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Strategic Plan for Implementation of Evidence-based Practice
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Central venous access devices are essential in today’s healthcare but can come with risks. Bloodstream infections by catheters account for 10-20% of nosocomial infections and central-line associated infections (CLABSI) are the cause of increase hospital stay and increase costs. Microorganisms can access the hub and spread through the bloodstream. This study focuses on aseptic technique during insertion and hub manipulation to prevent blood stream infections (Tejada et al., 2022).

      

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This study focuses on aseptic technique during insertion and hub manipulation to prevent bloodstream infections.

Blood stream infections by catheters account for 10-20% of nosocomial infections and central line associated infections (CLABSI).

CLABSI’s are the cause of increased hospital stays and increase in costs.

Microorganisms can access the hub and spread through the bloodstream.

Research problem

Problem: Central line bloodstream infections are both serious and sometimes can be a fatal complication, when micro-organisms enter the bloodstream.

Purpose: If aseptic barrier caps versus manual disinfection is effective in preventing central line associated bloodstream infections (CLABSI)

Purpose: The purpose of this study was to qualitatively assess the function of the line team.

Research question

Tejada: Will the use of aseptic hub caps help prevent CLABSI’s?

Stoever: Can a Line Team help to

prevent CLABSI’s?

5

Hypothesis

Will aseptic barrier caps minimize the risk of central line associated bloodstream infections (CLABSI)?

(Tejada, 2022)

Sample

Stoever et al, 2020

25 females participants who were nurses working with NICU patients.

12 of the nurses were on the Line Team and responsible for giving medications and fluids through surgically placed central lines and were responsible for dressing and tubing changes

Tajada et al., (2022)

Sample/Method: The sample was between intensive care unit (ICU) vs non-ICU settings.

Adult vs children population

Randomized-controlled trials (RCT) vs observational studies.

Method

Tejada et al., 2022

A SRMA according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. The review protocol was registered in PROSPERO (CRD42021259582)

study design of RCTs and observational studies

hospitalized patients of any age

anti- septic barrier cap in preventing CLABSI as intervention

manual disinfection as comparator.

Stoever et al., 2020

They used semi-structured interview questions.

Two investigators used the same codes to analyze the data.

There were a total of 24 codes

Data Extraction

The authors analyzed all the articles by reading the abstracts, titles and full text and then and a third viewer was brought in if there was a difference of opinion of the article.

The data extracted consisted of the study design, the number and type of patients, setting and the length of pre and post intervention phase (manual disinfectant or antiseptic cap).

The type of lines the patient had and the CLASBI rates and infection reduction rates.

Tejada et al., 2022

Semi structured interviews were conducted between October 12, 2018 and December 4, 2018 using an interview

Each participant provided oral consent to participate before the interview was conducted.

Eighteen of the 19 interviews were captured on audio recorder and transcribed for analysis.

Field notes were also documented by hand during each interview.

The single interview that was not captured on audio recorder was documented in detailed field notes during and immediately following the interview.

Stoever et al., 2020

Statistical analysis

There were 2 investigators

1 investigator reviewed transcripts to generate and define codes

1 investigator used the same codes to analyze the data a second time. 

They compared and discussed the findings

Summaries were made of any common themes.

Meta-analysis was performed on the data of each outcome.

Statistical analysis was performed by: Review Manager (RevMan) 

Outcomes were computed as Standardized Mean Differences (SMD) and then translated into original variable units. All statistical measures were calculated with 95% confidence interval (CI). 

Tejada et al., 2022 results

It was found that the use of antiseptic caps many reduce the occurrence of CLABSI as well as lower the rate of infection in 1000-line days compared to manual disinfection.

There was more compliance with the use of aseptic caps compared to manual disinfection.

REsults

Stoever etal., 2020 study findings:

The line team was critical in avoiding and preventing CLABSI.

The line team was shown to have extra knowledge and support while taking care of other patients.

Barriers

Tajada:

The study was weak because it was only based off observation.

There were only 2 studies in the pediatric trial so can be misleading.

Barriers

Stoever:

When a line team nurse works at the bedside, they cannot do both jobs, therefore a line team nurse is not available

A line team nurse can be pulled to being a bedside nurse but is still expected to be a line nurse

The overlapping of bedside nurse and line nurse can cause an error to occur due to distraction

Strategies

Tejada

There were only 2 randomized control trials

Twelve of the 14 studies were observational non-RTC’s

Heterogeneity can affect the intervention and make the results difficult to compare

Future studies should report catheter days, total length of stay both in hospital and in ICU, and time from catheter insertion to CLABSI to enable a more reliable analysis.

Stoever

Line team members also had to work as bedside nurses and could not check the lines as often as they should.

Many hospitals do not have Line Teams and nurses need to get more proficient at checking their patients lines

All nurses should know the medications they are giving and what is compatible and not compatible, not leaving it solely for the line team to know.

Evaluation

Tejada/Stoever: To measure the outcome will be to continue to evaluate for CABSI. Start a book in the unit to keep information on each pt with a line and if they developed a CABSI while they had lines in. Keeping track of aseptic hubs, when they were changed, who used them and how the procedure was performed.

Communication methods

Hold meeting to discuss the findings at employee monthly meeting.

Put outcomes on bulletin board in the units.

If there is a monthly newsletter add study findings to the letter.

references

Stroever, S., Boston, K., Ellsworth, M., Cuccaro, P., & McCurdy, S. (2020). Qualitative process

evaluation of a central line-associated bloodstream infection (CLABSI) prevention team

in the neonatal intensive care unit. American Journal of Infection Control, 48(9), 987–992. https://doi.org/10.1016/j.ajic.2019.12.020

Tejada, S., Leal-dos-Santos, M., Pena-Lopez, Y., Blotef, S., Alp, E., & Rello, J. (2022).

Antiseptic barrier caps in central line-associated bloodstream infections: A systematic

review and meta-analysis. European Journal of Internal Medicine. https://doi.org/10.1016/j.ejim.2022.01.040

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