The PICOT question concerning the continuous changing of IV tubings to prevent the occurrence of central line-associated bloodstream infections (CLABSI) bears high importance in the acute care medical-surgical settings as it is directly linked to dealing with morbidity, mortality, and costs of health care for the population. It has been recognized that the occurrence of CLABSI is highly preventable in cases when practitioners follow the prescribed methods of insertions and maintenance of IVs. Therefore, exploring the issue from the perspective of a measurable PICOT question can shed light on the existing errors and their impact on patients’ wellbeing.
CLABSI refers to a laboratory-confirmed bloodstream infection that is not related to an infection at any other site that develops within two days (forty-eight hours) of central line placement. According to Haddadin and Regunath (2019), CLABSI is the most costly and accounts for approximately $46,000 per patient. The occurrence of the infections in surgical settings is preventable through the implementation of appropriate aseptic, surveillance, and management techniques.
According to the prevention guide developed by Ling et al. (2016), procedures targeted at reducing the likelihood of CLABSI range from nurses’ hand hygiene to consistent reviews of line necessity and replacement. This suggests that a systematic approach is needed for ensuring that patients do not develop CLABSI after receiving surgical treatment. In addition, it is notable that the appropriate training of personnel is imperative for preventing infections from occurring, which points to the significance of the topic to nursing practice overall.
Researchers have explored the efficacy of changing IV tubing at frequent rates as a preventative measure for addressing CLABSI. For example, Duncan, Warden, Bernatchez, and Morse (2018) studied the bundled approach to decreasing CLABSI rates. They found that a new PIV bundle can reduce bloodstream infections with a decrease from 0.57 to 0.11 per 1000 patient days (p<0.001). They also found that it was safe and economically sufficient to change IV tubing every 96 hours for proper protection. These findings suggest that it is possible not to reduce the timeframes of a tubing’s insertion in instances when all other measures of safety and hygiene are maintained.
The topic of CLABSI occurrence is significant to nursing practice in general, as it is specifically concerned with the effectiveness of nurses’ performance in cases when special care and regulated procedures are needed. The exploration of various approaches to changing continuous IV tubings in clinical settings allows us to identify issues that nurses encounter on a regular basis and propose various methods for eliminating barriers. Overall, CLABSI prevention requires special attention from the clinical research standpoint as their occurrence significantly decreases patient outcomes and leads to additional costs that could have been used in other areas of clinical expertise.
The three PICOT questions that can be formulated to explore the issue of CLABSI occurrence are associated with nurses’ workload, hygiene practices, and daily reviews of line necessity and replacement. The questions are the following:
- In post-surgical care patients (P), what is the impact of implementing daily reviews of line replacement necessity (I) on the occurrence of CLABSI (O) when compared with 12-hourly reviews (C) during 3 months (T)?
- In post-surgical care patients (P), what is the effect of reducing the workload of nurses through effective shift scheduling (I) on the occurrence of CLABSI (O) when compared to regular workload management (C) during 3 months (T)?
- In post-surgical care patients (P), what is the impact of implementing innovative nurse hygiene procedures (e.g., information systems) (I) on the occurrence of CLABSI (O) when compared to regular hygiene practices (C) during 3 months (T)?
References
Duncan, M., Warden, P., Bernatchez, S., & Morse, D. (2018). A bundled approach to decrease the rate of primary bloodstream infections related to peripheral intravenous catheters. Journal of Association for Vascular Access, 23(1), 15-22.
Haddadin, Y., & Regunath, H. (2019). Central line associated blood stream infections. Web.
Ling, M. L., Apisarnthanarak, A., Jaggi, N., Harrington, G., Morikane, K., Thu, l., … Lee, C. M. (2016). APSIC guide for prevention of central line associated bloodstream infections (CLABSI). Antimicrobial Resistance and Infection Control, 5, 16.