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Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)

Submitted by

Kerry Sean Murphy

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

Prevention of Central Line-Associated Bloodstream Infections (CLABSIs) 1

June 26, 2019

Appendix A

Ten Strategic Points

Comments or Feedback

Broad Topic Area

1. Broad Topic Area:

The topic is the Prevention of Central Line-Associated Bloodstream Infections (CLABSIs).

Literature Review

2. Literature Review:

Summary Comment by Kathryn Flynn: summary

a. Background of the problem/gap:

· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs (Yaseen, et al., 2016).

· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections (Dick et al., 2015).

· The nurses need to have significant knowledge associated with evidence-based practices for the prevention of central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter in adult Intensive Care (ICU) units with (CVC) patients (Kadium, 2015). Comment by Kathryn Flynn: prevention of Comment by Kathryn Flynn: make this another clear sentence.

· Research has shown the existence of variations in the practice of nursing regarding the prevention of CLABSI, thus stressing the need for monitoring and education/training (Elbilgahy et al., 2015).

· There is a need for implementation of educational interventions to deal with the practice and knowledge gaps about CLABSIs prevention as well as ensuring that nurses apply prevention interventions which are evidence-based (Esposito et al., 2017).

· The Quality Health Outcomes Model (QHOM) Investigating Prophylactic measures to eradicate the incidence of Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich et al., 2014) Comment by Kathryn Flynn: Use primary sources (as many as you have) and not one author who synthesized the synthesis.

b. Carrying out a review of literature topics with a key theme for each one.

c. Prevention of Central Line Associated Blood Stream Infection (CLABSI) (Masse, Edmond, & Diekema, 2018).

· The Quality Health Outcomes Model (QHOM) is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. This model/framework has been used by various researchers to test the effectiveness of infection prevention measures (Gilmartin & Sousa 2016). Comment by Kathryn Flynn: &


· Adult ICU (Elbilgahy, et al., 2015).

· The incidence of Catheter-Related Infections (CRIs) in cancer patients at the hospital (Hentrich et al., 2014).


· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention through nursing education (Dombecki, Vercher, Valyko, Mills, & Washer, 2017).

· Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting. There seems to be a problem regarding the training and education regarding the procedures which should be followed when carrying out catheter-related procedures. The objective of this study is to address this issue (Dombecki, Vercher, Valyko, Mills, & Washer, 2017). Comment by Kathryn Flynn: The authors probably didn’t refer to your study. Clarify..

· Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site are necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia (Yaseen, et al., 2016)


a. Background of the problem/gap:

Even though earlier CVCs were associated with mechanical complications such as leaks, air embolisms, and hub separation, CLABSIs quickly became a serious problem when it came to the use of catheters. Studies indicate that elementary infection control steps may reduce incidences of CLABSIs significantly (Owings et al. 2017). Comment by Kathryn Flynn: cite with all the studies that indicate it, authors separated by ;

a. Theoretical Foundations (models and theories to be the foundation for the project). Specifically, the model proposed is the Quality Health Outcomes Model (QHOM), which is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. (Gilmartin & Sousa, 2016).

The theoretical model is associated with the strategies deployed and operational processes linked to the prevention of Central Line Association Bloodstream Infection. A meta-analysis review of randomized control and quasi-experimental studies (Moody, 2019). Comment by Kathryn Flynn: make this a full sentence.

b. Review of literature topic

Rapid Dissemination of Universal Decolonization in Adult Intensive Care Units (ICUs) reduces healthcare-associated (HA) central line-associated bloodstream infections (CLABSI) in over 100 Community Hospitals (Hickok et al., 2015).

a. Single Healthcare System

c. Prevention of Central Line Associated Blood Stream Infection (CLABSI).

Problem Statement

There are several safety measures to follow during a procedure involving the insertion of a central line catheter. Despite this, there still exist many cases of infections resulting from such insertions, especially in adult ICUs. For example, a study conducted in an ICU in northern India indicates that in spite of there being several guidelines for CLABSIs prevention, cases of such infections are still high (Mishra et al., 2016).

