Research Question
The group’s research question is to ascertain how the center line associated blood stream infection (CLABSI) prevalence has been handled by the health professionals through analysis of two studies from recent publication.
Overview and Significance of Problem
Patients being admitted to the healthcare facilities sometimes contact and acquire diseases in the process. Infections acquired at the healthcare facilities within 48 hours after admission, and proven to not have been at the incubation stage during admission are referred to as Healthcare Associated infections (HAIs) (Victor et al. 2019). Thin flexible tubes, also known as catheters, have been ascertained to be a source of infection, causing blood infections. The center line bloodstream infection (CLABSI) is one of the HAIs and is a serious and introduces pathogens to the body. CLABSI causes long term stay at the health facilities, increased morbidity, high mortality rates and increases the cost of healthcare to patients. It is essential to comprehend the prevalence of CLABSI, the major causes and the best ways in which it can be handled. The analysis of the two publications, as explained below, provide an insight on the effects of CLABSI and how to handle it.
Delegate your assignment to our experts and they will do the rest.
Overview of Problem
What do we already know about your topic in general?
The prevalence of CLABSI is common, both in developed and developing countries. It is caused by catheter related factors like host reactions and interventional factors, among others. The infections arise when, during insertion, there is a breach in the aseptic precautions, or other unhygienic conditions that may arise during insertions and when handling the patients. Developing countries have a fivefold higher chance of CLABSI rates than developed countries like the US. For instance, the rate of mortality associated to CLABSI was 56% according to a study conducted in North India. The question of HAIs and particularly, CLABSI, is of great concern and thus should be reviewed and measures taken to reduce the cases to zero.
Significance of Problem
Understanding of the incidences of CLABSI, the causative agents and the best ways of preventing it, alongside other HAIs will be a great step in reducing mortality rates among patients in intensive care, pediatric patients and other vulnerable patients. CLABSI is one among many HAIs that can be prevented and possibly eliminated entirely from the problems affecting patients under intensive care. Central lines are important in providing essential needs to the patients under care, and as such, any problem that may arise from their association, should be understood and handled appropriately. This will reduce the mortality rates at the hospitals and reduce the cost of healthcare to patients.
Article 1 Review
Pravin Charles Marie Victor, Kalaivani Ramakrishnan, Mohammad Hanifa, Joshy Maducollil Easow and Jayapal Venugopal. (2019, Dec.). An Intervention Based Prevention of Catheter Associated Blood Stream Infection in Adult Critical Care Unit. Journal of Pure and Applied Microbiology, 13 (4), 2209-2214. doi:doi.org/10.22207/JPAM.13.4.34
Purpose of the Study
The aim of the study was to implement bundle care approach and identify CLABSI rates post intervention in comparison with the retrospective data.
Variables
The variables in the study was the time in relation to the status of the patients in the study. Some patients had had the CL implanted in them for longer times than others.
Another variable was the state of intervention. The rates of CLABSI were measured before and after the bundle intervention
Quantitative Study
The dependent variable was the time which were observed in two phases: the phase of insertion and the phase of maintenance
The independent variables were the intervention status. The status of intervention: Pre-intervention or post-intervention affected the status of CLABSI.
Participants
Adult patients that had been admitted and with different surgical and medical conditions.
Enrollment
The participants to the study were the patients with the central line (CL) implanted in them. All admitted patients to the intensive care unit (ICU) who had central line (CL) implanted in them.
How did they recruit/enroll eligible participants in the study?
The eligibility of the patient was based on how long the CL had lasted in them. Those patients who had the CL in them for less than 48 hours were not eligible, while those who had the CL for over 48 hours were eligible.
Total Participant Numbers
The total number of participants in the study were not specified.
Intervention Group
Intervention/Treatment Group
The ICU nurses applied the bundle care approach to monitor the patients who were participants in the study. They had a checklist that had the bundle care units, which was administered to the patients. All patients who were suspected to have an infection were subjected to a blood test. About 10 ml of their blood was drawn from the brain-heart infusion (BHI) and the blood was then cultured on, mac-conkey and chocolate agar for between 24 to 48 hours. The blood was then subjected to one-week aerobic incubation. The organisms that developed were then identified using the standardized bacteria identification procedures (the Kirby-Bauer disc fusion method)
Control Group
The study did not have any control group. However, the results from the experiment were compared by the results of a similar experiment carried out in 2016 and 2017.
Results and Findings
The results of the study were compared in the two periods of intervention for the three years. The findings for the 2016 showed that the CLASBI rates fluctuated in despite the bundled care, reaching high rates in February, June and October. However, by December, the rates had plummeted to zero. In 2017, the rates remained zero during the intervention period, and finally rising in December. For 2018, the rates remained zero throughout, from January to December during the intervention. From the isolation of bacteria, the common bacteria found were Enterobacter aerogenes (30%), Klebsiella pneumonia (20%), and Pseudomonas aeruginosa (20%). Antibiotic resistance was highest in ceftriaxone (55.5%) and lowest in piperacillin tazobactam (11.1%).
