Prevention of Central Line

Prevention of Central Line

Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)

  Ten Strategic Points Comments or Feedback
Broad Topic Area

1. Broad Topic Area:

The topic is the Prevention of Central Line-Associated Bloodstream Infections (CLABSIs). Comment by Kathryn Flynn: Kerry, Your new submission does not have the corrections made. I am sending the corrections again. Please modify and only resubmit when corrections are done.

Literature Review

2. Literature Review:

a. Background of the problem/gap:

· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs (Yaseen, et al., 2016).

· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections (Dick et al., 2015).

· The nurses need to have significant knowledge associated with evidence-based practices for the prevention of central line-associated bloodstream infections (CLABSIs). Their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter in adult Intensive Care (ICU) units with (CVC) patients needs to change for the better (Kadium, 2015).

· Research has shown the existence of variations in the practice of nursing regarding the prevention of CLABSI, thus stressing the need for monitoring and education/training (Elbilgahy et al., 2015).

· There is a need for implementation of educational interventions to deal with the practice and knowledge gaps about CLABSIs prevention as well as ensuring that nurses apply prevention interventions which are evidence-based (Esposito et al., 2017).

· The Quality Health Outcomes Model (QHOM) Investigating Prophylactic measures to eradicate the incidence of Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich et al., 2014)

b. Carrying out a review of literature topics with a key theme for each one.

c. Prevention of Central Line Associated Blood Stream Infection (CLABSI) (Masse, Edmond, & Diekema, 2018).

· The Quality Health Outcomes Model (QHOM) is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. This model/framework has been used by various researchers to test the effectiveness of infection prevention measures (Gilmartin & Sousa 2016).

· The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed uses Standardized Infection Ratios (SIRs). Clear Lake regional Medical Center (“NHSN | CDC,” 2018) uses SIRs and this study will also utilize SIRs for measuring the effectiveness of preventivive CLABSI maintance bundles (“SIR Report | HAI | CDC,” 2019).


· Adult ICU (Elbilgahy, et al., 2015).

· The incidence of Catheter-Related Infections (CRIs) in cancer patients at the hospital (Hentrich et al., 2014).


· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention through nursing education (Dombecki, Vercher, Valyko, Mills, & Washer, 2017). Comment by Kathryn Flynn: Kerry, An education program alone is not enough, per AQR. Include in the lit review info about other DPI interventions you will include in the project to bring it up to a doctoral level. Other questions you’ll need to incorporate; nurses are already trained. Why is their current training not enough? Justify why extra interventions are needed to improve patient outcomes.

· Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting. There seems to be a problem regarding the training and education regarding the procedures which should be followed when carrying out catheter-related procedures (Dombecki, Vercher, Valyko, Mills, & Washer, 2017). The objective of this study is to address this issue. Comment by Kathryn Flynn: Vague, what study does ‘this’ refer to? Avoid using this, their, those..

· Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site are necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia (Yaseen, et al., 2016).


a. Background of the problem/gap:

Even though earlier CVCs were associated with mechanical complications such as leaks, air embolisms, and hub separation, CLABSIs quickly became a serious problem when it came to the use of catheters. A study by Owings et al. (2017) indicates that elementary infection control steps may reduce incidences of CLABSIs significantly.

a. Theoretical Foundations (models and theories to be the foundation for the project). Specifically, the model proposed is the Quality Health Outcomes Model (QHOM), which is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system (Gilmartin & Sousa, 2016). Comment by Kathryn Flynn: How does this relate to your project specifically?

The theoretical model is associated with the strategies deployed and operational processes linked to the prevention of Central Line Association Bloodstream Infection. This is demonstrated through a meta-analysis review of randomized control and quasi-experimental studies (Moody, 2019).

b. Review of literature topic

Rapid Dissemination of Universal Decolonization in Adult Intensive Care Units (ICUs) reduces healthcare-associated (HA) central line-associated bloodstream infections (CLABSI) in over 100 Community Hospitals (Hickok et al., 2015).

a. Single Healthcare System

c. Prevention of Central Line Associated Blood Stream Infection (CLABSI).

Problem Statement

There are several safety measures to follow during a procedure involving the insertion of a central line catheter. Despite this, there still exist many cases of infections resulting from such insertions, especially in adult ICUs. For example, a study conducted in an ICU in northern India indicates that in spite of there being several guidelines for CLABSIs prevention, cases of such infections are still high (Mishra et al., 2016). Comment by Kathryn Flynn: I thought you weren’t doing insertion? Modify and update all parts.


Clinical/PICO Questions

3. Clinical/PICOT Questions:

“In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of central line catheter maintain high levels of hygiene after its insertion, along with thorough cleaning of the insertion site, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) compared to standard care over a one-month period?” Many care givers seem to show more consistency in the application of evidence-based practices when inserting the CVC. However, this is not the case after the insertion, explaining the reason why many infections occur postinsertion. This study suggests an intervention measure targeting the post insertion period.