Clinical/PICO Questions

3. Clinical/PICOT Questions:

“In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of central line catheter observe hygiene after its insertion, along with the apt cleansing of the insertion site, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) compared to standard care over a one-month period?” In this case, standard care refers to the typical procedures which should be followed during a central line catheter insertion procedure. These include regularly monitor and assess the central line insertion site, looking for signs like redness, swelling, pain, and discharge (Painter & Painter Law Firm, 2018). While central lines are convenient for doctors and nurses, and more comfortable for patients, they increase the risk of infection. Any time a foreign body is present inside the human body, it provides a place for bacteria to grow (Painter & Painter Law Firm, 2018). Comment by Kathryn Flynn: Word Doesn’t seem to flow Comment by Kathryn Flynn: Think of more specific word. Comment by Kathryn Flynn: You should mention that there is a gap between how they are doing it now and best practice Comment by Kathryn Flynn: Find primary source, original studies. There should be many.

P: Patients > 65 years of age with a central line

I: Staff training and reinforcement of central catheter, hub hygiene. Along with teamwork and communication strategies such as structured multidisciplinary rounds and daily goal settings that educate staff on the utilization of The Central Line (CL) Bundle with a target of at least 100% compliance Successful implementation of CL Bundle can help in reducing the rates of CLABSI and achieving zero CLABSI events for a period of one month (Yaseen et al.). Comment by Kathryn Flynn: , along… find another way to break this sentence up. Comment by Kathryn Flynn: Is this the best way to get your point across to staff? This process will have to be justified by the literature that it improves outcomes. Comment by Kathryn Flynn: This last sentence should be broken into two.

C: Compared to standard care. The aim is to identify any discrepancies between the skills gained by trained staff and the standard care procedure. Comment by Kathryn Flynn: This should be part of your lit review to answer why is the project necessary.

O: Reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections). Pre and post intervention outcomes will be measured by counting the number of CLABSIs cases before and after the intervention. Using various questionnaire types (true/false, short answers, and fill in the blank. Comment by Kathryn Flynn: There should be two questions in this, one measurement should be increased knowledge, second is less infections. Consider both in questionsairre.

T: A period of one-month


4. Sample (and Location):

a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

b. Sample: The study seeks to sample 120 nurses from the adult intensive care unit department.

Define Variables

· Define Variables:

· Independent Variables: training and education on various safety measures when carrying out a central line catheter insertion. Comment by Kathryn Flynn: Good; have PICOT question align with both variables.

· Dependent Variables: number of cases of infections resulting from central line catheter insertion.

Methodology & Design

· Review of past research will form the core basis of collecting data for this project. Data on new infections related to the insertion of the central line catheter will be collected. Also, nurses working in adult ICUs will be surveyed, and the total number of infections resulting from their central line catheter procedures recorded. These cases will be recorded before and after an intervention to determine the effect of the intervention. The intervention will be a short training on how to apply various guidelines during central line catheter insertion. The likelihood of causing an infection post or pre-training will be determined by monitoring the number of infection cases recorded by each nurse before and after the training. Comment by Kathryn Flynn: What kind? In person? Slide deck? You mention up above you’ll do daily rounds. All parts should be aligned.

Purpose Statement

5. Purpose Statement:

The purpose of this project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff Clear Lake Regional Medical Center in Webster, Texas for the prevention of CLABSIs.

Data Collection Approach

6. Sample (and Location):

a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

b. Population: The population being sampled in the study is 120 adult ICU nurses.

7. Determining the Sample Size

· A sample population is often selected based on the PICOT question the evidence-based study is being held on people who are 65 years and more. The patients are with a Central line catheter hub hygiene.

· The sample population is targeted from the ICU unit at Clear Lake Regional Medical Center, Webster, Texas.

· After a focused consideration of the required population, a random sampling of nurses from the target group will be picked. Comment by Kathryn Flynn: so will there be 120? Or will they be randomly sampled from 120.

