NR451 RN Capstone

The hospital acquired diseases are prevalent in health care sector, which is significantly reducing the health outcomes of patients. One of the key hospital acquired disease is catheter associated infection. The central venous catheter is a common device, which is being used for several functions in hospitalized patients, which develops a high risk of developing infection at the site of catheterization, which ultimately enhances the mortality and morbidity rates (Regagnin et al., 2016).. Although several previous literatures have shown potential ways to reduce the mortality and morbidity rates associates with catheter-related infections. Within these interventions, use of skin antiseptics and assessment of skin antisepsis. However, the key issue is great uncertainties in those estimates due to underpowered analysis and low quality of evidences (Bouk et al., 2016). Thus, in this context, there is a potential need for assessing and reviewing the pre-existing evidences related to the issues and identifying the potential solutions from those evidences, in order to develop an action plan that will address the issue effectively. Here, an action plan would be proposed for addressing the issue.

Change Model Overview 

The ACE STAR model of knowledge transformation is a framework that helps to integrate evidences into practice through a systematic approach. The model includes five major stages including knowledge discovery, evidence summary, translation into practice recommendations, integration into practice and evaluation. In order to address the current issue, it is important to review what have already been done regarding this issue and what are left to be done, in order to improve the situation. For doing this, ACE STAR model is one of the best models that can be explored to integrate evidences into practice, leading to the integration of the best possible changes (Bondmass, 2012).   

Scope of the EBP

According to the study by Lai et al., (2016) there is significantly low evidence related to the best antiseptic medications related to catheter associated infection prevention. On the other hand, outcomes of those small scale interventions were also poorly reported. Thus, based on only this information, it is not relevant to administer interventions to the patients. Therefore, there is a need for an in-depth review of relevant literatures and an action plan for reducing the catheter-related infections. It has been estimated that the risk of central venous catheter associated infections is significantly high with the incident rate of 2 to 7 episodes within 1000 catheter days in hospital ward (Deatherage, 2016). As a result, the issue is significantly affecting the health care sector by enhancing the rate of mortality and morbidity rate of patients. In ICU patients, the net cost for infected patient is estimated to be from $34,508 to $56,000 per episode, which is significantly posing burden on health care sector (Lai et al., 2015).

Stakeholders

There is a need for selecting the team members and defining their roles, prior delegating tasks for developing the action plan based on reviewed literature. In this context, the current project team would include a team leader, pharmacist, skin specialist, registered nurse, charge nurse practioner, GP, HSC staff and financial analyst.

Determining the responsibility of team members

The team leader would disseminate tasks within the team members, while continuously monitoring their roles. For instance, the pharmacist will search the most appropriate skin remedies for reducing catheter-associated infections. On the other hand, the skin specialist and registered nurse would review the incidences of catheter related infections among hospital patients. The nurse practitioner, GP and skin specialist physician would search and review relevant literatures. The HSC staff would search the right method of conducting and developing the action plan (Walters, 2016). The financial analysis will develop the budget plan. All the team members will take part in developing the action plan.

Evidence

The central venous catheter is one of the devices that help to monitor the hemodynamic indicators as well as administer the intravenous medications. This can include the blood products, parental nutrition, and fluids. It may lead to the catheter- related blood stream infection as the micro- organisms colonize this foreign substance. As a result, it can increase the morbidity, health care loss, and mortality rate. However, for the research, there was no language barrier and some specific databases are used to find the data and only the randomized controlled trial articles are included. As the evidence- based practice is the standard of the health care practice; hence, it is followed in the review. The clinical practice guideline as well as the quality improvement data is added in the research. The evidence- based interventions include the staff education, hand hygiene, at insertion site effective skin antisepsis (Lai et al., 2016). Moreover, it states about the quality assurance that is monitoring the compliances systematically to the set up guidelines as well as evaluate the issues, which is related to the compliance. Another information that is gained from it is aseptic techniques are use while insertion as well as using the CVCs. It is necessary to maintain the maximum sterile barrier precautions by using the sterile gloves, masks, cap, using large sterile drape, and sterile gown. The skin antisepsis can prevent the microbial contamination at the time of catheter. In such way, the risk of the catheter can be prevented or reduced.

