Incorporating Theory

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Identify a theory that can be used to support your proposed solution.
My solution : Catheters- Associated Blood stream Infection
P – Hemodialysis patients with central line catheter
I – Proper hand washing and following good infection control practices
C – Proper hand washing prevents hospital acquired infections for healthcare workers and patients compared to not properly hand washing before and after patient contact and acquiring an infection or not following good infection control practices
O – Reduce infections by continuous education and surveillance
Write a summary (250-500 words) in which you:
1.Describe the theory and your rationale for selecting the theory.
2.Discuss how the theory works to support your proposed solution.
3.Explain how you will incorporate the theory into your project.
Refer to the “Topic 2: Checklist.”
Review of Literature
• Analyze and appraise each of the 15 articles identified in module 1. (15 articles).
• Analysis organized using the sample provided in “Sample Format for Review of Literature.”
Incorporating Theory • Identified a theory that can be used to support proposed solution.
• Main components of theory described.
• Rationale for selecting theory provided.
• Discussed how theory works to support proposed solution.
• Explained how theory will be incorporated into project.
Here are the 15 articles
Literature Research
Lincoln, M. (2011). Preventing catheter-associated bloodstream infections in haemodialysis centres descriptive research: The facility perspective. Nephrology Nursing Journal, 38(5), 411-415.
The article provides an overview of the bloodstream infections associated with hemodialysis treatment, how the infections may occur, and the possible reduction or prevention measures. These infections are related with high rates of morbidity and mortality. Hospitalization rate for bacteria/septicemia increased 47% from 1993 to 2008. The article looks at the practical experience of the author’s facility in preventing bloodstream infections such as participating in the Centers for Disease Control and Prevention’s bloodstream infection prevention collaborative. The review provides lessons learned including that systematic surveillance provides the framework on how to build prevention efforts, best practices should be reinforced and regularly assessed, and collaboration with other facilities provides opportunity to utilize other resources and gain learnings.
Lok, C. & Mokrzycki, M. (2011). Prevention and management of catheter-related infection in hemodialysis patients. Kidney International, 80, 587-598.
The authors provided a review on the prevention and management of catheter-related infection in hemodialysis patients, particularly the pathogenesis of CRB and microorganisms’ catheter colonization and biofilm production. Biofilm production prevents the antibiotic from entering the patient’s system, and to take action and further increase microorganisms. There are different prophylactic antimicrobial locking systems and some have shown the ability to prevent or eradicate biofilm formation.
Centers for Disease Control and Prevention. (2011, March 04). Vital signs: central line-associated blood stream infections quantitative research–United States, 2001, 2008, and 2009. MMWR: Morbidity and Mortality Weekly Report, 60(8), 243-248.
The report provides the estimates of the number of central line-associated bloodstream infections (CLABSIs) in the US among patients in intensive-care units (ICU), inpatient wards, and outpatient hemodialysis facilities in 2008 and 2009 compared with 2001 data. The estimate number of CLABSIs decreased to 18,000 in 2009 from 43,000 in 2001 in ICUs. An estimated 23,000 CLABSIs in 2009 occurred in inpatient wards, while 37,000 occurred among hemodialysis outpatients in 2008. The decrease in ICU CLABSIs can be credited to state and federal efforts implementation, while the continuous occurrence in inpatient wards and outpatient facilities suggests the areas where these efforts need to be expanded.
Tarricone, R., Torbica, A., Franzetti, F., & Rosenthal, V. D. (2010). Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy, quantitative research. Cost Effectiveness and Resource Allocation: C/E, 8, 8. doi:10.1186/1478-7547-8-8
The authors conducted a two-year, prospective case-control study in four ICUs in an Italian teaching hospital to evaluate the costs of direct health care of central line-associated bloodstream infections (CLABSI), as well as the cost-effectiveness of closed fully collapsible plastic intravenous infusion containers vs. open glass infusion containers. The results show that CLABSI increases, considerably, the utilization of hospital resources, and that the use of closed infusion containers, and significantly the incidence of infection acquired while receiving healthcare without hurting hospital budgets.
Yoshida, J., Ishimaru, T., Kikuchi, T., Matsubara, N., & Asano, I. (2011, September). Association between risk of bloodstream infection and duration of use of totally implantable access ports and central lines: a 24-month study, a quantitative study . American Journal of Infection Control, 39(7), e39-43.
The authors conducted a receiver operating characteristic curve analysis for 24 months to determine the safe cutoff day for discontinuing use of totally implantable access ports (AP) and central lines (CL). Results show that using an AP for more than 33 days and a CL for more than 10 days pose increased risk of bloodstream infections. These indicate that postplacement care is important.
