Research Critiques and PICOT Statement Final DraftShalom782
Running head: CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS 1
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS 4
Central Line-Associated Bloodstream Infections (CLABSIS)
Research Ethics and Evaluating Quantitative Research
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Central line-associated bloodstream infections (CLABSIs)
The purpose of the article “One Rural Hospital's Experience Implementing the Society for Healthcare Epidemiology of America (SHEA) Guidelines to Decrease Central Line Infections” by Curlej and Katrancha is to review the CLABSI rates as well as the assessment of the prevention strategies after the SHEA guidelines implementation. The SHEA guidelines entail education to the healthcare personnel and specific interventions at as well as after the Central venous catheters (CVCs) insertion. The study involved 78 individuals who had CLABSI infection aged between 26 weeks and 91 years with 61 percent of the individuals being male; the patients were admitted to the hospital between July 2007 and June 2010.
The study was done in three time periods. The setting of the study was in a Pennsylvania level 1 hospital with a bed capacity of 486. The CLABSI rates data was gotten from the National Healthcare and Safety Network CDC database. According to Curlej & Katrancha (2016), the CLABSI rate is obtained by multiplying CLABSI episodes with 1,000 and divided by the total number of CLD. Results indicated that the CLABSI rates were on the downward trend with the implantation of SHEA guidelines. The SHEA guidelines offered a generic framework for prevention of CLABSI. The results also indicated a LOS decrease for the CLABSI-positive patients during the study period since it has an inverse relationship with the CLABSI rate. Additionally, the FLD (44–36) and Femoral Site utilization rates decreased with FLURs estimation since it relies on CLDs.
Chlorhexidine and Silver Sulfadiazine-impregnated (CSS) CVCs
The usage of CSS Central venous catheters has been shown not to decrease the catheter-related bloodstream infection rate in intensive care units. The aim of the article “Effectiveness of minocycline and rifampin vs. chlorhexidine and silver sulfadiazine-impregnated central venous catheters in preventing central line-associated bloodstream infection in a high-volume academic intensive care unit: a before and after trial” by Stephanie Bonne and others is to determine whether Minocycline and rifampin-impregnated (MR) Central venous catheters usage decreases the CLABSI rates compared to the CLABSI rates observed when using CSS-impregnated CVCs. The study involved 7181 patients who were in a university hospital surgical ICU with a bed capacity of 24. The research was done in two phases: period 1 (between March 2004 and August 2005 and it involved 2551), period 2 (between April 2006 and July 2008 which included 4630). Every patient that required a CVC replacement in period one had a CSS inserted with all patients in period two having all the MR CVSs replaced. The results indicated a decrease in CLABSI rate in ICU with the usage of MR CVCs as compared with CSS CVCS usage (Schuerer et al. 2015).
CLABSI Prevention Best Practices and CLABSI Reporting Legislation
The article “Review of best practices for CLABSI prevention and the impact of recent legislation on CLABSI reporting” by Woodward & Umberger reviews pay-for-performance, the Affordable Care Act (ACA), and mandatory reporting since they are used to incentivize hospitals towards best practices implementation as well as punish the ones that fail to do so. The pay-for-performance aims at rewarding hospitals that improve in HAIs, surgical care, heart failure, pneumonia, and acute myocardial infarctions, and punish the ones that do not. The “Hospital Value-Based Purchasing” program (which is outlined by Medicare) adjusts the sum which the government agency pays hospitals, and it is based on total performance score (Woodward & Umberger, 2016). Mandatory reporting requires hospitals to report their ICD actions and findings so that they are eligible for full reimbursement from the insurance agencies which include Medicaid and Medicare. Hospitals which high rates of CLABSIs have their federal reimbursement rates cut. ACA affects the use of incentives with penalties affecting CLABSIs incidence and reporting. The ACA also requires mandatory reporting by health centers.
In these studies, the researchers should weigh the benefits and risks to which the participants are exposed to ensuring their welfare and rights are protected. All the participants should be informed about the project’s purpose and should participate voluntarily. Permission should be sought when recording interviews; the participants should be assured that their responses will be kept confidential and that their identity will not be identified in any publication or report. All members who agree to take part in the research should sign a document which shows that they have agreed to participate voluntarily.
Additionally, the nurses should use a utilitarian approach when making decisions; they should be clear on what is a good and bad consequence. In the past, this has been defining as material gain, happiness, the satisfaction of desires and knowledge. The other question that needs to be addressed is “whose good is being promoted.”
The hospital-acquired infections affect millions of patients and result in numerous deaths annually. The SHEA guidelines can be used by healthcare professionals to reduce the CLABSI rates. MR-impregnated CVCs can be used in ICUs to reduce the CLABSI rates. According to Schuerer et al. (2015), impregnated antimicrobial or antiseptic catheters can be used to decrease the CLABSIs rate in the ICU.
CLABSIs are the common causes of healthcare-associated infection. Hospitals adopt various strategies of reducing or keeping the CLABSIs rates low such as the use of CVCs, implementing the SHEA guidelines and adopting the CLABSIs prevention best practices.
Curlej, M. H., & Katrancha, E. (2016). One Rural Hospital's Experience Implementing the Society for Healthcare Epidemiology of America Guidelines to Decrease Central Line Infections. Journal of Trauma Nursing, 23(5), 290-297.
Bonne, S., Mazuski, J. E., Sona, C., Schallom, M., Boyle, W., Buchman, T. G., & Schuerer, D. J. (2015). Effectiveness of minocycline and rifampin vs. chlorhexidine and silver sulfadiazine-impregnated central venous catheters in preventing central line-associated bloodstream infection in a high-volume academic intensive care unit: a before and after trial. Journal of the American College of Surgeons, 221(3), 739-747.
Woodward, B., & Umberger, R. (2016). Review of best practices for CLABSI prevention and the impact of recent legislation on CLABSI reporting. SAGE Open, 6(4), 2158244016677747.