Does an increase in nurse’s knowledge concerning CLABSIs infections reduce the number of infections in the Intensive Care Units?

Morbidity has been defined as how often a disease occurs or is reported in a population. The morbidity rate is determined by examining the number of patients with a certain disease at a given period (Kim & Biorn, 2017). Reduced cases of a disease mean that preventive and treatment measures are effectively implemented by all stakeholders involved. CLABSIs infections are no exceptions here. The literature work of the previous authors appreciates that the health care institutions that have adopted the interventions measures above report few and reduced cases of the infection.
CLABSIs SymptomsSite DischargeThe area where the catheter is placed should remain dry, and no discharge should be coming from the area. Some patients, however, may notice yellow or green discharge (Conley et al., 2018). The drainage should be a cause for alarm, and the authors have identified the discharges as some of the top indicators that something has gone wrong and healthcare providers should act up. Discharges show that the area is not fresh and has been exposed to bacteria and germs, something that should be of great concern.
Site SwellingPatients may experience additional swelling at the place where the catheter line has been inserted. The swelling is an indicator that there is no healing that is taking place and that there is every reason to worry about the well-being of the patient (Castagna et al., 2016). The authors suggest that nurses should give attention to the recovery process of patients and ensure that such instances are noted and addressed. In cases where there is no close relationship between the health caregivers and the patients, such incidents may be hard to notice, and the patients end up suffering and worse still, be exposed to the ugly infection which may even cost them their lives.
Site RednessA patient may develop red streaks at the area where the line has been inserted. Another warning sign that the patient may be headed to a CLABSIs. Again, if there is no close interaction between patients and their caregivers such may be hard to notice (Chesshyre et al., 2015). Worse still if the patient is not aware that such are causes for alarm. They may never report the same and end up risking their lives. Adult patients and children are at the greatest risk of these symptoms because in most cases they do not know what should be made known to the health care providers and what should not be a cause for worry.
Research QuestionsHow does the training of health-care providers on the risks and the preventive measures of CLABSIs impact the overall infection rates?What is the level of knowledge of nurses regarding the use of evidence-based guidelines to prevent central venous catheter bloodstream infections?Does an increase in nurse’s knowledge concerning CLABSIs infections reduce the number of infections in the Intensive Care Units?Sample PopulationsThe authors have utilized different study populations to accomplish their objectives. The two major categories of respondents that are common to all authors are healthcare professionals and adult patients suffering from or who have suffered the CLABSIs infections in the past (Hsu et al., 2014). These two categories have a rich knowledge on the study topic. Such enables researchers to collect adequate data for their research topics and also draw logical conclusions.
There are several processes through which people sample information in studies. For Alfonso et al. (2016) the search of the various database using key terms gave 291 records, however, based on relevance only 4 articles were suitable for the study. In a study by Dougherty, there was convenience sampling of a population of registered nurses in the LTACH setting after completion of orientation to the unit. Out of 52 eligible nurses, 31 participated in the survey response. The study by Lin et al (2015) utilized a cross-sectional design in the qualitative analysis of sources based on the key concepts of the study. Moreover, O’Grady et al. (2011) used data from a variety of available studies. Perin et al. (2016) explored a purposive sampling and selection of 34 studies that formed a set through which to assess results after a systematic review of academic and health database. In the sampling process, Esposito (2017) utilized a cross-sectional design in 16 non-teaching and teaching public and private hospitals with units utilizing CVCs for oncological patients. The target group was 472 nurses in the oncology and outpatient chemotherapy units of the selected hospitals. Likewise, Oliveria et al (2016) samples were collected through a cross-sectional study with questionnaires to 76 professionals in the intensive care. Zu & Wu (2017) utilized the qualitative process and a systematic search of databased on CINAHL, ABI INFORM, and OVID through which they established more than a hundred articles before applying the exclusion-inclusion criteria and utilizing ten articles in the study. Han et al (2010) searched from a variety of available studies for healthcare workers in all units using CVCs in the Calabria region of Italy. Bianco et al. (2013) used samples from a number of CLABSIs which were collected by the hospital-based IP in line with the NHAN approach and definition of CLABIs. The CUSP teams of hospitals receive monthly feedback on infections and quarterly feedback on rates of infection per 1,000 catheter days. Basinger (2016) samples were collected through a cross-sectional study with questionnaires to 76 professionals in the intensive care. In another study by Chidambaram (2015) the samples used were acquired from existent studies. On the other hand, Kadium (2015) utilized a convenience sampling of registered dialysis nurses in the hemodialysis unit was used in a pre and post-test educational interventional design among 60 registered dialysis nurses. CDC and NCBI (2011) worked by using the patients aged 1 year and above in the inpatient, outpatient and ICU settings. The acquisition of the participants was through Fistula First breakthrough initiative. Finally, Srinivasan, et al. (2011) used the ICU, inpatient ward, and hemodialysis facility records for years 2007, 2009 and 2001 to establish the rates of infection.
LimitationsThere are several obvious limitations in the studies. For example, Esposito et al. (2017) opine that self-reported questionnaires affected accuracy in response. Questionnaires ought to be anonymous to encourage correct reporting. He also notes that a cross-sectional study hindered establishing a causative relationship with outcomes of interest. Future studies need to focus on non-evidence-based practices and dressing of catheters and how they relate with CLABSI (Han et al., 2013). Also, the study by Basinger (2014) was limited by failure to separate the efforts that aim at improving the use of CUSP, related approaches, and technologies that reduce compliance.