Galpern, D., Guerrero, A., Tu, A., Fahoum, B., & Wise, L. (2008, October), a qualitative study. Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery, 144(4), 492-495.
The study was conducted to find a way to decrease central line-associated bloodstream infections in the critical care setting. Data were collected for a period of 24 months and after five months of baseline data, a central line bundle was created to be used when placing central venous catheters. The implementation of the bundle, a protocol that ensures that a procedure is done using the latest evidence-based techniques, resulted in a significant decrease in bloodstream infections associated with central line. The authors recommended that the bundle be adopted nationwide.
Dixon, J. & Carver, R. (2010, December). Daily chlorohexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line-associated bloodstream infections qualitative study. American Journal of Infection Control, 38(10), 817-821. doi: 10.1016/j.ajic.2010.06.005
As central line-associated bloodstream infections (CLABSI) continue to contribute to increase in morbidity, mortality, length of stay, and cost of care, the authors conducted an observational cohort study using historical controls in the setting of a nine-bed surgical intensive care unit in a Level I trauma center. It used a quality improvement intervention protocol to reduce the infections within three months using, a 2% chlorhexidine gluconate-impregnated cloths for daily patient bathing. The incidence rates were reduced by 73.7%.
Ye, X., Rupnow, M., Bastide, P., Lafuma, A., Ovington, L., & Jarvis, W. (2011, October). Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States, a qualitative study. American Journal of Infection Control, 39(8), 647-654. doi: 10.1016/j.ajic.2010.11.008
The authors looked at the economic impact of adding chlorhexidine gluconate (CHG)-impregnated sponge dressing to standard care for the prevention of central line-related infections. Data were gathered through peer-reviewed published studies. The findings show that a CHG-impregnated sponge dressing is a cost-effective prevention treatment option for patients who need central venous catheters. The authors recommend that these results be considered in federal government and insurance company policies that no longer permit enhanced reimbursement for catheter-related bloodstream infection.
De Andra, D., & Ferreira, V. (2007). Central venous access for hemodialysis: prospective evaluation of possible complications. Journal of Clinical Nursing, 16(2), 414-418. doi:10.1111/j.1365-2702.2006.01654.x
The authors studied hemodialysis patients with chronic renal insufficiency undergoing treatment using a temporary double-lumen catheter. The results show that permanence time in using catheter exposes patients to different complications and infections and that inadequate catheter functioning makes the hemodialysis treatment ineffective. Having the knowledge about complications is helpful in planning a systematic care, prevention and control actions.
Chu, G., Adams, K., & Crawford, S. (2013). Improving catheter-related blood stream infection in hemodialysis patients using a practice development framework. Renal Society of Australasia Journal, 9(1), 16-21.
This study used a practice and development framework to engage clinicians in reviewing their practice and developing strategies to reduce catheter-related bloodstream infection (CRBSI) among hemodialysis population. This is because CRBSI numbers are increasing and contribute to hospitalization and death among hemodialysis patients. CRBSI is preventable although it is common. The study found out that dialysis nurses play a big role in preventing such infection and that having basic effective control standards is important.
Bakke, C. (2010). Clinical and cost effectiveness of guidelines to prevent intravascular catheter-related infections in patients on hemodialysis. Nephrology Nursing Journal, 37(6), 601-615.
According to this study, catheter-related infections (CRI) lead to increased hospitalizations, morbidity, mortality, and financial burdens in the healthcare system. In fact, the cost of healthcare system for CRI averages from $4,000 to $80,235 for each occurrence. The study was conducted to evaluate the cost effectiveness of implementing published guidelines to prevent CRI among hemodialysis patients. Results show that guidelines implemented not only reduced CRI incidence but also provided significant cost savings to the healthcare system.
See, I., Shugart, A., Lamb, C., Kallen, A.J., Patel, P.R., & Sinkowitz-Cochran, R. (2014). Nephrology Nursing Journal, 41(1), 37-39, 50.
In addressing the high rate of hospitalization and death among hemodialysis patients due to catheter-related infection, patients also needed to be educated and involved. This study looked at how the patients understand the concept of infection control and bloodstream infection and how they can participate in the education efforts related to dialysis bloodstream infection. The conclusions include the importance of early education and culture established in the facility to guide and support the patients.
