This article covers a sample assignment solution about Central Line Associated Blood Stream Infections (CLABSI) in the Intensive Care Unit (ICU).
This week you will identify the focus of your project and anticipate the ethical, legal, and regulatory concerns that may arise.
For this assignment, you will:
- Define the problem (CLABSI in the ICU)
- Identify the problem to be addressed and the setting in which it occurs.
- Summarize and briefly discuss your proposal to address the problem.
- Identify and discuss:
- and regulatory concerns relating to the problem.
- Explain why you chose the problem. (okay to use first person)
You must cite at least two scholarly references (within past 5 years).
Format your assignment as one of the following:
- Minimum 875-word paper; your paper must be organized using APA Level I headings for the assignment requirements noted above.
Central Line Associated Blood Stream Infections (CLABSI) in the Intensive Care Unit (ICU)
The central line-associated bloodstream infection (CLABSI) is a common Intensive Care Unit clinical problem globally. In the USA, CLABSI is considered one of the leading causes of hospital-associated infection deaths. According to Haddadin et al. (2020), CLABSIs have the highest direct medical cost burden at about $46,000 per case. Significantly, CLABSI leads to prolonged hospital stays, significant morbidity, and mortality. CLABSIs are laboratory-acquired bloodstream infections that develop following central line placement in the ICU, usually within a window of 48 hrs. The CLABSI rate in US intensive care units stands at 0.8/1000 central line days.
Moreover, ICU patients have higher risks of CLABSI due to the frequent insertion of multiple catheters (Marschall et al., 2014). Besides, most catheters associated with substantial risks are exclusively used with ICU patients, including central line-catheters. Moreover, most catheter insertions are done during emergencies, which can also contribute to poor insertion procedures. Lastly, ICU catheters are repeatedly accessed daily and used for extended periods contributing to higher infection rates. Therefore, ICU patients are at high risk of CLABSIs, requiring an evidence-based practice to minimize incidences.
This activity proposes a tailored routine nurse training (Demonstration-based competency training) and patient education on evidence-based and current peripherally inserted central catheter line placement. Higher CLABSI incidences are due to a lack of awareness and application of evidence-based prevention guidelines. Nurses play vital roles in providing care, monitoring, and maintaining the central line in ICU settings (Cooper, 2019). Moreover, significant studies and the Centre of Disease Control and Prevention (CDC) have shown that inadequate knowledge transfer, particularly with the definitions of CLABSI, lead to misinterpretation and misreporting.
As a result, the associated state and federal hospital-associated infections (HAIs) prevention guidelines are underutilized (cited in Woodward & Umberger, 2016). Consequently, nurses tend to overrule the need to report CLABSI incidences to the National Hospital Safety Network.
Clinicians often change their clinical assessment processes to avoid categorizing patient infections as hospital-acquired. This is despite clinical practice guidelines outlining ways to identify, classify and manage central lines (Esposito, Guillari, & Angelillo, 2017). Such cases lead to increased cases of HAI’s, crippling hospital-based measures aimed at preventing occurrence and reoccurrence. More than 70% of infections associated with central lines can be prevented through adherence to institutionalized, local, or federal evidence-based practices (APICE, 2016).
Having inadequate knowledge on effective care provision, monitoring, and maintenance of central lines unintentionally contributes to high CLABSI cases. The fact that such practices are common in clinical facilities presents a worrisome trend that puts patients in danger of clinical malpractices. However, through proper patient education and training of nurses, hospitals and associated entities can identify a standard approach to identifying, reporting, and preventing CLABSI s
Ethical and conflicting issues are common and harmful in intensive care units. For this recommendation, a crucial concern would be to encourage collaboration during insertion, monitoring, and replacement of catheters to avoid adverse events. Collaboration encourages accountability through feedback mechanisms, surveillance of infection rates, and sharing appropriate data on risk factors and efficacy of prevention initiatives. A study conducted by Park et al. (2015) revealed that healthcare professionals tend to have opposing views and decisions on appropriate treatment despite being part of the same medical team with the same nursing care goal.
The nursing code of ethics dictates that nurses must avoid causing harm to the patient (Haddad & Geiger, 2018). The other crucial ethical concern is improving nurses’ competency relevant to catheter insertion and management. According to the American Nurses Association Code of Ethics, nurses are obliged to advance their profession through adequate research knowledge and professional development, including contribution to nursing and health policy (Haddad & Geiger, 2018). Therefore, the recommended nurse training should include knowledge of research to facilitate competency in applying existing research work and practice guideline inquiry.
