The study will be based on the PICOT question, which is “In hospitalized patients on the medical-surgical unit, does the use of a dedicated team to care for central venous catheters compared to having a staff nurse to care for the central venous catheter decrease the number of Central Line-Associated Bloodstream Infections (CLABSI)?” A central line refers to a catheter that directly gains access to the bloodstream with its tip sitting within the inferior or the superior vena cava- the great vessels in the neck. Its location may result in pathogen entry into the bloodstream (Johnson, Snyder, Strader, & Zamora, 2017). There are various ways in which contamination occurs causing bloodstream infections. They include contamination when inserting, the patient's skin normal flora, central venous catheter care, immunosuppression among others (Wilder et al., 2016). Of importance in this paper is hospital care of the central venous catheter that is a risk for the Central line-associated bloodstream infections.
P (Population of Interest): Hospitalized patients in the medical-surgical unit.
I (Intervention of Interest): Central venous catheter care.
C (Comparison of Interest): Use of a dedicated team in the care of central venous catheter versus a staff nurse in the care of the central venous catheter.
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O (Outcome of Interest): Acquisition of Central Line-Associated Bloodstream Infections ( CLABSI)
T (Time):
Picot Question: In hospitalized patients on the medical-surgical unit, does the use of a dedicated team to care for central venous catheters compared to having a staff nurse to care for the central venous catheter decrease the number of Central Line-Associated Bloodstream Infections?
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Articles (level of evidence/evaluation of strength of the evidence) |
Who Involved (sample size, sampling method, population) |
What Occurred (qualitative, quantitative) |
Where Completed (the type of agency, state, country) |
When (year research is done) |
Why (research question) |
How (data collection, the tool used with validity and reliability, statistical tests, qualitative control) |
Consistencies (how addresses the PICOT question, how alike with other studies reviewed) |
Gaps (how it does not address the PICOT question, what did the researchers state still needed to be studied) |
| An article on the successful implementation of a Unit-based quality nurse to reduce central line-associated bloodstream infections by use of a unit based quality nurse of patients hospitalized after surgery at the University of Mary Land medical center (Thom et al., 2014). | It is a study of patients hospitalized after surgery at the University of Mary Land medical center. | Over the study period, the unit based quality nurses describe a quasi-experimental study quantitative research. | It was conducted at the University of Mary Land medical center (Thom et al., 2014). | The research period was from June 2008 to June 2012. | The research question in the paper was, ‘What is the effect of the presence of a unit based quality nurse dedicated to performing patient safety and infection control activities for central line-associated bloodstream infections?’ | A quasi-experiment was conducted on patients admitted after surgery in the ICU and data collected was compared before and after the interventions. | The study revealed that use of a dedicated team for central line care is correlated with the reduction of central line-associated bloodstream infections. | The study, however, does not compare directly between a team dedicated to the management of central line and staff nurses since it used the staff nurses as the dedicated team in control of the central line-associated bloodstream infections. On that note, it does not address the PICOT question of comparing the dedicated team to the staff nurses. |
| The CLABSI reduction strategy: A systematic Central line quality improvement initiative integrating line rounding principles and team approach. | It involved A small dedicated team was tasked in the prevention of central line-associated infections and neonates at the neonatal intensive care unit. | An evidence-based practice literature review, which is qualitative | The project was done in a level 4 neonatal intensive care unit in the southwest of the United States. | The improvement project was done between 2011 and 2014. | What policies and adaptations would reduce central line-associated bloodstream infections in the neonatal intensive care unit? | Data were obtained by direct observations. The objective criteria were obtained from literature | The article concludes that by utilizing a dedicated central line maintenance team, the newborn intensive care unit demonstrated a marked reduction of CLABSI infections as well as cost savings in the hospital (Wilder et al., 2016). | The article, however, fails to address the comparison between the dedicated team and nursing staff on the reduction of CLABSI infections in the neonatal intensive care unit of the level 4 facility. |