Rosenthal, V., Maki, D., Rodrigues C., et al. (2010, December). Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line-associated bloodstream infection rates in the intensive care units of 15 developing countries. Infection Control & Hospital Epidemiology, 31(12), 1264-1272. doi: 10.1086/657140
This article report a time-sequence analysis of the effectiveness of the approach established by the International Nosocomial Infection Control Consortium (INICC) to reduce central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units among INICC members of at least six months. Findings show that CLABSI incidence was reduced by 54% and associated death by 58% in INICC hospitals during the first two years of implementing INICC approach through improved infection control adherence influenced by education, performance feedback, and outcome and surveillance of CLABSI rates.
Taylor, J. (2012). Using Low-Fidelity Simulation to Maintain Competency in Central Line Care. The Journal of the Association for Vascular Access, 17(1), 31-37.
The article studied if the simulation provide a better assessment of nurses’ competency and help them retain such competencies longer. There have been studies that identified simulation as an advantageous method and linked it with decreased central line-bloodstream infections. However, in a simulation environment conducted for this study, almost all of the participants omitted a critical step which puts the patients at risk for infections and other complications.
Frampton, G.K., Clegg, A., Cooper, K., Harris, P., Jones, J., Shepherd, J., Cooper, T., & Welch, K. (2014, February). Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation. Health Technology Assessment, 18(15). doi:10.3310/hta18150
The authors assessed the effectiveness and cost-effectiveness of educational interventions for preventing vascular catheter bloodstream infections in critical care in England to provide a guidance on which types of intervention might be most clinically effective. Studies from several databases were screened and experts were contacted for additional references. Results suggest that implementing educational intervention in critical care units can be cost-effective and cost-saving for the NHS, which spends £19.1-36.2M annually managing catheter-related bloodstream infections.
References
Bakke, C. (2010). Clinical and cost effectiveness of guidelines to prevent intravascular catheter-related infections in patients on hemodialysis. Nephrology Nursing Journal, 37(6), 601-615.
Centers for Disease Control and Prevention. (2011, March 04). Vital signs: central line-associated blood stream infections–United States, 2001, 2008, and 2009. MMWR: Morbidity and Mortality Weekly Report, 60(8), 243-248.
Chu, G., Adams, K., & Crawford, S. (2013). Improving catheter-related blood stream infection in hemodialysis patients using a practice development framework. Renal Society of Australasia Journal, 9(1), 16-21.
De Andra, D., & Ferreira, V. (2007). Central venous access for hemodialysis: prospective evaluation of possible complications. Journal of Clinical Nursing, 16(2), 414-418. doi:10.1111/j.1365-2702.2006.01654.x
Dixon, J. & Carver, R. (2010, December). Daily chlorohexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line-associated bloodstream infections. American Journal of Infection Control, 38(10), 817-821. doi: 10.1016/j.ajic.2010.06.005
Frampton, G.K., Clegg, A., Cooper, K., Harris, P., Jones, J., Shepherd, J., Cooper, T., & Welch, K. (2014, February). Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation. Health Technology Assessment, 18(15). doi:10.3310/hta18150
Galpern, D., Guerrero, A., Tu, A., Fahoum, B., & Wise, L. (2008, October). Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery, 144(4), 492-495.
Lincoln, M. (2011). Preventing catheter-associated bloodstream infections in hemodialysis centers: The facility perspective. Nephrology Nursing Journal, 38(5), 411-415.
Lok, C. & Mokrzycki, M. (2011). Prevention and management of catheter-related infection in hemodialysis patients. Kidney International, 80, 587-598.
Rosenthal, V., Maki, D., Rodrigues C., et al. (2010, December). Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line-associated bloodstream infection rates in the intensive care units of 15 developing countries. Infection Control & Hospital Epidemiology, 31(12), 1264-1272. doi: 10.1086/657140
See, I., Shugart, A., Lamb, C., Kallen, A.J., Patel, P.R., & Sinkowitz-Cochran, R. (2014). Nephrology Nursing Journal, 41(1), 37-39, 50.
Tarricone, R., Torbica, A., Franzetti, F., & Rosenthal, V. D. (2010). Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy. Cost Effectiveness and Resource Allocation : C/E, 8, 8. doi:10.1186/1478-7547-8-8
Taylor, J. (2012). Using Low-Fidelity Simulation to Maintain Competency in Central Line Care. The Journal of the Association for Vascular Access, 17(1), 31-37.
Ye, X., Rupnow, M., Bastide, P., Lafuma, A., Ovington, L., & Jarvis, W. (2011, October). Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States. American Journal of Infection Control, 39(8), 647-654. doi: 10.1016/j.ajic.2010.11.008
Yoshida, J., Ishimaru, T., Kikuchi, T., Matsubara, N., & Asano, I. (2011, September). Association between risk of bloodstream infection and duration of use of totally implantable access ports and central lines: a 24-month study. American Journal of Infection Control, 39(7), e39-43.
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