The occurrence of central line-associated bloodstream infections (CLABSI) is a high-rate and severe medical condition that endangers the health and lives of many patients across various healthcare settings. This issue occurs due to the entrance of bacteria into the patient’s central line by contaminating blood and causing general infection of the organism. It has been found that the most frequent causes of CLASBI are improper hand hygiene of health care workers, non-hygienic preparation of patient’s skin, or failure to change catheters after three days since placement (Cho & Cho, 2019; Hanson, 2017). Neonatal patients constitute a substantial group of risks that are significantly exposed to the threats of CLASBI. According to Cho and Cho (2019), “bloodstream infections are the most common type of hospital-associated infections” occurring in newly born children, where 20-36 percent of babies suffer from “late-onset sepsis occurring after three days of birth” (p. 79). In addition, patients at intensive care units are prone to continuous intravenous (IV) treatment that is associated with an extensive rate of CLASBI. However, the problem might be prevented by changing IV tubing regularly.
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Topic’s Significance to Nursing Practice
CLASBI prevention interventions are significant to nursing practice due to the necessity to find effective ways of minimizing the risks of CLABSI occurrence. Moreover, the relevance of the nursing problem is validated by the proven preventability of CLASBI using compliance with evidence-based guidelines (Hanson, 2017). The morbidity and mortality associated with hospital-acquired CLABSI impose high health care costs and, therefore, necessitates nurses’ accuracy and evidence-based intervention application (Ling et al., 2016). Importantly, the prevention of a “bloodstream infection relies heavily on the nurse’s authentic presence with the patient and being cognizant of taking extra steps necessary to prevent an infection” (Hanson, 2017, p. 108). Therefore, evidence should be gathered to identify the most favorable outcomes generated by efficient means of preventing CLASBI and helping nursing staff implement the safest practices for the most favorable patient outcomes.
Given the high rate of morbidity and mortality caused by CLASBI and its relevance to the nursing practice, the formulation of PICOT questions might be approached from a perspective of intervention, population, and timing alterations. Since the data on the time that is considered proper for replacing IV tubing varies from two days (Hanson, 2017) to three days (Cho & Cho, 2019), the PICOT questions should address the time frame differences.
PICOT question 1: In patients administered to an intensive care unit (P) and exposed to the change of IV tubing every two days since catheter placement (I), how often does CLASBI occur (O) in comparison to the patients whose IV tubing is changed every three days (C) within three months (T)?
PICOT question 2: In neonatal patients (P), what is the effect of changing umbilical catheters every five days (I) on the occurrence of late-onset sepsis (O) in comparison to the changing umbilical catheters every four days (C) within three months (T)?
PICOT question 3: In patients in an acute care setting (P), what is the difference in the rate and severity of CLASBI (O) between catheterization through the internal jugular vein (I) and through the subclavian vein (C) within six months (T)?
Cho, H. J., & Cho, H. K. (2019). Central line-associated bloodstream infections in neonates. Korean Journal of Pediatrics, 62(3), 79–84.
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Hanson, D. (2017). Reducing central line-associated bloodstream infection rates in the context of a caring-healing environment. Journal of Infusion Nursing, 40(2), 101–110.
Ling, M. L., Apisarnthanarak, A., Jaggi, N., Harrington, G., Morikane, K., Ching, P.,… & Lee, C. M. (2016). APSIC guide for prevention of central line associated bloodstream infections (CLABSI). Antimicrobial Resistance & Infection Control, 5(16), 1–9.