PICO Statement and Literature Search
In researching articles for this paper, I turned to both Qualitative and Quantitative peer reviewed articles. I also performed a lot of independent research so I could knowledgably select the best articles for this research. According to the United States Centers for Disease Control and the Society for Healthcare Epidemiology of America and the Disease Society of America (SHEA-IDSA) report, the most common Healthcare Associated Infection are Central Line Associated Blood Stream Infections or CLABSI. With nearly 50% of all ICU patients requiring a central line, the amount of recorded CLABSI infections is extremely high. The research on CLABSI indicates the most common pathogens are Staphylococcus Aureus, Enterococci, and Candida. To better PICO Statement and Literature Search understand the nature of CLABSI incidence and therefore employ prevention strategies we must understand the dynamics of a central line. The National Healthcare Safety Network defines a central line as “a catheter whose tip terminates in a great vessel” (IHI, 2011). The catheter on a central line punctures the skin, which by default makes bacterial and fungal infections possible. Once the infection has entered the body it can spread to the blood stream. The infection can then cause hemodynamic changes possibly causing death of a patient. Proof of an infection is found in the recovery of a pathogen from a blood culture from a patient who had a central line. For declarative purposes, a pathogen not commonly present on the skin must only be found in one culture whereas a pathogen commonly found on the skin must be detected in two or more cultures. PICO Statement and Literature Search
To be confirmed as a central line infection, the central line must have been installed a minimum of two days prior to the development of the infection and there must be no other apparent source of the infection. Regarding the cost of Healthcare Associated Infections; both are indicators of the enormity of the problem. The 2010 CDC report titled “Preventing Healthcare-Associated Infections” stated 1.7 million cases occur each year in the United States. According to the same report 99,000 cases result in death. The Institute for Healthcare Improvement estimates that of these 99,000 deaths, up to 4,000 are a direct result of bloodstream infections. The human cost is much greater than the financial costs, which alone have a crippling effect on the healthcare industry. Reflecting on the Institute for Healthcare Improvement report, each CLABSI incident prolongs hospitalization on average of seven days. Each infection costs between $3,700 and $29,000. Having established the common CLABSI incidents, identifying the risk of infection, and examining the cost, the healthcare staff must move into prevention strategies.
PICO Parts and PICO Question
P- Patients developing central line associated bloodstream infections (CLABSI).
I- Chlorohexidine daily bath to decrease CLABSI
C- Regular bath with soap and water
O- Decreased rates of CLABSI infections in patients with Central vein catheters.
In hospitalized patients with central access devices (P), what is the effect of daily chlorohexidine baths (I) on decreasing incidence of CLABSI infections (O) compared with daily baths with soap and water (C) within a hospital stay (T)? PICO Statement and Literature Search
Six (6) Peer Reviewed Research Articles
Quantitative with Abstract-
Curlej, MH. 2016. One Rural Hospital’s Experience Implementing the Society for Healthcare Epidemiology of America Guidelines to Decrease Central Line Infections. Journal of Trauma Nursing. 23 (5):290-297.
In an effort to take advantage of the Highmark Quality Blue Initiative requiring information from hospitals detailing their central line-associated blood stream infections (CLABSIs) surveillance system, quality improvement program, and statistics regarding the CLABSI events, our institution investigated the latest evidence-based recommendations to reduce CLABSIs. Recognizing the baseline rate of 2.4 CLABSIs per 1,000 central line days and its effect on patient outcomes and medical costs, our hospital made a commitment to improve their CLABSI outcomes. As a result, we adopted the Society for Healthcare Epidemiology of America (SHEA) guidelines. The purpose of this article is to review the CLABSI rates and examine the prevention PICO Statement and Literature Search strategies following implementation of the SHEA guidelines. A quantitative, descriptive retrospective program evaluation examined the hospital’s pre- and post-SHEA implementation methods of decreasing CLABSIs and the subsequent CLABSI rates over 3-time periods. Any patient with a CLABSI infection admitted to our hospital July 2007 to June 2010 (N = 78). CLABSI rates decreased from 1.9 to 1.3 over our study period. Compliance with specific SHEA guidelines was evaluated and measures were put into place to increase compliance where necessary. CLABSI rates at our facility remain below the baseline of 2.4 for calendar year 2013 (0.79), 2014 (0.07), and 2015 (0.33). PICO Statement and Literature Search
Evans HL, Dellit TH, Chan J, Nathens AB, Maier RV, Cuschieri J. Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients. Arch Surg. 2010;145(3):240–246.doi:10.1001/archsurg.2010.5 http://jamanetwork.com/journals/jamasurgery/fullarticle/405800
Objective: To demonstrate whether daily bathing with cloths impregnated with 2% chlorhexidine gluconate will decrease colonization of resistant bacteria and reduce the rates of health care–associated infections in critically injured patients. Patients: Two hundred eighty-six severely injured patients underwent daily chlorhexidine bathing during the 6-month intervention; 253 patients were bathed without chlorhexidine prior to the intervention. Outcome: Our study showed that daily bathing of trauma patients with cloths impregnated with 2% chlorhexidine gluconate is associated with a decreased rate of colonization by MRSA and Acinetobacter and lower rates of catheter-related bloodstream infection and MRSA VAP. PICO Statement and Literature Search
Hoffman, J. 2016. Daily Chlorhexidine Gluconate Bathing Reduces CLABSI Rates. Oncology Nurse Advisor. 2016, April. Retrieved from http://www.oncologynurseadvisor.com/ons-annual-congress-2016/chlorhexidine-gluconate-bathing-reduces-clabsi-rates/article/493333/ PICO Statement and Literature Search
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