364JA Nursing

Fundamentally, sick patients are those individuals who are often affected with disease and  need consistent clinical observation and clinical management support from health care staffs; In case of deterioration of health conditions, they are often admitted to medical intensive care units (MICUs) ((Nogueira, Koike, Sardinha, Padilha, and Sousa, 2013). In the perspective of hospitalized patients, the utilization of the focal venous catheters (CVCs) is crucial for the administration of medicines and nutrients to patient. CVC can be effectively inserted from the bedside without causing any convenience to patient. This way, they are viewed as a necessary gadget, broadly utilized as a part of MICUs (Gavin, Webster, Chan, and Rickard, 2016). Regardless of its advantages, the use of CVCs in patients is challenged by risk of infection and thrombotic and mechanical complications (Ullman et al., 2016). Such challenges or error during error of CVC is seen because of loss of skin elasticity as a result of the insertion of the intravascular catheter; Infection also occurs along these lines due to movement of surface pathogens around the inclusion point and tip of the catheter (Ullman et al., 2016). As catheter-related diseases are associated with great complication and even death of sick and hospitalized people, utilizing intravascular gadgets and doctor’s facility-associated costs, avoidance and regulation mechanisms is considered necessary (Weeks, Hsu, Yang, Sawyer, and Marsteller, 2014). One such regulatory mechanism is the utilization of occlusive cataplasm at the CVCs inclusion points.

A promising strategy implemented to reduce the extra luminal course of contamination is the use of chlorhexidine gluconate-impregnated dressing set at the time of CVC insertion (Ullman et al., 2017). Chlorhexidine is a disinfectant and germ-free solution that is utilized for skin sanitization purpose before surgery and to clean surgical instruments. It might be used both to purify the skin of the patient and the hands of the staffs using the CVC. There is argument regarding the decision whether surface disinfectants with chlorhexidine-liquor only need to be performed before the exercise of inserting intravascular gadgets like CVCS.  Such arrangement before CVCs insertion is appropriate  to counteract and regulate bacterial colonization around the skin entry point and consequently prevent intravascular catheter-associated contaminations and infection (Bashir, Olson, and Walters, 2012). Düzkaya, Sahiner, Uysal, Yakut, and Çitak (2016) led an investigation looking at the viability of chlorhexidine-impregnated dressing and the standard dressing in preventing catheter-related circulation system diseases (CRBSIs) on 100 patients (50 for standard and 50 for Chlorhexidine dressing conceded at the pediatric emergency unit). The result was that in case of patients group who were provided a chlorhexidine dressing, improvement in rates of catheter-related circulation system diseases, contamination, colonization, and local catheter contaminants were seen. Another meta-analysis of nine randomized medical tests presumed that chlorhexidine-impregnated gel poultices diminish the rate of catheter-associated circulation system contamination and the colony formation in few catheter needles. Therefore, the utilization of these applications is recommended, and the requirement for additionally strategies with this dressing only in focal catheters is recommended (Safdar et al., 2014).

Another examination has demonstrated that Chlorhexidine-soaked gel cataplasm provides fast, successful antibiotic movement; they consist of a straightforward polyurethane pellicle and a hydrogel that consistently discharges chlorhexidine at 2% (Pfaff, Heithaus, and Emanuelsen, 2012). Evidence based studies have showed that cataplasm ought to be removed each week, if the dressing shows wetness, separation and releases of exudates outperforming the edges of the gel (Timsit et al., 2012).

In another meta-investigation, day by day showering with chlorhexidine was associated with  decrease in the rates of measured healing facility procured circulatory system contaminations along with no challenges in fundamentally sick patients. Day by day showering with chlorhexidine diminished the frequency of Gram-positive bacteremia utilizing mupirocin (Choi, Park, Kim, and Park, 2015). In this regard, it makes sense that if chlorhexidine dressing is used to prevent CVC line infections, it could yield positive results.  

Research Approach

A quantitative report, with an exploratory approach, will be used to break down the utilization of chlorhexidine-impregnated gel dressings in fundamentally sick patients in contrast with povidone-iodine dressing in averting CVC inclusions diseases. The investigation will concentrate on using randomized clinical trial study design (Septimus, 2016) and collecting the data from test group and control group.

One set of patients in MICU utilizing catheters will be treated with Chlorhexidine dressing. The second arrangement of patients using CVC additions will be subjected to povidone-iodine while the last set won’t use any of the treatments. The patients’ treatment will be observed for duration of one year. At that point, information on the rate of infection cases that would get a disease because of CVC addition will be collected and categorized on the basis of severity.

This method of conducting research and collecting research data will give proper information related to outcome in three sample groups. On analysis of the research data, the information can be utilized to find out whether chlorhexidine counteracts CVC line disease and how it differs from other disinfectant.

Exploratory research is the excellent approach for attaining causal inferences, concerning interventions or medication. This is mostly because major emphasis is on analyzing the impact of certain outcome. If other elements are regulated, the specialist can mention with the assurance that independent control variable caused a change in the reliant entity (Tashakkori and Teddlie, 2012). The exploration enables the analyst to weigh and categorize data. The connection between an independent and dependent variable is examined in depth. This is worthwhile since the analyst is more accurate about the outcomes of the study. Quantitative exploration can be employed to test the theories in research due to its capacity to quantify data using measurements. Likewise, this study configuration is repeatable, and in this way, results can be checked and confirmed. Hence, this research design is most suitable for getting the desired outcome from the study.

The challenge in the process  is that appropriate sample must be selected that is representative of the whole target population; the bigger the sample size, the more is the chance of getting valid data. However, conducting research with large sample size is both time consuming and costly process.

