Article One: Knowledge, attitudes and practice on the prevention of central-line associated bloodstream infections among nurses in oncological care. By Esposito, Guillari and Angelillo.
Background of Study
One common public health problem across the globe is Health Care-Associated Infections and has lead to high morbidity and mortality rate among patients who are hospitalized. CLABSI (Central line-associated bloodstream infections) are related to CVC (central venous catheter) use in critical care. The study done by Esposito, Guillari, and Angelillo, was meant to establish the attitudes, knowledge, and practices for central-line associated bloodstream infections prevention among nurses in oncological care. The study is of significance to the nursing community since the reduction in central-line associated bloodstream infections leads to improved quality of patient’s health and also it can be attained through adherence to preventive measures based on evidence-based research recommendations. The study had two main objectives; one was to establish the level of attitude, knowledge, and behavior with regards to CVC procedures and the second objective was to establish any predisposing factors for the behavior, attitude, and knowledge.
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Discussion of Methodology
The study was done in Italy and utilized a cross-sectional design. The study was conducted across all sixteen teaching and non-teaching private and public hospitals that utilized CVCs in providing care for oncological patients. The target population of the study comprised 472 nurses working in different outpatient chemotherapy and oncology units that were involved with CVCs utilization in patient care. A questionnaire was the main data collection instrument, and the nurses filled questionnaires that sought to delineate their attitudes towards the available standards concerning central lines dressing and insertion and knowledge concerning the available evidence-based practices for CLABs’ control and prevention. The study was however based on the CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections theoretical framework.
Discussion of Study Results
The study established that nurses in oncological care have adequate knowledge of evidence-based recommendations put forth by current studies on effective ways of preventing CLABSIs. 85.9% had good knowledge of the type of patient dressing to prevent CLABSIs, and 76% had knowledge of the change frequency for catheter insertion sites, and 70% had knowledge of skin antisepsis agents. Results showed that nurses within the age bracket of 36-50 had limited knowledge concerning CLABs prevention. The same applied to nurses with low academic credentials. Most knowledge was gained from reading academic material. Medical institutions should encompass educational programs to widen nurses’ knowledge base concerning CVC care bundles and improve their attitudes towards the set guidelines for reduced CLABs.
Discussion of Ethical Considerations
To ensure that research ethics were observed and human elements participating in the study have their rights not infringed, each head physician in all selected hospitals was officially invited with a letter. The letter clearly stipulated the fact that the study would be voluntary and participation shall be anonymous. The study participants’ details would not be held to ensure the anonymity of all participants. The questionnaire would guide the study participant on all information needed for the study; however, all the research participants were fully informed on the objective of the study and the fact that all information collected shall be kept in confidence and be used solely for the research purpose. The questionnaire also contained an informed consent section where participants confirmed and were self-administered to the participants who volunteered to participate, and no financial payment or incentives were provided to study participants.
Conclusion
The study was meant to establish the attitudes, knowledge, and practices for central-line associated bloodstream infections prevention among nurses in oncological care. It adopted a cross-sectional design and was done in Italy and used a questionnaire as the main data collection instrument. The study is of significance to the nursing community since a reduction in central-line associated bloodstream infections leads to improved quality of patient’s health and also it can be attained through adherence to preventive measures based on evidence-based research recommendations.
Article Two: Evidence-based measures to prevent central line-associated bloodstream infections. By Perin, Erdmann & Sasso.
Background
Central Venous Catheters (CVC) are critical for the treatment of critically ill patients. However, Central Venous Catheters can lead to complications triggered by healthcare-associated infections. The central line-associated bloodstream infection (CLABSI) is a healthcare-associated infections complication of the CVC. Studies have indicated that there is an estimate of between 250,000 to 500,000 CLABSIs happening every year. The high CLABSIs rate has been linked to between 10% to 30% patients mortality. The study’s main objective was to establish evidence-based care practices to prevent CLABSIs among hospitalized adult patients in intensive care units. The study is of great significance to the nursing community since the study results will equip nursed offering intensive care with efficient, evidence-based care practices hence also improve the quality of patient care.
Discussion of Methodology
The study adopted a systematic review of published sources on the topic of evidence-based care practices to prevent CLABSIs among hospitalized adult patients in intensive care units. A critical review was done in international medicine and science databases including the Lilacs/BDENF, Cinahl, Cochrane, Scopus, Pubmed/Medline and Web of Science. Search terms, fields and forms, as well as descriptors and Boolean operators, were established and used for easy search in the databases. Exclusion criteria for the study included information from neonatal and pediatric population, peripherally inserted central catheter, arterial catheter and hemodialysis since they were not related to addressing the preventive measures to CLABSIs among hospitalized adult patients in intensive care units. At first 1611 references were established but after a critical review of the references, only 34 qualified to participate in the final review the study adopted.
Discussion of Study Results
Among the 34 studies reviewed, nine studies addressed the use of a safety culture, Education, Care bundles as the main effective preventive measures to CLABSIs among hospitalized adult patients in intensive care units. Care bundles involve five main elements; maximum hand hygiene, sterile barrier precautions when performing CVC insertions, use of chlorhexidine in skin preparation, femoral site avoidance, and unnecessary catheters removal. Another intervention that was effective in preventing CLABSIs among hospitalized adult patients in intensive care units was the replacement of appropriate bandage and use of aseptic technique during the change of connectors. The daily monitoring of the CVC need also proved a good method of minimizing possible emergency of Health Care-Associated Infections due to the CVC insertions. Educational interventions to both nurses and patients were also noted to be among the overemphasized way of preventing CLABSIs among hospitalized adult patients. Educational programs on CLABSIs prevention are implemented through video teaching, conferences and surveillance and research indicate that its results are valued additive since the adult patient can assist in monitoring their own health status to prevent CLABSIs.
Discussion of Ethical Considerations
The study did not involve human beings as part of the study population but used published information from credible sources. The researcher conducted a systematic review of published information on the way of preventing CLABSIs among hospitalized adult patients. Well known international and credible databases were selected to draw the study information. To ensure selected articles contained the very information required for study, the researcher only established 34 relevant studies out of the first collected 1611 studies.
Conclusion
The study was done to establish evidence-based care practices to prevent CLABSIs among hospitalized adult patients in intensive care units. It adopted a systematic review of 34 studies done on Evidence-based measures to prevent CLABSIs. From the study findings, it is evident that education, care bundles and commitment among the nursing community are the best strategies to reduce CLABSIs among hospitalized adult patients. The study findings are important evidence-based findings that when practiced, the level of CLABSIs among hospitalized adult patients will significantly reduce.
References
Esposito,M. R., Guillari, A. &Angelillo, I. F. (2017). Knowledge, attitudes and practice on the prevention of central-line associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLoS ONE , 12(6). doi: 10.1371/journal.pone.0180473
Perin, D. C., Erdmann, A. L. & Sasso, G. T. (2016). Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Rev Lat Am Enfermagem , 24. doi: 10.1590/1518-8345.1233.2787