In the study by Afonso et al. (2015) the limitation was in the use of cumulative analysis on line-associated HABSI types while reporting the catheter culture is a diagnosis of infection. Moreover, another study by Lin et al. (2015) showed that the limited time and consideration of barrier towards quality, an aspect that needed adequate time hindered acquisition of enough information. Furthermore, Perin et al. (2016) note that the use of one type of catheter hindered generalization of information to other health departments.
Chidambaram (2015) assert that the limited evidence and utilization of exploratory method when conducting a study on CLABSIs. According to Kadium (2015) the small sample size and short duration within which it was conducted limited the results that were acquired. Another problem emerged because there was no assessment of the learning styles of the patients. CDC and NCBI (2011) states that even though there has been a reduction in the infections of CVC users, there is a need for more solutions to preventing this According to Srinivasan et al. (2011), there is a need for continuous studies on CLABSIs as they enhance establishing the preventive mechanism.
the Conclusions and recommendationsOverall, there are various issues that are addressed in the various papers in this analysis. From the literature review Afonso et al. (2016) conclude that hospitals achieve zero infections of CLABSI rates meaning the continued usage of surveillance together with a washcloth bathing for they curtail Gram-positive bacteria. Thus, hospitals with high baseline hygienic standards of care and lower CLABSI rates might benefit less from CHG washcloth bathing. Additionally, Lin et al. (2015) note that the adherence to the current evidence-based practice guidelines, education, and consideration or compliance to hygiene, and use of chlorhexidine antiseptic bathing instead of the soap helps in the prevention of CLABSIs. For example, according to O’Grady et al. (2011), maximal sterile, cautious insertion of catheters, avoidance of routine catheter replacement, usage of the antiseptic/antibiotic impregnated short-term central venous catheters and chlorhexidine-impregnated sponge dressings help to prevent and manage CLABSIs.
Similarly, Perin et al., (2016) opine that the consideration of necessary interventions on the catheters can prevent infections. According to Esposito et al. (2017) in situations where nurses have a positive attitude, and perceive hygiene as a risk in CLABSIs as well as where evidence-based practice programs are used, infection is likely to be prevented. There is still a low adherence to handwashing. Xu & Wu (2017) note that patient cooperation and knowledge of proper care for CVC prevent infections. There is a need for studying practical clinical nurse interventions in the care for CVC. In the study by Han et al (2013) state that blood culture is necessary for managing CVC patients. Formal training, years of experience, written policies, enhance compliance to proper CVC care and reduce infections (Han et al., 2013). In a study by Bianco et al. (2013), there is a conclusion that less costly evidence-based education, CUSP prevent infections. It is also indicated that multidisciplinary education programs improve assistance to patients (Oliveira et al., 2016)
According to Afonso et al. (2016), an analysis into the topic requires separate primary, secondary and central line-associated HABSI types in reporting catheter culture during the diagnosis of bloodstream infection that increases certainty and lowering of risks of bias as a result of improper attribution of blood culture contaminants.
Furthermore, Dougherty, (2012) suggests that in future research there is a need for an investigation into the personal motivation in adherence to the clinical practice guidelines of CVC care. Further examination into the required time, barriers towards quality care. Another important area of analysis is the LTACH specific practice in the assessment of CLABSI and prevention strategies towards CVC infections (Dougherty, 2012).
In the study by Chidambaram (2015), the conclusive view offers that the dental care process is necessary for pediatric CKD patients if studies on CVC are being held. Besides, CVC benefits CKD patients but poses a threat for long-term candidates due to negligence on disinfection and sterilization processes. According to Kadium (2015), high education levels do not affect pretest, but the completion of infection control course affects pretest scores. Another argument is that evidence-based care allows students to work purposefully. Moreover, the provision of continuous education enhanced retention and application of knowledge in tasks. In another study by CDC and NCBI (2011), it is indicated that while 2009 has about 25000 (58%reduction) fewer than 2001 but substantial numbers of infections caused by Staphylococcus aureus continue to exist. Ultimately, Srinivasan et al. (2011) opines that HAI best practices help prevent CLABSI cases. It is thus necessary for future studies to focus on more than one type of catheter for results to be relevant to various departments of health.
From the above literature review, it is clear that evidence-based practice, policies, hygiene, education and attendance of workshops are important aspects that need to be studied. Besides, the consideration of study population, using the adequate time for the study, having confidential questionnaires are part of the essentials of conducting a useful study on CVCs and CLABSI’s.
The conclusions and recommendations are drawn from what the authors had from their results. There is the need for continued monitoring and feedback concerning compliance with the set hygiene practices aimed at preventing CLABSIs infections. The infection basics, such as patient and health care providers’ education, should be addressed (Beverly et al., 2018). Public health funding has also been suggested as a recommendation towards the prevention of the infection. Further areas of the study should address different ways of tracking infections, whether they are high at the emergency rooms or the operation rooms. The areas for further research should also focus on strategies aimed at removing barriers in policies and practices.
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