P: Patients > 65 years of age with a central line

I: Staff training on proper CVC maintenance, reinforcement of central catheter, and hub hygiene to educate staff on the utilization of the Central Line (CL) Bundle with a target of at least 100% compliance. This intervention has been proposed by (Tomlinson, 2015) but has not been implemented effectively across centers. Successful implementation of CL Bundle can help in reducing the rates of CLABSI and achieving zero CLABSI events for a period of one month (Yaseen et al, 2016). Comment by Kathryn Flynn: Needs to be more than education, per AQR; simulation? Repeat demonstration? Develop interventions.

C: Compared to standard care. The aim is to identify any discrepancies between the skills gained by trained staff and the standard care procedure.

O:  Reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections). Pre and post intervention outcomes will be measured by counting the number of CLABSIs cases before and after the intervention. Using various questionnaire types (true/false, short answers, and fill in the blank. Comment by Kathryn Flynn: This is floating; connect it to a full sentence and surrounding sentences that give it meaning.

T: A period of one-month



4. Sample (and Location):

a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

b. Sample: The study seeks to sample 60 total nurses from the adult intensive care unit department. 30 nurse’s utilizing the CLABSI bundle and 30 nurse’s not utilizing the CLABSI bundle (specifically CHG bathing). Patient sample size will be >30.

Define Variables

· Define Variables:

· Independent Variables: training and education on proper CVC maintenance when carrying out a central line catheter insertion. Comment by Kathryn Flynn: Develop doctoral level interventions, education only is not enough, per AQR

· Dependent Variables: number of cases of infections resulting from central line catheter insertion.

Methodology & Design · Review of past research will form the core basis of collecting data for this project. Data on new infections related to the insertion of the central line catheter will be collected. measures which are in place to prevent CLABSI include ensuring procedural pause, aseptic techniques, hand hygiene, optimal site selection, use of Chlorhexidine Gluconate (CHG) to protect the skin and taking maximal sterile precautions. According to Iliopoulou, Anderson, & Day (2015) other measures include education on appropriate indications for central lines, including antibiotics indications & durations. There is a need for 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. Also, nurses working in adult ICUs will be surveyed, and the total number of infections resulting from their central line catheter procedures recorded. These cases will be recorded before and after an intervention to determine the effect of the intervention. The intervention will be a short training on how to apply various guidelines after central line catheter insertion, maitance bundle, and its application. Daily monitoring will be done via daily rounding. The likelihood of causing an infection post or pre-training will be determined by monitoring the number of infection cases recorded by each nurse before and after the training. Comment by Kathryn Flynn: Explain specifically what this means.. Comment by Kathryn Flynn: You said you weren’t doing insertion? Please review and modify all parts of this before resubmission. Make sure it is in shape otherwise your project will not be ready to go to AQR in a few weeks. Comment by Kathryn Flynn: Aren’t these in place already? Why do you need the project? Explain how your process differs from what is being done to justify the project. As is, this sounds like you are reviewing what they already know. Comment by Kathryn Flynn: Shouldn’t this be under lit review? Only place methodology here. Organize, use economy of expression, per APA. Comment by Kathryn Flynn: Under this methodology section, you need to write exactly what the intervention is. Right here. Comment by Kathryn Flynn: This needs to be expanded and an education isn’t enough for a doctoral study. Develop interventions and resubmit asap. Comment by Kathryn Flynn: Of what? What will you do exactly. Will there be a validated tool? What will you measure exactly. Be specific.  
Purpose Statement

5. Purpose Statement:

The purpose of this project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff Clear Lake Regional Medical Center in Webster, Texas for the prevention of CLABSIs. Comment by Kathryn Flynn: Organize and be more specific.



Data Collection Approach

6. Sample (and Location):

a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

b. Population: The population being sampled in the study is 60 adult ICU nurses. Comment by Kathryn Flynn: How many patients have central lines? Keep the project patient outcome centered.

7. Determining the Sample Size

· A sample population is often selected based on the PICOT question the evidence-based study is being held on people who are 65 years and more. The patients are with a Central line catheter hub hygiene.

· The sample population is targeted from the ICU unit at Clear Lake Regional Medical Center, Webster, Texas.

· After a focused consideration of the required population, a random sample of 60 nurses from the target group will be picked. 30 nurse’s utilizing the CLABSI bundle and 30 not utilizing the CLASI bundle (specifically CHG bathing). Comment by Kathryn Flynn: How? What methodology? Comment by Kathryn Flynn: Will they all have central line patients? How many? Your sample should be patient focused.

· The selection of a sample population should not be haphazard for it will lead to biased results. Furthermore, a large sample size helps in having precise results (Nayak & Singh, 2015). Comment by Kathryn Flynn: Ok, so how are you going to sample? Be specific and back up with citations.

