The first thing that should be done is the analysis of five peer-reviewed evidence-based articles on the issues of central line-associated infections with older adults and ways of preventing and reducing the rate of infections. 1a. Read and review five articles for the strategies and interventions known as the central line bundle in older adults requiring a central line. 1b. Evaluate the effectiveness of interventions used in studies and the possibility of their implementation into nursing practice. 1a. Annotated bibliography of the five peer-reviewed evidence-based articles on the prevention of central line-associated bloodstream infections.1b. Report on interventions: Reaction to the articles in terms of their effectiveness, the strength of evidence, and usefulness in the education of nursing staff in hospitals and ICUs in particular.
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For instance, Berenholtz et al. (2004) suggest the following interventions aimed at decreasing the risk of infection occurrence. All these interventions can also be seen in researches of other scholars who attempted to reduce the risk of infection that occurs when a catheter was injected. The only limitation of the study by Berenholtz et al. (2004) was the absence of demographic characteristics and other data that could have influenced the outcomes of the research.
Another study is written by McGee and Gould (2003) and it focuses mostly on types of catheters and types of complications that can take place when a patient experiences catheterization. Besides, this study includes a list of possible interventions appropriate for each type of complication about the type of catheter used in each case. For instance, “As with most medical procedures, the level of experience of the physician reduces the risk of complications” (McGee and Gould, 2003, p. 1128); this means that interventions can happen to be ineffective if the physician has little experience in catheterization and coping with complications such as central line-associated bloodstream infections.
As suggested in the study by Mermel (2000), simple strategies can reduce the rate of bloodstream infections occurrence related to catheterization. “The microbes that colonize catheter hubs and the skin surrounding the insertion site are the source of most catheter-related bloodstream infections” (Mermel, 2000, p. 391).
The key strategies aimed at coping with the occurrence of bloodstream infections include intravenous antimicrobial prophylaxis and warfarin and heparin prophylaxis (p. 393), site of insertion, subcutaneously tunneled catheters, and cutaneous antisepsis (p. 394), sterile barrier precautions, catheter dressing, ointments, contamination-shielded pulmonary artery catheters, and catheter maintenance (p. 395), injection hub and connection port (p. 396), and other strategies.
The educational effectiveness of interventions and strategies related to coping with bloodstream infections caused by catheterization was reviewed by Coopersmith (2002). Such strategies as sterile gloves used during catheterization were of primary importance for the outcomes of the study to make it more cost-efficient. The educational module was designed to meet the needs and expectations of the nursing staff and teach them to prevent infections by washing their hands each time before the procedure of catheterization. According to the results of the research, the education of nursing staff of intensive care units can decrease the occurrence of bloodstream infections caused by catheterization.
The incidence of line-associated bloodstream infections was also evaluated in the evidence-based study by Pronovost et al. (2006) who analyzed the effectiveness of measures that can be taken to reduce the incidence and save lives of people because these infections are “…common, costly, and potentially lethal” (p. 2725). Safety measures introduced by the team of researchers resulted in the reduction of the incidence of bloodstream infections.
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Week Two: Key strategies to reduce the risk of CLABSI
- Enumerate the key strategies used in the studies reviewed.
- Evaluate the effectiveness of strategies enumerated.
- Offer other strategies that could apply to the incidence of line-associated bloodstream infections.
- List of key strategies: The key strategies included education of the nursing staff in ICUs as most cases with the incidence of infections take place in ICUs. Besides, hygiene and sterile gloves, as well as masks, are effective in this case.
- Report of the effectiveness of strategies to be used: The simplest interventions are the most effective and cost-efficient. Hand hygiene and education of the nursing staff are the simplest and most effective methods to use.
- List of strategies with ways of their application: The strategies that could also be applied to the incidence of line-associated bloodstream infections are not cost-efficient and require more resources in terms of finance and personnel.
Week Three: Impact of environment on infections
- Identify the influence of the environment on the incidence of infections.
- Assess the influence.
Written report on different environments and their influence on the incidence of infections: The ICUs are the most frequent environments where central line-associated bloodstream infections occur. So, it is necessary to provide a sterile and hygienic environment not to allow the incidence of infections. Report on the level of influence: The influence of ICUs environment is mostly negative as not all patients can receive adequate and timely manner.
Week Four: Implementation of scenarios
- Make the requirement of clean hands an integral part of the preventive strategy on the central line-associated bloodstream infections.
- Educate the nursing staff members about the importance of hand hygiene and sterile masks and gloves during catheterization.
Sanitary bulletins informing about the importance of hand hygiene and report on the efficiency of this measure: Hand hygiene can be considered one of the simplest, cost-efficient, and most effective methods of preventing bloodstream infections. Survey of nursing staff in terms of knowledge about the infections caused by catheterization before and after educating measures: Education of the nursing staff can contribute positively to the reduction of the incidence of central line-associated bloodstream infections.
Berenholtz, S. M., et al. (2004). Eliminating catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine, 32(10): 2014-2020.
Coopersmith, C. M., et al. (2002). Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Critical Care Medicine, 30(1): 59-64.
McGee, D. C., and Gould, M. K. (2003). Preventing complications of central venous catheterization. The New England Journal of Medicine, 348(12): 1123-1133.
Mermel, L. A. (2000). Prevention of intravascular catheter–related infections. Annals of Internal Medicine, 132(5): 391-402.
Pronovost, P., et al. (2006). An Intervention to decrease catheter-related bloodstream infections in the ICU. The New England Journal of Medicine, 355(26): 2725-2732.