Introduction
Over the decades, there have been increasing cases of adverse health practices and cases of deaths, which have prompted healthcare systems to seek appropriate solutions. The practicum experience is an evidence-based solution to ensure that nurses are competent in their medical practices to avoid the occurrence of adverse health practices that often result in death. An issue of patients’ safety in hands of medical professionals has haunted patients, families, healthcare professionals, and healthcare systems in general because there are medical errors that result from sheer negligence. To enhance the safety of healthcare practices and prevent the unnecessary occurrence of deaths due to medical errors, nurses should undergo a comprehensive education curriculum that provides practicum experience.
Practicum Experience in Nursing
The practicum experience is critical in the nursing curriculum for it helps nurses to gain hands-on nursing experience and therefore shape their careers. During the nursing practicum, nursing students get the opportunity to engage with mentors and nursing experts who direct and guide them in carrying out complex nursing practices. According to Leape and Berwick (2005), the essence of the nursing practicum experience emerged after the Institute of Medicine released a comprehensive report in the year 2000, which showed that about 98,000 patients die annually due to medical errors (p.2384). Medical errors due to negligence are to blame for adverse effects of healthcare practices and increasing cases of deaths that occur in hands of medical professionals. In view of medical errors, this presentation examines catheter-related bloodstream infections and explores the essence of practicum experience in the prevention of central line-associated bloodstream infections.
Catheter-Related Bloodstream Infections
Medical negligence by healthcare professionals results in adverse health effects and contributes to the increasing number of deaths that occur in healthcare institutions. Catheter-related bloodstream infections that affect central venous are examples of infections that emanate from contamination during insertion of catheters and administration of drugs particularly to patients who are in intensive care units. This implies that the insertion of catheters and administration of drugs need the highest standards of hygiene to prevent the transmission of microbes from surfaces into the bloodstream of the patients.
Central Line-Associated Bloodstream Infections
Central line-associated bloodstream infections are a class of infections that belong to a category of primary bloodstream infections. There are two categories of bloodstream infections viz. primary and secondary bloodstream infections. Primary bloodstream infections occur due to complications of many infections, hence have no specific cause and forms central line during their infection. Maki, Kluger and Crnich (2006) argue that central line-associated bloodstream infections increase complications of patients who are in the intensive care unit, prolong their hospitalization, and increase mortality risk (p.1163). On the other hand, secondary bloodstream infections are systemic and easily detected in the blood samples of patients affected.
Epidemiological Studies
Epidemiological studies show that catheter-related bloodstream infections are more predominant in intensive care units than general hospital units because patients who are in intensive care units frequently receive medications and other fluids through catheters, which are prone to contaminations. According to Berenholtz, Pronovost and Lipsett (2004), statistics have shown that there are high cases of catheter-related bloodstream infections that affect central venous among patients of intensive care unit, which range from 48,600 to 80,000 cases annually in the United States (p.2017). This implies that catheter-related bloodstream infections pose a great threat to the lives of intensive care unit patients.
Medical Interventions
The Healthcare system has put effective interventions in place to prevent catheter-related bloodstream infections by promoting hygienic health practices, creating awareness among healthcare professionals, empowering nurses to utilize central venous catheters effectively, and providing practicum experience to nursing students. The practicum experience is an evidence-based solution aimed at enhancing the practical skills of nurses.
Project Development
To reduce the rate of catheter-related bloodstream infections, this project focuses on employing multiple interventions for patients who have intravascular central catheters. The central line bundle consists of multiple evidence-based interventions designed to zero-rate incidences of catheter-related bloodstream infections. The central line bundle interventions consist of five elements which include enhanced hand hygiene, skin antisepsis using chlorhexidine, a constant review of central lines, optimal selection of catheter sites, and maximal barrier protection.
Hand Hygiene
Given that catheter-related bloodstream infections occur due to contamination of catheters during insertion and administration of drugs, hand hygiene becomes a central remedy. Therefore, nursing students should have practicum experience concerning the essence of hand hygiene to avoid infecting patients through contaminated catheters and administration of medications. Hand hygiene is an effective preventive strategy that nurses should sensitively practice to enhance the reduction of contamination and subsequent infection of patients. When carrying out any medical procedures, healthcare practitioners should always disinfect their hands before and after handling patients.
Skin Antisepsis
Patients’ skins patients have pathogens that can enter the vascular system and cause systemic infections, which adversely affect the recovery of patients in hospitals. Due to the presence of pathogens, healthcare practitioners need to disinfect the skin at the site of injection or catheter insertion to prevent the entry of pathogens into the vascular system. Chlorhexidine is the most appropriate form of disinfectant that healthcare practitioners should use when disinfecting the skin.
