Reducing Central Line Bloodstream Infections (Research Paper Sample)

Reducing central line bloodstream infections (CLABSIs)
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Central Line Bloodstream Infections (CLABSIs)
Central line-associated bloodstream infections (CLABSI) are usually severe infections in hospitalized patients that increase the time of hospitalization, intensive care admissions, the risk of mortality and extensive antibiotic therapy. Central line bloodstream infections occur as a result of the use of indwelling devices that terminate at or proximal to the heart or in one of the great vessels and are used for infusion, hemodynamic monitoring, and withdrawal of blood. The surveillance areas in the hospital for CLABSI includes the critical/Intensive care unit(ICU), Specialty Care Areas (SCA), Neonatal Intensive Care Unit (NICU), Stepdown Units, Wards, and long-term care units (Ogrinc, 2012).Catheter-related blood stream infections (CRBSI) causes the greatest risk of healthcare-associated bloodstream infections and are implicated in life-threatening diseases. An approximate of 249,000 healthcare-associated bloodstream infections occurs every year in the United States, and 32.2% of the BSI constitutes the CLABSI. An estimate of 30,100 central line-associated bloodstream infections occurs in intensive care units and the wards yearly (CDC, 2011).
The Healthy People 2020 projects a 75% reduction of CLABSI by the year 2020 in the United States (CDC, 2011). The baseline years are 2006-2008, therefore, increasing the precision of the probability of attaining the health promotion strategic plan. The Prevention of CLABSI includes the proper insertion techniques and management of the central lines. According to the Center for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN), the definition of CLABSI is used for surveillance purposes According to the 2002 CDC guidelines, the primary prevention strategies and emphasis is education and training of the respective healthcare providers who insert and maintain the catheters, use of maximal sterile techniques during catheter insertion, use of 2% chlorhexidine skin antiseptic, avoid routine replacements of central line catheters, using antibiotic-impregnated catheters for short duration venous catheterization and use of chlorhexidine-impregnated sponges when the infection rate is high (Lanken, 2014).
Despite the evidence-based CRBSI preventative strategies in the US, the implementation is suboptimal as indicated by the national survey that was conducted in 2005 for over 700 US hospitals. The study showed that a quarter of the hospitals did not implement the maximal sterile measures and use of chlorhexidine gluconate for site disinfection. 15% of the US hospitals practiced the routine replacement of the catheters despite research showing that regular catheter replacements are a contributing factor for CRBSI (Krein, 2015).
The 2011 CDC guidelines increased the emphasis on the maximal sterile techniques and set the minimal use of chlorhexidine antibiotic use to 0.5% .However, catheter-related bloodstream infections continue to cause a significant level of health associated infections. The new methodology stated by the 2011 CDC guidelines aim to improve the validity and the usability of the guidelines while simultaneously addressing the emerging challenges of health prevention and control. There is the need to reduce the incidence rates of CRBSI to improve the health care. The effort should be multidisciplinary ranging from the healthcare professionals who order the insertion and removal of catheters, the health care providers who insert and maintain the intravascular catheters, the health care managers and the patients who help manage the catheters. The collaborative effort ensures there are maximal sterility techniques in catheterization and reduction of CRBSI.
The CDC guidelines outline the maximal sterility that have not been a success story for the US. The hand hygiene procedures either by the conventional soaps and the alcohol-based hand rubs. The guidelines emphasize the need to observe hand hygiene after palpation of the catheter insertion site, before and after insertion of the catheter, replacing, accessing and repairing. The aseptic technique should be maintained during the insertion of the intravascular catheter. Clean gloves should be worn when inserting the intravascular catheters and sterile gloves when inserting the arterial, midline, and central catheters (Lanken, 2014). The conventional measures are aimed at ensuring that no external contamination or pathogens are introduced into the system. Ensuring maximal sterility is thus the basis for successful intravascular catheterization and the projected attainment of the healthy people 2020 to reduce the standardized infection ratio to 0.25 (CDC, 2011).