· To avoid oversampling to have a minimal sample size that we are targeting are the 60 adult nurses out of the 120 (Andersomn, Kelley, & Maxwell, 2017). Comment by Kathryn Flynn: Keep patient focused.

· The proposed intervention is training on the basic guidelines on safety measures to follow when conducting central line catheter insertions. With the confidence level of 95% calls upon the usage of 30 nurses to have an error of 5% only. This population will be equally divided between the intervention group and the control group. The particular ratios of gender are not necessary, yet the ration of re-trained and those left without that are of significance. Time will be 2-4 weeks post insertion. Comment by Kathryn Flynn: Haven’t ICU nurse been trained in basic guidelines? You’ll have to develop and evidence based practice intervention based on best practices and most current literature. Show that nurses are not performing maintenance according to best practices, and justify why you need the interventions. Comment by Kathryn Flynn: This is a sentence frag and does not contain clear information on data collection for this section. Comment by Kathryn Flynn: Keep population patient centered. Comment by Kathryn Flynn: Kerry, unless you justify what interventions you are planning, no IRB is going to let you use patients as experiments to try a new technique. The project has a way to go to solidify very essential parts to get ready for IRB. Comment by Kathryn Flynn: Time for what? Be specific and use full thoughts in sentences.

· This population will be equally divided between the intervention group and the control group.

The formula below will help determine the population to be sampled. The sample size is 60 nurses.

8. Inclusion/exclusion criteria of the subjects

· People who are 65 or above and are from ICU Lake Regional Medical Centre, the central line catheter hub clinic section. Comment by Kathryn Flynn: Patients?

· The nurses who are not core staff of the ICU at Clear Lake Regional Medical Center will be excluded (Patino & Ferreira, 2018).

· Those who will have signed consent will be included in the study because of having fulfilled the research ethics standards. Comment by Kathryn Flynn: Those what? Avoid using those, their, etc.

· When the interviews and questionnaires have been conducted, the incomplete questionnaire forms will be excluded while the interview subjects who have not attended the interview will not be considered. Comment by Kathryn Flynn: What do you mean? Who are the subjects here? It’s not clear what you are doing.

Data Analysis Approach

9. Data Collection Instruments

· The sample of nurses operating within adult intensive care units will be subjected to a training and their efficiency to insert the central line catheter without causing infections tested before and after the training. Comment by Kathryn Flynn: You said you weren’t doing insertion?

· The training will be as much comprehensive and intensive as possible. This is to make sure that the participants have undergone a process that would impact their skills regarding the insertion of the central line catheter. Comment by Kathryn Flynn: Delete; need details..

· To ensure validity, measures will be taken to ensure that the sample used is a true representative of the nursing population serving patients with CVCs.

· Reliability will be addressed by ensuring that the instrument is consistent and collects cosnsistent information from all the participants. Comment by Kathryn Flynn: What instrument? The project can’t progress unless you share info on what you are doing…

· Statistical Package for the Social Sciences (SPSS) to understand research and data analysis will be utilized (Arkkelin, 2014). Comment by Kathryn Flynn: To do what? Now is the time to explain how you will analyze with SPSS; be specific.


Ethical Consideration

· In this research study, any details that the respondent will not want it disclosed will be removed and deleted from any written or oral records, while others are candidly presented. Comment by Kathryn Flynn: What do Comment by Kathryn Flynn: You mean?

· Before the recruitment process, the participants will be contacted and be informed of the research and its significance (Castillo-Montoya, 2016). Comment by Kathryn Flynn: Who?

· They will then be the free times they have for the interview process or questionnaire filling process. Comment by Kathryn Flynn: explain

· The form will have the clinical question, the usability of results, assurance of anonymity and confidentiality in which the researcher will indicate how the results will be exposed, to whom they will be exposed and how the subjects will be prevented from harm. Comment by Kathryn Flynn: what form? Clarify all steps.

· To avoid mentioning of names, the participants will be allocated unique numbers (codes) and the analysis will be based on these. This will ensure that no participant is victimized or embarassed by negative results. This will effectively help avoid labeling the nurses as unhygienic, hygienic, effective or ineffective, and mentioning their particular names.

· It is necessary that Clear Lake Regional Medical Cemter be informed of the study.

Before the study, the researcher will seek the participants’ permission through formal e-mails, which will be sent to the administration for approval. Comment by Kathryn Flynn: Kerry, The project needs work. Participants are not clear, interventions are not clear, data collection and analysis is not clear. Please spend time to modify all parts before any more submissions. There are only weeks left of this class and I still don’t know what you are wanting to do. You mentioned maintenance but half of this says insertion .Be very concise and accurate when you fill in sections. Complete sections with appropriate info for that section only. Let me know if you have any questions.







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