Constant Review of Central Lines
The risk of catheter-related bloodstream infections increases with the period of using catheters and central lines. Therefore, a constant review of catheters and central lines is important in monitoring and determining their usage and the extent of infections. According to Mermel (2000), prevention of central venous catheter-related bloodstream infections requires constant review of patient’s condition and usage of central lines to avoid excessive use of central lines that predispose patients to infections (p.396). Hence, a constant review of central lines minimizes their usage and thus reduces predisposition to catheter-related bloodstream infections.
Optimal Selection of Catheter Sites and Barrier Protection
The site of catheter insertion significantly determines the extent of predisposition to catheter-related bloodstream infections. More exposed sites are prone to contamination and infection as compared to less exposed sites. Thus, the subclavian vein is the best site for catheter insertion because it is less exposed, easy to dress and free from disturbance. During insertion of the catheter, medical practitioners should create a sterile environment by clothing patients and themselves with sterile attire such as gowns, facemasks and gloves.
Practicum Learning Agreement
Effective implementation of practicum learning agreements requires the cooperation of students, healthcare institutions and academic institutions. The three should define their roles and responsibilities to prevent any overlap or interference during the process of implementing the practicum-learning agreement. Since the nursing student is a subject, the academic institutions and healthcare institutions should clearly outline the practicum responsibilities period necessary to carry out and the expected outcomes of practicum experience. Milliken (2007) argues that the implementation of the practicum learning agreement depends on the concerted efforts of students, academic institutions, and healthcare institutions (p.27). Therefore, healthcare and academic institutions need to provide enough resources for nursing students to gain enough practicum experience.
Central Line Bundle
The central line bundle consists of multiple interventions targeted at preventing the occurrence of catheter-related bloodstream infections. The central line bundle is an evidence-based intervention that depends on medical practitioners in its implementation. Joch (2008) asserts that the central line bundle is an effective preventive program for it can zero rate catheter-related bloodstream infections in a health institution within a short period (p.8). Since nurses are advocates of patients, they play a significant role in the implementation of the central line bundle program as a critical practicum experience for nursing students.
Value of Practicum Project
Practicum experience has tremendously shaped and enhanced my career as a nurse. The practicum project has made me realize the consequences of medical negligence and the importance of evidence-based practices in the prevention of catheter-related infections. Simple medical negligence of hygienic practices predisposes patients to more pathogens thus extending the period of hospitalization coupled with increased medical costs. Through the practicum project, I have noted that evidence-based practices such as central line bundle practices are central in the prevention of catheter-related bloodstream infections. Therefore, I have understood that evidence-based practices are core competencies that are essential in my career.
Professional Relationships
The practicum project provided an enriching platform where I got an opportunity to interact with mentors and varied medical experts who gave me a great deal of advice and skills. Interacting with mentors and medical experts enhanced my professional knowledge and skills since I had the opportunity to consult them in many instances when I needed help. Relating with nurses and physicians gave me a chance to gain hands-on experience when performing varied evidence-based practices. Moreover, relating and interacting with patients improved my confidence when performing varied medical procedures and practices.
Conclusion
Given that many patients die due to medical negligence or ignorance on the part of healthcare practitioners, the healthcare system has added practicum experience into the nursing curriculum to enhance the professional competence of nurses. The practicum experience is an integral part of the nursing curriculum that aims at enhancing professional competence and consequently reduces the occurrence of adverse health practices in healthcare institutions. Catheter-related bloodstream infections are examples of infections that occur due to poor medical practices. Medical practitioners can easily prevent such infections using evidence-based interventions such as the central line bundle.
References
Berenholtz, S., Pronovost, P., & Lipsett, P. (2004). Eliminating Catheter-Related Bloodstream Infections in the Intensive Care Unit. Critical Care Medicine, 32(10) 2014-2020.
Joch, A. (2008). Sutter’s Bundle of Joy: Hospital Cuts Catheter-Related Bloodstream Infection. Materials Management in Health Care, 17(6), 7-9.
Leape, L., & Berwick, D. (2005). Five Years After To Err Is Human: What Have We Learned? Journal of the American Medical Association, 293(1), 2384-2390.
Maki, G., Kluger, M., & Crnich, J. (2006). The Risk of Bloodstream Infection in Adults With Different Intravascular Devices: A Systematic Review of 200 Published Prospective Studies. Mayo Clinic Procedures, 81(1), 1159-1171.
Mermel, L. (2000). Prevention of Intravascular Catheter-Related Infections. Annals of Internal Medicine, 132(5), 391-402.
Milliken, J. (2010). Practicum Handbook: Nursing. Canada: University of Victoria Press.