Four mechanisms of catheter contamination have been confirmed. The surface contact of the extraluminal catheter with the skin flora was identified as the common source. The organisms move along the catheter tube to colonize at the tip of the catheter. Another common method of contamination is when the health care provider does not follow the maximal sterile procedures and the contaminated devices and hands come into contact with the catheter tube. A less common route is the hematogenous spread from another site, for instance, the respiratory and the urinary tract infections. Finally, contamination can be attributed to the administration of the contaminated infusate. Short term CRBSI are associated with extraluminal contamination while the long term CRBSI is linked to the intraluminal disease. To improve the patient’s outcome and reduce the elevated medical expenses, the new tool to combat CRBSI comprises teamwork of health care providers, insurers, regulators and patients’ advocates (Rello, 2007).
Impact of CRBSI prevention strategies to ARPN
The new disease prevention movement in CRBSI will incorporate the experts to the field of intensive care unit. The strategy creates a broad avenue and opportunities for the Advanced Registered Nurse Practitioner (ARPN) to provide the expert knowledge base on complex decision making and clinical competencies. Initially, the ARPN model limited the advancement and specialty in nursing roles. The problems arose due to lack of standard definitions of ARPN roles, lack of common legal recognition among different jurisdictions. The new regulatory model seeks to provide comprehensive, far-reaching impacts on nursing roles education and licensing of different expertise. The CRBSI programs will absorb the ARPN nurses in the field of intensive care unit. However, in the US the clinical doctorate is needed for APRN practice (Krein, 2015).
APRNs in the United States play a vital and distinct roles in the health system. The APRN are nurses educated to masters and post-masters level and certified to be able to assess, diagnose and manage the patient problems. They also order tests and prescribe medications. For example, the clinical nurse specialist would be integrated into the CRBSI health promotion and give the full spectrum care to the patients. Advanced Registered Nurse Practitioner (ARPN) can, therefore, function as a consultant, educator, case manager, direct care manager and a researcher (Krein, 2015).A projected improved health promotion is anticipated. Such expertise in the field of intensive care unit and reduction of standardized infection rate of CRBSI seems a reality. The outcome would be improved health care systems, reduced incidence rates for CRBSI and reduced medical expenses.
The future of nursing is promising with the current trends in the intensive care unit. Job opportunities would be significantly increased accompanied by quality remuneration. Advancing education level demands improved salary that is the motivation for better health care services. The APRN model outlines the need for primary education for nurses to assume responsibility and accountability for maintenance of health promotion, especially in ICUs. Further studies call for increased responsibility and specialized services. The nurses can practice and specialize in the open field thus probing for the quality outcome. However, the tag of war between the physicians and the APRN continue even after the introduction of the new legislation (Krein, 2015). Though research has proven that the APRN provides good leadership. The varying scope of practice from one state to state tends to obscure the APRN practice (Lanken, 2014). Also, the collaborative agreements to get the free license is a barrier to implementation of the full scope of the APRN practice. The APRN nurses have an opportunity for diverse and specialized health care opportunities but not the leadership of the health care systems. The dispute on who takes the leadership of the health promotion between the physician and APRN remains an unresolved conflict.
Literature review on central line blood stream infections (CLABSI)
CLABSI poses the threat to hospitalized patients increasing the morbidity, mortality, and the medical expenses. However, CLABSI is preventable through the use of evidence-based guidelines followed during the insertion and the maintenance of the catheters. A report by the CDC and NSHN in 2011 highlights data from 1545 hospitals in 48 cities and the District of Columbia that monitor the ICUs, patient care areas, and wards (CDC, 2011). The report establishes that CRBSI is influenced by many factors such as patient related factors. The type of illness and the severity of the infection that the patient is suffering. Third-degree burns and post-cardiac surgery are conditions that need extreme care and are subject to CRBSI. The second factor is the catheter-related factors such as the type of catheter and the situation involved for the catheter to be placed. Bed-size and academic affiliation are the institutional factors that aggregate risk-adjuste...