Participant Characteristics/Socio demographic Findings
The participants characteristics were as described above, with no socio demographic variables.
Other Results/Findings
There were no other findings related to the study.
Article 2 Review
Hanan M. Abdelmoneim, Hanan M. Ibrahim, Ahmed R. Ahmed, Khaled A. Mohammed. (2020, January). Incidence of Central Line-Associated Blood Steam Infection in Pediatric Intensive Care Unit (PICU). The Egyptian Journal of Hospital Medicine, 78 (1), 136-141.
Purpose of the Study
The purpose of the study was to assess the occurrence of CLABSI at Pediatric Intensive Care Unit (PICU) of Ain-shams University Hospital for 6 months.
Variables
The variables in the study was the time (6 months) in relation to the status of the patients in the study. Some patients had had the CL implanted in them for longer times than others.
Another variable was the state of intervention. The CLABSI rates were measured before the bundle intervention and after the bundle intervention
Quantitative Study
The dependent variable was the time which was observed in two phases: the insertion phase and the maintenance phase.
The independent variables were the intervention status. The status of intervention: Pre-intervention or post-intervention affected the status of CLABSI.
Participants
The participants to the study were the patients in the Pediatric Intensive Care Unit of Ain-shams University Hospital with the CL inserted in them.
Enrollment
The enrollment was automatically done when the patients were registered under the PICU unit of the hospital.
Inclusion & Exclusion Criteria
109 patients with CL admitted at PICU were all included in the study. Patients with ineffective endocarditis were excluded from the study.
Total Participant Numbers
The total number of participants were 109.
Intervention Group
The intervention group included 109 patients with 152 catheters inserted in them. Although age, sex, history of the current illness and the cause of admission were considered during the intervention, they were not considered as variables to the study.
Intervention/Treatment Group
The intervention included the investigation of complete blood count (CBC) creatin protein (CRP) before and after insertion of the central intravenous catheter (CVC). Two of 2 ml blood sub-cultured were drawn from the patients and then placed in inoculated aerobic bottles for 7 days. The bottles were then examined for microscopic evidence of microbial growth. The aliquot of MacConkey was used in the environment.
Control Group
There was no control group for the experiment.
Results and Findings
The results showed that the patients admitted to PICU all showed higher rates for CLASBI before the CVC days and during the PICU admission days. During the intervention stage, the CLABSI rates reduced significantly and eventually became non-observable in the blood from the jugular vein.
Participant Characteristics/Socio demographic Findings
There were no socio-demographic factors considered during the study.
Other Results/Findings
There were no other findings related to the study.
Synthesis of Findings
The findings by these two studies shows that the CLABSI rates are still high for patients with catheter insertions. The rates may be different for developed worlds in relation to the developing worlds, but it confirms that the continued prevalence of CLABSI are still a threat to the health care provision. For example, the study by Abdelmoneim et al. (2020) confirms that the CLABSI scores were found to be 14.1 for every 1000 catheter days for Ain-shams University Hospital. In India, another study had reported 7.9, 2.8 and 18.5% CLABSI rates for every 1000 catheter days.
Nursing Implications
The implication to the nursing fraternity is that the nurses must exercise great hygiene practices when handling CVCs to avoid CLABSI cases. CLABSI cases, as a HAI is the fault of the health facilities and the patients should not be subjected to duress by the cases. Also, since it is proven that CLABSI cases can be reduced to zero, the nursing fraternity must consider adopting the recommendations from various studies to reduce the cases.
Article Summary Table
| Article 1 | Article 2 |
| CLABSI cases are confirmed to still exist in health facilities in developed and developing countries | CLABSI cases increases the cost of healthcare as well as the stay of patients in hospitals. |
| The developing countries are more affected than the developed countries. | CLABSI rates can be reduced to zero through proper strict bundle care adherence. |
| CLBSI increases the mortality and morbidity rates. | The ICU team should be educated on how to reduce CLABSI cases. |
| CLABSI rates can be reduced to zero through proper strict bundle care adherence. | CLBSI increases the mortality and morbidity rates. |
References
Hanan M. Abdelmoneim, Hanan M. Ibrahim, Ahmed R. Ahmed, Khaled A. Mohammed. (2020, January). Incidence of Central Line-Associated Blood Steam Infection in Pediatric Intensive Care Unit (PICU). The Egyptian Journal of Hospital Medicine, 78 (1), 136-141.
Pravin Charles Marie Victor, Kalaivani Ramakrishnan, Mohammad Hanifa, Joshy Maducollil Easow and Jayapal Venugopal. (2019, Dec.). An Intervention Based Prevention of Catheter Associated Blood Stream Infection in Adult Critical Care Unit. Journal of Pure and Applied Microbiology, 13 (4), 2209-2214. doi:doi.org/10.22207/JPAM.13.4.34