· The selection of a sample population should not be haphazard for it will lead to biased results. Furthermore, a large sample size helps in having precise results (Nayak & Singh, 2015).

· To avoid oversampling to have a minimal sample size that we are targeting are the 120 adult nurses out of the 300 (Andersomn, Kelley, & Maxwell, 2017).

· The proposed intervention is training on the basic guidelines on safety measures to follow when conducting central line catheter insertions. With the confidence level of 95% calls upon the usage of 120 nurses to have an error of 5% only. This population will be equally divided between the treatment group and the control group. The particular ratios of gender are not necessary, yet the ration of re-trained and those left without that are of significance.

· This population will be equally divided between the treatment group and the control group. Comment by Kathryn Flynn: Ok, so the question would compare the intervention group with the control group. Align this in all sections.

The formula below will help determine the population to be sampled. The sample size is 120 nurses.

8. Inclusion/exclusion criteria of the subjects

· People who are 65 or above and are from ICU Lake Regional Medical Centre, the central line catheter hub clinic section.

· The nurses who are not core staff of the ICU at Clear Lake Regional Medical Center will be excluded (Patino & Ferreira, 2018).

· Those who will have signed consent will be included in the study because of having fulfilled the research ethics standards.

· When the interviews and questionnaires have been conducted, the incomplete questionnaire forms will be excluded while the interview subjects who have not attended the interview will not be considered.

· Questionnaires that are entirely filled and interview subjects who will turn for the interview and response will be included in the findings. Comment by Kathryn Flynn: Rephrase to clarify.

Data Analysis Approach Comment by Kathryn Flynn: Address validity and reliability

9. Data Collection Instruments

· The sample of nurses operating within adult intensive care units will be subjected to a training and their efficiency to insert the central line catheter without causing infections tested before and after the training.

· The training will be as much comprehensive and intensive as possible. This is to make sure that the participants have undergone a process that would impact their skills regarding the insertion of the central line catheter.

Ethical Consideration

· A valid research design will be created while taking into account the methods used, the theories, and the findings on crisis management from different organizations. Comment by Kathryn Flynn: How? Move to data analysis.

· Since crisis management as a subject matter is very sensitive to the organization, compliance with confidentiality agreements is paramount (Mkunga, 2017). Comment by Kathryn Flynn: Clarify why this topic is coming up now.

· In this research study, any details that the respondent will not want it disclosed will be removed and deleted from any written or oral records, while others are candidly presented.

· Before the recruitment process, the participants will be contacted and be informed of the research and its significance (Castillo-Montoya, 2016).

· They will then be asked to declare their readiness to partake in the study and the free times they have for the interview process or questionnaire filling process.

· The form will have the clinical question, the usability of results, assurance of anonymity and confidentiality in which the researcher will indicate how the results will be exposed, to whom they will be exposed and how the subjects will be prevented from harm. Comment by Kathryn Flynn: In methodology and analysis, write how you will deidentify any data collected by using assigned numbers to each participant..

· The only harm could be labeling the nurses as unhygienic, hygienic, effective or ineffective, and mentioning their particular names. Comment by Kathryn Flynn: See above. You might want to analyze the cohort, and not individuals. Talk to the methodologist about this. You should pick one way and stick to it.

· Since the study is checking on evidence-based care and its impact, the subjects will not be mentioned, and the results will be written in a manner that they do not openly show which health care has a particular condition (Kamat, 2018). Comment by Kathryn Flynn: Which health care what?

· It is necessary that health care centers be informed of the study.

Before the study, the researcher will seek the participants’ permission through formal e-mails, which will be sent to the administration for approval. Comment by Kathryn Flynn: Kerry, The project is coming along; this version is very much improved. There are some minor adjustments, then you can submit for a grade. Let’s review comments over phone tomorrow in case I can clarify any. Great work.


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I, Kerry Murphy, verify that I have completed (30) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.


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