However, the contamination can lead to the colonisation of the external catheter infection and the skin antisepsis can reduce the BSIs. This can be done with the short- term CVCs. As mentioned by Galeon and Romero (2014), the antisepsis is the infection prevention by the help of the inhibition of the growing micro- organism. The antiseptic agent starts its working instantly after injected in the living tissues. This can include the presences f the small blood and is very much effective against the pathogenic bacteria. However, Chen et al., (2015) stated that it needs to be non- toxic for the living cells and can be used safely on the all body parts repetitively. The mechanical actions of washing hands with soaps, and water can reduce the risk of the catheter and the residential flora can tend to be inhibited in the deeper layer of skin.  As the resident as well as the transient flora implicate in pathogenesis of the CVC that is Associated with the infection can be effective for the skin antisepsis. Moreover, it requires the mechanical removal as well as the chemical killing. On the other hand, Cheung et al., (2015) mentioned that the inhibition of the resident as well as transient flora is included. The evaluation strategies are identified in accessing the baseline data, data result of pilot implementation, and interim data. The CAUTI program can help to reduce the problem. Hence, before implanting the plan, it is necessary to check the strength and weakness of the project.

Translation 

Initially, based on the reviewed evidences and knowledge base of the team members, the goals for the action plan will be developed.

Action plan

Evaluation

The desired outcomes of the above action plan are reduced incidents of catheter associated infections among patients and reduced mortality rate in the hospital. The outcomes would be measured after exceeding the timeline, by estimating the total number of catheter associated infection and fatal cases in the hospital and the reports would be disseminated within the stakeholders through meetings, emails and publishing the report in hospital website (Fasugba et al., 2016). Based on the outcomes of this pilot study, the applicability of the interventions in major scale would be decided.

Conclusion

In conclusion, it can be said that the central venous catheter associated infection is one of the most common issues identified in hospital, which significantly affects patient’s well being. There is significantly little evidences related to the best antiseptic solutions for the issue. With the help of ACE STAR model, the current project proposed a change plan for resolving the issue.

Reference List

Bondmass, M. D. (2012). Application of the ACE Star Model and Essential Competencies in a DNP Program.

Bouk, M., Mutterer, M., Schore, M., & Alper, P. (2016). Use of an electronic hand hygiene compliance system to improve hand hygiene, reduce MRSA, and improve financial performance. American Journal of Infection Control, 44(6), S100-S101.

Chen, W. T., Wang, C. Y., Huang, H. R., Tseng, H. C., & Shih, C. C. (2015). Reducing catheter-related bloodstream infection by implementing hospital-wide central venous catheter bundle at a cancer hospital. Journal of Microbiology, Immunology and Infection, 48(2), S155-S156.

Cheung, C. W. Y., Wong, Y. Y., Lau, S. S., Ching, P. T. Y., Li, K. H., & Seto, W. H. (2015). Implementation of the catheter associated urinary tract infection (cauti) bundle with the help of infection control link nurses and infection control practice auditors. Journal of Microbiology, Immunology and Infection, 48(2), S95.

Deatherage, N. (2016). Impact of Reduced Isolation and Contact Precaution Procedures on Infection Rates and Facility Costs at a Non-Profit Acute Care Hospital. American Journal of Infection Control, 44(6), S101-S102.

Denny, J., & Munro, C. L. (2017). Chlorhexidine Bathing Effects on Health-Care-Associated Infections. Biological research for nursing, 19(2), 123-136.

Fasugba, O., Koerner, J., Mitchell, B. G., & Gardner, A. (2016). Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. Journal of Hospital Infection.

Galeon, C. P., & Romero, I. (2014). Implementing a Performance Improvement Project in a Multi-level Teaching Facility on Reducing Catheter Associated Urinary Tract Infections (CAUTI). American Journal of Infection Control, 42(6), S130-S131.

Lai, N. M., Lai, N. A., O’Riordan, E., Chaiyakunapruk, N., Taylor, J. E., & Tan, K. (2016). Skin antisepsis for reducing central venous catheter?related infections. The Cochrane Library.

Lai, Y. H., Tsai, G. H., Liou, Y. S., Shih, M. L., Tsaig, S. S., Hung, Y. P., … & Yang, Y. C. (2015). The effectiveness of using bundle care to reduce the incidence of central line-associated blood stream infection in a regional hospital. Journal of Microbiology, Immunology and Infection, 48(2), S95.

Regagnin, D. A., da Silva Alves, D. S., Cavalheiro, A. M., Camargo, T. Z. S., Marra, A. R., da Silva Victor, E., & Edmond, M. B. (2016). Sustainability of a program for continuous reduction of catheter-associated urinary tract infection. American journal of infection control, 44(6), 642-646.

Walters, E. (2016). Using Process Measures to Improve Compliance with Evidence-Based Infection Prevention Activities. American Journal of Infection Control, 44(6), S10