The legal concerns relevant to the clinical issue regards nurse and patients’ knowledge of central lines insertion and management of infection risks. Nurses are expected to have competency in catheter insertion and management (National Healthcare Safety Network, 2021). Typically, nurses are required to assess patients’ and colleagues’ educational deficits and needs regarding clinical issues impacting patients’ health and care provided (Miracle, 2011).
In this regard, an appropriate assessment of nursing staff and patients’ knowledge on central line risk factors is necessary before planning, implementing, and evaluating the proposed demonstration-based competency of central line insertion and management. The other legal concern regards compliance and adherence to the patients’ rights and regulations. Patients have the right to safe care and to receive information concerning their care and the associated risks. In this regard, patient t education is a crucial measure to HAIs.
Nurses have a professional obligation to comply and adhere to the state and federal laws and regulations relating to the prevention of HAIs. The NHSN provides guidelines on identifying healthcare-associated infections in Central Vascular Catheters (NHSN, 2021). The recommended intervention should promote adherence to existing guidelines since they are evidence-based. In addition, it is vital to adhere to the established central line insertion and maintenance practices, including precautions, minimizing infection risks from routine assessments, and using data to monitor and prevent future infections (Valencia et al., 2016). Therefore, it is crucial to consider these guidelines to contribute to the infection prevention proposal.
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Explain Why you Chose the Problem
I chose this problem because it is common, yet studies have shown the most CLABSIs cases are preventable through appropriate hygiene, monitoring, and management strategies. Unfortunately, CLABSIs incidence is still high in the USA due to inadequate knowledge on existing prevention and management measures (Bell & O’Grady, 2017). I believe that the role of nurses is to promote the health and safety of patients. This is only possible through the maintenance of competence and continuing personal and professional growth.
EBP nursing education will reinforce the need to follow existing guidelines, which have been shown to have a good effect in mitigating CLABSIs. For instance, clinical factors such as the choice of a catheter, selection of appropriate catheter placement site, insertion technique, and maintenance contribute to lower incidences of CLABSIs (Bell & O’Grady, 2017). The existing guidelines are supported by evidence and include simple clinical practices and behavioral changes that should be easy to implement (Latif, Halim, & Pronovost, 2015). I believe that effective and long-term CLABSIs prevention requires a multidisciplinary approach involving EBP and effective implementation competency.
Association for Professionals in Infection Control and Epidemiology (APICE). (2016). States targeting a reduction in infections via engagement (STRIVE) program. Prevention Strategist, 1-16. Retrieved from http://apic.org/Resource/TinyMceFileManager/Periodicalimages/STRIVEsup plementCDCWinter2016.pdf
Cooper, M. (2019). Improving Nurses’ Knowledge of Central Line-Associated Bloodstream Infection (Doctoral dissertation, Walden University). https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=7469&context=dissertations
Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PloS one, 12(6), e0180473. 10.1371/journal.pone.0180473
Haddadin, Y., Annamaraju, P., & Regunath, H. (2020). Central line-associated bloodstream infections (CLABSI). StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK430891/
Latif, A., Halim, M. S., & Pronovost, P. J. (2015). Eliminating infections in the ICU: CLABSI. Current infectious disease reports, 17(7), 35. 10.1007/s11908-015-0491-8
National Healthcare Safety Network (January 2021). National Healthcare Safety Network (NHSN) Patient Safety Component Manual. Retrieved 12 August 2021, from https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf
Park, D. W., Moon, J. Y., Ku, E. Y., Kim, S. J., Koo, Y. M., Kim, O. J., … & Koh, Y. (2015). Ethical issues are recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods. Journal of Korean medical science, 30(4), 495-501. 10.3346/jkms.2015.30.4.495
Valencia, C., Hammami, N., Agodi, A., Lepape, A., Herrejon, E. P., Blot, S., … & Lambert, M. L. (2016). Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey. Antimicrobial Resistance & Infection Control, 5(1), 1-8. 10.1186/s13756-016-0139-y
Woodward, B., & Umberger, R. (2016). Review of best practices for CLABSI prevention and the impact of recent legislation on CLABSI reporting. Sage Open, 6(4), 2158244016677747. https://doi.org/10.1177/2158244016677747
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