTigue, S., & Roberts, G. K. (2016). Suspected Origins of Bacteremia in Center for Disease Control (CDC) National Healthcare Safety Network (NHSN) Defined Central Line Associated Bloodstream Infections (CLABSI) at a Tertiary Care Academic Medical Center. American Journal of Infection Control, 44(6), S11. doi:10.1016/j.ajic.2016.04.183

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