Sampling Method

The individuals will be selected on the criteria that they must be sick person and hospitalized patients. All information related to the purpose of research and key procedures will be given to participants and they will be included in the study after getting informed consent for participation.  

The  main research will be conducted in the MICU of a sophisticated high quality healing center in the United States of America (Florida doctor’s facility Orlando). As per inclusion criteria, the current examination involves patients above 18 years and nurses providing them medications or nutrients through CVCs, and utilizing chlorhexidine-soaked gel cataplasm.

A non-probability sampling plan will be done to collect information. For quality information, a standard example is chosen to be used all over the period. In this testing strategy, all confounding factors will be eliminated to promote the validity of the research.

The sample group  (150 MICU patients) will be allocated to chlorhexidine, povidone-iodine group and the no treatment group. The survey will done with participants after one week, two weeks and following a month. The variable to be checked is pain, stress, white blood count, temperature and color change. This data will be recorded, and the progression will be noted until the stipulated time is finished.

A company will make Chlorhexidine-soaked gel poultice that will be utilized in the study. It will  be a 8.5cm X 11.5cm sterile pellicle with translucent gel soaked with 2% chlorhexidine gluconate in its focal bit, with a territory of 3cm X 4cm and  glue edges composed of polyester texture.  Two adhesive tapes will be used after the dressing to settle the catheter. The same will be applied in making the povidone-iodine impregnated dressing.

This inspecting system is more illustrative contrasted with other examining strategies, for example, convenience testing. This can give credible information with logical significance of effect of intervention on people

In any case, the technique faces biasness due to the selection of large sample size in the study. It is  also likely that the large sample size will make the investigation a monotonous process.

While evaluating the impacts of the medications on the two sample groups, questionnaires will be distributed to each participant.  The response to the questionnaire will be managed independently and any data recorded will be kept confidential. Before any data is gathered from the patient, their rights will be clarified to them. They will be asked to participate only when participant’s are sure about that right to confidentiality will be maintained during the research. The data collected will be analyzed by the expert who will categorize results on the basis of different outcomes.

References

Bashir, M. H., Olson, L. K., & Walters, S. (2012). Suppression of regrowth of normal skin flora under chlorhexidine gluconate dressings applied to chlorhexidine gluconate-prepped skin. American Journal of Infection Control, 40(4), 344-348. doi:10.1016/j.ajic.2011.03.030

Choi, E. Y., Park, D., Kim, H. J., & Park, J. (2015). Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis. Annals of Intensive Care, 5(1). doi:10.1186/s13613-015-0073-9

Düzkaya, D. S., Sahiner, N. C., Uysal, G., Yakut, T., & Çitak, A. (2016). Chlorhexidine-Impregnated Dressings and Prevention of Catheter-Associated Bloodstream Infections in a Pediatric Intensive Care Unit. Critical care nurse, 36(6), e1-e7.

Gavin, N. C., Webster, J., Chan, R. J., & Rickard, C. M. (2016). Frequency of dressing changes for central venous access devices on catheter?related infections. The Cochrane Library.

Nogueira, L. D., Koike, K. M., Sardinha, D. S., Padilha, K. G., & Sousa, R. M. (2013). Nursing workload in public and private intensive care units. Revista Brasileira de Terapia Intensiva, 25(3), 225-232. doi:10.5935/0103-507x.20130039

Pfaff, B., Heithaus, T., & Emanuelsen, M. (2012). Use of a 1-Piece Chlorhexidine Gluconate Transparent Dressing on Critically Ill Patients. Critical Care Nurse, 32(4), 35-40. doi:10.4037/ccn2012956

Safdar, N., O’Horo, J. C., Ghufran, A., Bearden, A., Didier, M. E., Chateau, D., & Maki, D. G. (2014). Chlorhexidine-Impregnated Dressing for Prevention of Catheter-Related Bloodstream Infection. Critical Care Medicine, 42(7), 1703-1713. doi:10.1097/ccm.0000000000000319

Septimus, E. J. (2016). Faculty of 1000 evaluation for Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. F1000 – Post-publication peer review of the biomedical literature. doi:10.3410/f.1166053.793513076

Tashakkori, A., & Teddlie, C. (2012). Integrating Qualitative and Quantitative Approaches to Research. The SAGE Handbook of Applied Social Research Methods, 283-317. doi:10.4135/9781483348858.n9

Timsit, J., Mimoz, O., Mourvillier, B., Souweine, B., Garrouste-Orgeas, M., Alfandari, S., … Lucet, J. (2012). Randomized Controlled Trial of Chlorhexidine Dressing and Highly Adhesive Dressing for Preventing Catheter-related Infections in Critically Ill Adults. American Journal of Respiratory and Critical Care Medicine, 186(12), 1272-1278. doi:10.1164/rccm.201206-1038oc

Ullman, A. J., Kleidon, T., Gibson, V., McBride, C. A., Mihala, G., Cooke, M., & Rickard, C. M. (2017). Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial. BMC Cancer, 17, 595. https://doi.org/10.1186/s12885-017-3606-9

Ullman, A. J., Cooke, M. L., Mitchell, M., Lin, F., New, K., Long, D. A., … Rickard, C. M. (2016). Dressing and securement for central venous access devices (CVADs): A Cochrane systematic review. International Journal of Nursing Studies, 59, 177-196. doi:10.1016/j.ijnurstu.2016.04.003

Weeks, K. R., Hsu, Y., Yang, T., Sawyer, M., & Marsteller, J. A. (2014). Influence of a multifaceted intervention on central line days in intensive care units: Results of a national multisite study. American Journal of Infection Control, 42(10), S197-S202. doi:10.1016/j.ajic.2014.06.003.