Introduction
Central venous catheters (also abbreviated as CVC) can be used to monitor health indicators and vitals in addition to regulating the intake of medication and blood products or important nutrients. The issue that will be reviewed within the current study revolves around the idea that CVCs are susceptible to being colonized by various microorganisms. The key objective of the reviewed study is the application of antiseptics on the patients’ skin and observing the ultimate occurrence of blood infections because of the use of CVCs (Bion et al., 2012).
The data concerning the use of almost 3500 CVCs were analyzed (Lai et al., 2016). The significance of the problem can be explained by the fact that some patients were assigned more than one CVC and subsequently, this number did not correlate with the total number of patients.
Change Model Overview
The ACE Star Model is usually applied to comprehend the stages and key characteristics of knowledge acquiring and transmittance within the framework of evidence-based practice. Using this particular model, the nurses can make the best use of the exclusive features of evidence-based practice. Therefore, the existing knowledge is also reviewed within the context of evidence-based practice and serves as the basis of the overall evidence-based practice network. The sequential representation of knowledge significantly impacts the process of implementing it in real-life situations. The five stages of knowledge transformation are as follows:
- Research
- Evidence Summary
- Transition to the Strategy
- Implementation
- Evaluation of the Outcomes
The Star Model is used to outline the evidence-based processes, and the outcome of the transformation is the improvement of the quality of health care.
Define the Scope of the EBP
The practice issue of the current evidence-based project is the use of antiseptics when dealing with central venous catheters and the subsequent prevention of blood infections. This is a rather important problem because these infections are recurrently associated with increased health care costs, causal morbidity, and subsequent death. The existing statistic suggests that the current percentage of blood infections is 0,07% (meaning that 7 out of 1000 patients died because of a blood infection that was transferred using the CVC. On a broader scale, this issue is relevant because the existing body of knowledge presents insufficient evidence regarding the use of antiseptics in addition to the CVC.
Stakeholders
The key team members that will be included in the team are as follows:
- Nurse manager
- Two nurse practitioners
- Pharmacist
The decision to pick these four health care practitioners is based on the supposition that the researcher will have to gain insight into each of the stages of the project.
Determine Responsibility of Team Members
The role of nurse practitioners can be described as the implementation of the developed evidence-based practice plan. They will have to follow the guidelines and apply necessary antiseptic treatments on the skin of the patients with CVCs in the area where the catheter enters the body. Consequently, the pharmacist will be responsible for providing the nurses with the necessary medications and consult them regarding the application of the antiseptic treatment. The nurse manager will ultimately guide the team and give out internal team directions intended to help them handle the assignment.
Evidence
In addition to the existing evidence, the researcher identified certain data regarding the risks of CVCs in comparison to peripherally introduced catheters and analyzed the method of subclavian insertion in terms of the risk of blood infection. No particular evidence-based or clinical practice guidelines were identified. The strength of the research projects lied in the low level of partiality of the obtained data.
Summarize the Evidence
If we take into consideration the strength of the evidence, we may see that the comparison between povidone-iodine and chlorhexidine solution provides us with the most robust results. Nonetheless, one should remember that the strength of these antiseptic solutions was approved by a relatively small number of catheters (Lai et al., 2016). Another finding of the study consisted in the fact that the amount of obtained data was insufficient to reach a verdict regarding the statistical significance of the results of the conducted research (Chopra, O’Horo, Rogers, Maki, & Safdar, 2013).
Therefore, Lai et al. (2016) were concerned by the amount of bias generated by their research and could not make a univocal conclusion regarding the effect of small studies that were analyzed within the framework of the presented research.
Develop Recommendations for Change Based on Evidence
Several recommendations can be formed based on the obtained evidence. First, the author proposes to use chlorhexidine solutions when performing the antiseptic treatment of CVCs during the pilot program. Second, the author intends to use the subclavian site as the primary place of catheter insertion (Parienti et al., 2012). Third, it is important to evade idle catheter days to certify the timely replacement of catheters and minimize the chance of triggering blood infections or catheter colonization.
