Team D’s clinical outline is based on our selection of the clinical issue of central-line bloodstream infections (CLABSI) and treatment using evidence-based practice (EBP) in acute care. To gain an understanding of the clinical issue and the EBP central-line bundle, the team performed both quantitative and qualitative literature researches. A quantitative literature review found the effect of implementing the central-line EBP decreased central-line bloodstream infections, mortalities, and hospital costs. Qualitative research found the effect of central-line EBP from a nursing staff and administrator’s perspective provided additional insight into operational issues, both internal and external, that influence the success of implementing the central-line bundle EBP in the acute care hospital.
I. The Focus of Step 1
Step 1 of the project aims to establish the significance of CLABSI outside of the critical care setting and the importance of using evidence-based practice guidelines in preventing and reducing CLABSI rates specifically in acute care. In this phase of the project, an overview of CLABSI and a justification of why it needs to be addressed were given. A discussion of what clinical guidelines are and their relationship to CLABSI was also provided.
A. Overview of the Clinical Issue
Central venous catheters facilitate treatment involving fluids, nutrition, blood, medications, hemodialysis and hemodynamic monitoring. However, it is a risk factor for bloodstream infections, an adverse event with an incidence of 41,000 cases each year. Central-line associated blood stream infection is associated with longer hospital stays, further illness, patient deaths, and increased medical costs.
B. Justification of the Clinical Issue
CLABSI occurs not only in critical care units but in other clinical settings as well and requires that nurses monitor patients for associated signs and symptoms. In recent years, guidelines have been developed to address CLABSI problems in care for critical patients, notably by the Center for Disease Control and Prevention (CDC) and the Institute of Healthcare Improvement (IHI). Their joint efforts, combined with those of other organizations, significantly reduced CLABSI rates in critical care units. However, CLABSI remains a significant event within and outside the CCU justifying the team’s decision to focus on this issue.
C. Clinical Guidelines: The Central Line Bundle
Guidelines represent best practice or practice that is highly supported by evidence generated through research. These standards direct nursing practice towards the provision of optimal patient care or care that is safe and of high quality. The central-line bundle is a guideline consisting of five interventions put together and proven effective in addressing CLABSI. These interventions are as follows:
1. Hands need to be washed before and after placement of the central venous catheter.
2. Individuals, performing the central line insertion, must wear the appropriate personal protective equipment (PPE) or attire.
3. The insertion site must be cleansed with 2% chlorhexidine prior to the procedure.
4. The best site for insertion must be identified and used.
5. The central venous catheter must be removed as early as possible.
D. Relationship of Clinical Guidelines to CLABSI
In relation to the clinical issue, the selected guideline is a summary of a research evidence on various interventions that were studied to see if they are effective in preventing CLABSI. It incorporates interventions with the most evidence for prevention. As a guide to practice, the central-line bundle ensures a reduction of CLABSI rates.