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medications and fluids at once, especially when in the intensive care unit.
However, when a patient has a central line, it significantly increases the risk for
infection. The central line catheter provides bacteria with the opportunity to enter
According to the Centers for Disease Control and Prevention (2011), central
that occur when pathogens enter the bloodstream through a central line. These
infections cause thousands of deaths every year. The mortality rate for central line
infections ranges between 4% and 20%, with the average cost per CLABSI
reported around $45,685 per patient (Bakdash, Drews, & Gleed, 2017). However,
significantly in the past 5 years. This dramatic decrease in the number of CLABSIs
can be attributed to the CLABSI bundle, which is a set of guidelines created by the
Center for Disease control (along with other organizations), which has been proven
The CLABSI bundle is the current standard of care when it comes to prevention
including checklists for the insertion, maintenance, and removal of central lines.
For example, the checklist requires that central line catheters be inserted using
sterile technique and that a sterile dressing be placed over the insertion site. The
CLABSI bundle checklist also states that central line dressings be changed
changing the IV tubing anywhere between 4-7 days, bathing patients with
chlorhexidine every day, and scrubbing the access port with alcohol before every
use.
Question to be explored
Are the components of central line bundle kits significant regarding a reduction in
Methodology
We searched PubMed and Medline for the term “CLABSI prevention” and were
able to find 433 articles which matched our search criteria. Of these 433 articles,
we chose 4 articles to read and summarize for this project. We chose these 4
articles specifically because they were the most pertinent to our research question.
We also chose these articles because the studies were conducted within the past 5
years, which makes the information obtained more relevant to our research.
Summary with analysis of literature and conclusion
This article was chosen because it was specific towards our topic but also had
teaching nurses about the new protocol guidelines. The article’s question was
adherence to the new practice. In this study, some nurses were educated about
the protocol by administrators and then those nurses went on to teach the other
nurses. The rationale behind this was that learning-by-teaching was the most
effective way to retain the information and therefore reduce the incidence of
central line infections. In fact, this study was able to conclude that 90% of the
content of a specific subject was retained when a person tried to teach the
information to someone else (Park, Ko, An, Bang, & Chung, 2017). Research
months post-intervention. After this time frame, the CLABSI rate was further
monitored for the next 3 years. The study had taken place in a 767- bed tertiary
facility and only measured a single hospital. The practicality could be taken
to other hospital sites with limited resources though. The results were that the
implemented peer-tutoring did help reduce CLABSI infections but it was not
sustainable.
(McPeake, Cantwell, Booth, & Daniel, 2012) wrote this article to address the
initial use of central line insertion bundles in an adult ICU. The authors address
concerns about patient health and financial cost when central line infections
impede the healing process. The purpose was to improve methods of central line
insertion in order to prevent central line associated blood infections. The study
help reduce CLABSI in the hospital care setting. The model used a checklist for
insertion for those assisting with CVC placement. There were three ways that
helped improve accuracy of data collection. First, the data collection was
incorporated into the daily goals worksheet. (McPeake, Cantwell, Booth, & Daniel,
2012). Second, the date collection was created to be simple by incorporating it into
routine patient charting and care planning. Third, if extra data needed to be
collected it was not too complicated or cumbersome on nursing staff. The results
were that when the checklist was adhered to, the rates of CLABSI went down
significantly. There were even moments in the ICU where the unit went 300 days
without CLABSI. There were difficulties with informing staff of new procedures
because of turnover rate and because of the high number of staff. The authors
outcomes.
Articles cited
pdfs/bsi/checklist-for-CLABSI.pdf
Linder, L., Gerdy, C., Abouzelof, R., & Wilson, A. (2017). Improve supportive
McPeake, J., Cantwell, S., Booth, M. G., & Daniel, M. (2012). Central line
Development, 123-129.
Melville, S., & Paulus, S. (2017). Impact of a central venous line care bundle
from http://www.sagepub.co.uk/journalsPermissions.nav
Park, S., Ko, S., An, H., Bang, J., & Chung, W. (2017). Implementation of
https://aricjournal.biomedcentral.com/articles/10.1186/s13756-017-0263-3
Using Practice-Based Evidence to Improve Supportive Care Practices to
Oncology Unit
protocols based on research that was conducted on their own unit. By doing
2017). With this information, they were able to conclude the organisms
causing the infections were commonly found on the skin or from the GI
tract. Taking this into account, the project team created a 1-2-3 mnemonic
which reminded patients that they needed to take one shower, brush their
teeth twice, and get out of bed three times daily (Linder, et al., 2017). In
addition to this, patients also were required to have their linens changed
every day. The thought behind this was that by reducing the amount of
pathogens on the patient’s skin and surroundings, the risk of getting a central
Data was collected by audits that were conducted randomly throughout the
study period. This specific study concluded that the introduction of the new
the CDC bundles or new protocol was introduced, the total number of
CLABSI events was 156. With the implementation of the bundles alone, the
number of CLABSI events dropped to 44. Finally, with the addition of the
new protocol and the bundles, the number of CLABSI events decreased to
39 (Linder, et al., 2017). One significant limitation of this study is that it was
only specific to one unit in a pediatric hospital. However, one strength is the
yielded similar results, which further strengthens the validity of the current
practice related to this issue. This study also sought to lower the risk of
CLABSIs in patients. This study was over a period of three years, during
which researchers implemented a central venous line care bundle that was
very similar to the CDC care bundle. The central venous line care bundle
required hand washing both before and after patient contact, hourly
and dry dressing, scrubbing ports with alcohol prior to access, and the
CLABSI rates from the first year following implementation to the third year
of the study. This study was able to further confirm the efficacy of central
line bundle kits in reducing central line infection rates. One weakness of this
CLABSI can affect patients in all areas of care but CVCs are mostly seen in an
ICU setting. Central lines are important tools used to give medicine, fluids, blood
products, or nutrition during their time of care in an ICU. It’s important to note that
infection. The results of our studies show that constant vigilance and awareness of
Central Line Bundles helps prevent CLABSI. Although many nurses may not place
a central line it is in a Nurse’s scope of practice to assess the lines and administer
medication, fluids, and clear minor blockages. This research helps change nursing
environment for patients. Any of these helpful charts, assessments, and policies
can help change nursing practice. Nurses are able to change policies based on their
Abstract
the clinical setting. However, patients who have central lines have a significantly
higher risk for developing a serious bloodstream infection. The purpose of this
research was to determine whether or not central line bundle kits were effective
Question: Are the components of central line bundle kits significant regarding a
Methods: We searched for our scholarly articles on PubMed and Medline. 433
articles matched our search criteria and out of these we chose 4 that were the most
relevant to our research topic. We then read each article and created a summary
Outcomes: Overall, based on the articles we reviewed, the use of central line
bundle kits is an effective way to reduce the incidence of central line associated
bloodstream infections.