Translation
Action Plan
The first step will be to develop a specific schedule to define working hours for each of the members of the team. The second step will be to assign roles and tasks because it is necessary to plan this activity efficiently. The third step will be to communicate the objectives of the project to the team and the patients that will be involved in the project. The fourth step will be to implement the plan and follow the preset guidelines. The last step will be to gather feedback from all the participants of the experiment, analyze the obtained data, and make conclusions regarding the usefulness of nurse rotation and antiseptic treatment. The results will be reported in the form of a survey (a mixed questionnaire with both open and multiple-choice questions). The timeline for this plan is 60 days.
Process, Outcomes Evaluation, and Reporting
The researcher expects to define perfect nurse rotation times and assess the effectiveness of antiseptic treatments with CVCs. These outcomes will be measured qualitatively to support the evidence-based approach to this study. The results will be reported on internal meetings to support the principle of confidentiality and not to disclose any of the important findings or claims before the end of the project.
Identify Next Steps
To implement the proposed plan on a larger scale, the researcher will need to evaluate more relevant literature on the subject to synthesize a more significant body of knowledge and adjust the project accordingly so that it would comply with the concepts of the knowledge transformation model discussed above. The application of this project to the facility as a whole is questionable due to the local character of the research project. To make the changes permanent, the researcher expects to conduct meetings and discuss the key aspects of the innovative plan to integrate it into the practice of the designated hospital department.
Disseminate Findings
The findings of the study will be communicated using weekly gatherings. These gatherings will include the team responsible for the implementation of the project and other health care specialists that are interested in the outcomes of the research. The investigator expects to communicate the findings in the electronic format as well to reach out to the external stakeholders and other health care organizations.
Conclusion
The current paper dwelled on the basic stages and implications of a plan intended to mitigate the adverse outcomes of using central venous catheters (CVCs) without applying antiseptic treatments. The problem, in this case, consists in the fact that blood infections triggered by the colonization of catheters may lead to serious health damage or even death. The results of the research showed that it is important to use antiseptics when dealing with preventing blood infections (chlorhexidine solutions in particular). Also, the author was able to find that CVCs may be applied to the subclavian site to reduce the load on catheters. The concluding finding helped the researcher to suggest that evading idle catheter days will be beneficial and no catheter colonization will take place.
Extensive research on the use of central venous catheters and antiseptic treatments was conducted within the framework of the current study. The author analyzed the information presented by other investigators and put it together to get an evidence summary. Then, the researcher discussed the proposed strategy and its probable implications for the evidence-based practice and the given healthcare facility. The next step on the way to conducting an effective project was the implementation of the proposed plan that suggested that nurses should use antiseptic treatments and rotate after a specified period. The evaluation of the outcomes showed that the project is reasonable and can be applied in bigger-scale environments.
References
Bion, J., Richardson, A., Hibbert, P., Beer, J., Abrusci, T., Mccutcheon, M.,… Harrison, D. (2012). ‘Matching Michigan’: A 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Quality & Safety, 22(2), 110-123. Web.
Chopra, V., O’Horo, J. C., Rogers, M. A., Maki, D. G., & Safdar, N. (2013). The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: A systematic review and meta-analysis. Infection Control & Hospital Epidemiology, 34(09), 908-918. Web.
Lai, N. A., Lai, N. M., O’Riordan, E., Chaiyakunapruk, N., Taylor, J. E., & Tan, K. (2012). Skin antisepsis during catheter insertion for reducing central venous catheter related infections. Cochrane Database of Systematic Reviews, 7(10), 1-14. Web.
Parienti, J., Cheyron, D. D., Timsit, J., Traoré, O., Kalfon, P., Mimoz, O., & Mermel, L. A. (2012). Meta-analysis of subclavian insertion and nontunneled central venous catheter-associated infection risk reduction in critically ill adults. Critical Care Medicine, 40(5), 1627-1634. Web.