24 Sep Lit Review 3
Submitted by
Kerry Sean Murphy
DPI Project Proposal Chapter 2 – Literature Review
Doctor of Nursing Practice
Grand Canyon University
Phoenix, Arizona
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs) 1
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)
July 17, 2019
Chapter 2: Literature Review
Introduction
The Purpose of this study project is to explore the problem of CLABSIs and examine available measures to prevent, control and reduce incidences. In particular, this project proposes teaching proper CVC maintenance as the intervention to prevent CLABSI. In addition to the educational interventions, evidence-based practices such as care bundles which include elements such as using chlorhexidine for proper clean-up of the sight of insertion, proper hand hygiene, and ensuring that the catheter is removed as soon as it is no longer needed. Another intervention proposed in this project is monitoring and appropriate inspection of all procedures around CVC processes. With this in mind, this literature review section will sample various studies which have been done with regard to prevention of CLABSI. Past studies which have been done in this area will be analyzed with more attention being paid to the methodology used, the results, and the solutions they proposed. This section of the project will analyze the theoretical foundations of the approach used, the review of literature, and the key themes which will guide the projectstudy. After choosing the topic, the databases from which the searches will be conducted were identified. The searches were then conducted with the key words being “management and prevention of CLABSIs.” The references and bibliographies of research studies found were used to locate others. Comment by Kathryn Flynn: Educational sessions are not enough for a DNP project, per AQR. EBP interventions should be used to support project.
A total of 200 articles with researches and findings about CVCs, their risk factors, CLABSIs, interventions, and the benefits of preventive measures when handling ICU patients with CVC insertions were identified to be used as references for this project. were established to talk about the CVCs, CLABSIs, risk factors, intervention, and benefits of preventive measures. Through inclusion and exclusion criteria many journal articles were left out because of being written in other languages rather than English. Therefore, the use of the English language index the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was used to search related journal articles. Other search tools include The National Center for Biotechnology Information (NCBI) – PubMed. Studies older than five years were excluded to ensure that the research project remained current and up to date. Using real-time cases or conditions helps to improve the quality and validity of the resulted studies. Comment by Kathryn Flynn: Fix sentence Comment by Kathryn Flynn: clarify
Background
Central Line-Associated Bloodstream Infection (CLABSIs) iins a fatal infection that results from bacteria or viruses entering the bloodstream through the central line. A central line, also known as a central venous catheter (CVC), refers to a tube used by doctors to administer medication, fluids or to collect blood from the body of a patient (Deason & Gray, 2018). CLABSIs are among the leading causes of deaths each year in different countries across the globe. These types of infections have been an area of interest for many healthcare researchers representing a diverse body of knowledge about the infection while still expanding on what is already known. This section of the research project is an analysis of articles related to CLABSIs with the significant themes of concern to the authors including risk factors, interventions, CLABSIs and Hospital Acquired Infections (HAIs), benefits of the preventive measures and the common symptoms of CLABSIs. Several interventions have been suggested for prevention of CLABSIs, but practitioners do not seem to apply the interventions appropriately. This explains why there are still a significant number of infections despite the interventions. This project seeks to bridge this gap by introducing educational interventions and evidence-based practices. A quick survey of the literature indicates that many scholars have investigated various prevention measures but none has explored training on CLABSIs maintenance bundle as a preventive measure. This is the gap that this project seeks to fill. Comment by Kathryn Flynn: sp Comment by Kathryn Flynn: delete; don’t incriminate yourself
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 researchers to test the effectiveness of infection prevention measures, for instance by Gilmartin and Sousa (2016). The QHOM theoretical framework has been increasingly forming the conceptual framework for projects projects which assess quality and system interventions for care improvement. Providing high quality healthcare services is the interest of every health care provider. Even ancient renowned philosophers such as Plato and Aristotle identified quality as one of the “great ideas.” The question of how quantity can be quantified has been under discussion for a long time. The QHOM is one of the models proposed to quantify the quality of healthcare (Mitchell & Lang, 2004). The model can be used to show the relationship between adherence to CLABSI prevention interventions as demonstrated by Gilmartin and Sousa (2016). This model will effectively be used by the researcher to answer the fundamental question asked in this studyproject: How does staff training of proper CVC maintenance and the use of evidence-based care bundles which include elements such as using chlorhexidine for proper clean-up of the sight of insertion, proper hand hygiene, and ensuring that the catheter is removed as soon as it is no longer needed, monitoring and appropriate inspections reduce the incidence of CLABSIs? Comment by Kathryn Flynn: Need to include specifics on how you will integrate into your project Comment by Kathryn Flynn: Be used by the researcher to.. Comment by Kathryn Flynn: EB best practice Comment by Kathryn Flynn:
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