Revisions

The topic is the Central Line-Associated Bloodstream Infections (CLABSIs) and prevention.

Summery

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

· The nurses need to have the significant knowledge associated with evidence-based practices for the 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).

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

· There is 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)

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

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

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

Setting

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

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

Summary

· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention throuth nursing education

· 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.

· Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site is 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)

2.

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).

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 betweeen interventions, characteristics and outcomes of patients, and the characteristics of the healthcare system.

The theoretical model is associated with the strategies deployed and operational processes linked to the prevention of Central Line Association Bloodstream Infection (Hickok, J. et al., 2014).

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 in a. Single Healthcare System

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

“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).

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).

C: Compared to standard care. The aim is to identify any discrepancies between the skills gained by trained staff and the standard care procedure.

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 intervention. using various questionnaire types (true/false, short answers and fill in the blank.

T: A period of one-month

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

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

· Independent Variables: training and education on various safety measures when carrying out a central line catheter insertion.

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

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.

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.

· 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.

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.

· 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 proces that would impact their skills regarding the insertion of the central line catheter.

· Since crisis management as a subject matter is very sensitive to the organization, compliance with confidentiality agreements is paramount (Mkunga, 2017).

· 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.

· The only harm could be labeling the nurses as unhygienic, hygienic, effective or ineffective, and mentioning their particular names.

· 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).

· 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.