| Positive Influence of a Dedicated Vascular Access Team in an Acute Care Hospital is an article that describes the decline of CLABSI infections at the Banner Bowell Medical Centre after the introduction of a dedicated team of registered respiratory therapists were integrated to take up the role of central venous catheter management (Johnson, Snyder, Strader & Zamora, 2017). | It involved registered respiratory therapists and hospitalized patients who required central venous catheters during the entire study period. | A qualitative study that integrated a team of registered respiratory therapists | It was conducted at the Banner Bowell Medical Centre as part of the facility based optimization program in 2013. | This took place between 2013 and 2015. | The research aimed to find and implement recommendations and streamline policies, increase efficiency and reduce variations in the care that is provided at all facilities in the system. | The cardiopulmonary department in the institution collected data and compared it with previous data before the integration of the dedicated therapists (Johnson, Snyder, Strader & Zamora, 2017). | The team was present at the medical center 24 hours a day and seven days a week for the insertion, maintenance and the removal of the central catheters. | This also does not compare staff nurses with the dedicated team as would be required of it if the Picot question were anything to go by. |
(Boswell & Cannon, 2017)
Summary of Findings
The study on the successful implementation of a Unit-based quality nurse to reduce central line-associated bloodstream infections use of a Unit based Quality nurse revealed that use of a dedicated team for central line care is correlated with reduction of central line-associated bloodstream infections. In patients or areas with an increased risk of having central line-associated bloodstream infection, a dedicated team such as the unit-based quality nurse should be considered (Thom et al., 2014). Over the study after the introduction of the dedicated team for infection prevention, the rates of central line-associated bloodstream infections reduced by approximately 4.8 percent. That is 36 bloodstream infections per 10,000 central line days down from 50 bloodstream infections per 10,000 central line days (Thom et al., 2014).
The central line-associated bloodstream infections (CLABSI) reduction strategy article concludes that by utilizing a dedicated central line maintenance team, the newborn intensive care unit demonstrated a marked reduction of CLABSI infections as well as cost savings in the hospital (Wilder et al., 2016). During the study, there was a decrease in the rate of central line-associated bloodstream infections by 92 percent which equaled to a reduction of seven CLABSI infections over the three years. The results of the article on Positive Influence of a Dedicated Vascular Access Team in an Acute Care Hospital showed a decrease in the peripherally inserted venous catheter (PICC) orders in the emergency department, a decrease in the total number of PICC order lines and a decrease in the CLABSI rate from 60 percent in 2013 to 34 percent in 2015. It marked a benefit in the use of a dedicated vascular access team in the reduction of Central Line-Associated Bloodstream Infections (Johnson, Snyder, Strader & Zamora, 2017).
Application of Findings to Evidence-Based Practice to Policies and Procedures
A dedicated team should be used in all health facilities for the care of central catheters to reduce the incidence of central line bloodstream infections as evidenced in the articles. The use of dedicated team should be in place to educate bedside staff on the preventive measures and management of central catheters. The dedicated team in central catheters should have policies and regular continuing medical education on measures to prevent CLABSI infections.
References
Boswell, C & Cannon, S. (2017) Introduction to nursing research: Incorporating Evidence-Based Practice. (4 rd ed). Burlington, MA: Jones and Bartlett Learning.
Johnson, D., Snyder, T., Strader, D., & Zamora, A. (2017). Positive influence of a dedicated vascular access team in an acute care hospital. Journal of the Association for Vascular Access , 22 (1), 35-37.
Thom, K. A., Li, S., Custer, M., Preas, M. A., Rew, C. D., Cafeo, C., ... & Lissauer, M. E. (2014). Successful implementation of a unit-based quality nurse to reduce central line- associated bloodstream infections. American journal of infection control , 42 (2), 139-143.
Wilder, K. A., Wall, B., Haggard, D., Epperson, T., Ikuta, L., & Zukowsky, K. (2016). CLABSI Reduction Strategy. Advances in Neonatal Care , 16 (3), 170-177.
