Nosocomial Bloodstream Infections: Interventions

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Introduction: Significance of Innovative Interventions for Controlling Nosocomial Infections

Preventing hospital-acquired infections is a crucial step toward facilitating high-quality healthcare services and increasing recovery rates among patients (Centers for Disease Control and Prevention, 2016). Typically defined as the infections that have been acquired in the course of staying in a healthcare or nursing facility, nosocomial infections pose a considerable threat to patients’ well-being since they delay the recovery process and may lead to a number of complications, thus, jeopardizing the patient’s chances to recover successfully. The design of a flexible prevention strategy that can be used to isolate the patients from the factors contributing to nosocomial infections development, as well as increasing awareness rates on the subject matter, is bound to lead to numerous improvements.

Considering the issue closer, one must admit that the current approaches toward enhancing the CLABSI management process, while being admittedly sensible, lack a deep insight about the external factors that contribute to the problem’s development. For instance, the fact that the current frameworks tend to embrace only one area at a time needs to be brought up as a primary stumbling block. Although addressing the issue on the level of inventory management is crucial for the control of the procedures and the facilitation of patients’ safety, the framework that will help prevent and handle the CLABSI issues, as well as raise awareness about the subject matter among nurses and patients alike, needs to focus on not only the central line implantation procedure but also the management of the information available to the nursing staff and the patients, the supervision of the latter, the process of collecting feedback from the customers and addressing the emerging problems in a timely manner, etc.

Innovative Interventions for Managing Central-line Associated Bloodstream Infections: Description

Supporting the National Initiative as the Primary Measure to Be Taken

Much to its credit, the Agency for Healthcare Research and Quality (AHRQ) has suggested the national initiative that is bound to reinvent the very concept of CLABSI-related issues management. The tools designed by the organization are bound to serve as the premises for reducing the rates of CLABSI development dramatically. Designed as the measures to address the problem on a national level, the toolkit created by AHRQ can be applied easily to the target nursing setting.

The fact sheets, the inventory, and the checklists designed by the organization serve a rather simple purpose; they can be used to raise awareness among the nursing personnel, as well as make sure that the specific guidelines designed for CLABSI prevention are followed to a T. Apart from providing basic guidelines about hygiene and the ways of maintaining it, the initiative strives to reduce the threats associated with the mismanagement of the available nursing resources. Furthermore, the time used to carry out the necessary procedures can be shrunk to a considerable extent, therefore, reducing the patients’ exposure to the threat of CLABSI contraction (Agency for Healthcare Research and Quality, 2014). By arranging the inventory located in the central line cart, a nurse will be able to manage their time and resources in a more sensible way (Lin et al., 2012).

Central Line Cart Inventory (Agency for Healthcare Research and Quality, 2014, para. 3)

Once the National Initiative receives enough support, it can become the foundation for reinventing the current concept of CLABSI management, as well as handling the CLABSI-associated issues. For instance, the program will help build awareness among not only nurses but also patients, which is critical for the further improvements. Indeed, because of the target audience’s inability to detect the issues that they develop shortly after CLABSI is implanted into their system, the problems associated with the central line are attended to at a very late stage. Thus, the chances of success are very few. Raising awareness among patients, therefore, will help improve the outcomes and increase the chances for recovery.

Using a Multifaceted Intervention Involving Enhancement of Safety, Cooperation, and Communication among Nurses

It should also be borne in mind that whether the patient develops a CLABSI problem in the ICU issue hinges on the quality of communication and congruence in the actions of the nurses (Marsteller et al., 2012). Therefore, the promotion of efficient information management practices, as well as a heavier emphasis on communication quality, must be brought up as a possible framework for building a nursing initiative. As a recent study indicates, the promotion of the associated principles in the environment of the ICU causes an immediate drop in the frequency of the CLABSI issues development (Marsteller et al., 2012). The multifaceted intervention in question implied creating a set of very rigid hygiene rules in the nursing setting.

For instance, the members of the facility were instructed to wash hands before placing the line, follow the full-barrier principles (e.g., wearing a gown, a mask, etc.), never place the line at the femoral cite, including chlorhexidine into the list of cleaning tools, and remove any lines that are not necessary for maintaining the patient’s well-being (Marsteller et al., 2012, p. 2936). In fact, the idea of incorporating the data retrieved from several units to cater to the needs of the patients has proven to be rather successful in some of the recent studies – according to AHRQ, the average CLABSI per unit changed from 3.12% to 0.93% to 0.72% to 0.65% to 0.64% after the introduction of the framework into the target setting (Agency for Healthcare Research and Quality, 2011).

Information management, in its turn, may be improved by incorporating IT technologies to improve the hand-off communication. Seeing that the study showed an unbelievable 81% reduction in the number of CLABSI issues among the patients, it must be considered a crucial addition to the intervention framework, even though the principles on which it lies are rather basic (Marsteller et al., 2012).

Promoting a Patient-Centered Approach by Using Simulations to Shed Light on the Related Issues

Sadly enough, the tools listed above are unlikely to have any effect on the current situation unless nurses have an opportunity to develop empathy toward the target audience. Once the members of the ICU services realize what patients are forced to experience, they will learn to empathize with the people that are subjected to the threats of CLABSI development. For these purposes, the development of Emotional-Intelligence-related (EI) skills among nurses should be considered (Kaur, Sambasivan, & Kumar, 2015). According to the Centers for Disease Control and Prevention (2016), the focus on the patient-centered strategies allowed for a 50% drop in the CLABSI rates among the U.S. population. Furthermore, between 2013 and 2014, a 9% drop in CLABSI was documented (Centers for Disease Control and Prevention, 2016).

Along with the enhancement of EI strategies in the identified environment, simulations must be viewed as the primary tool for helping nurses train the required skills and become proficient in managing the process of catheter placement, as well as the further observation of the patient. A recent study pointed to the fact that the use of simulations had contributed to a rapid drop in the number of readmissions in a local hospital (Liebrecht & Lieb, 2016). Furthermore, the application of simulations can be considered a foot forward in developing the appropriate risk management strategies.

Indeed, the framework of simulations allows taking an array of possible scenarios into consideration, therefore, providing nurses with the essential information about the actions that they need to take in case of specific emergencies. Furthermore, the adoption of simulations as the primary means of training the staff’s abilities to cater to the needs of patients will permit designing the strategy that can be used as a general guidance for addressing emergency issues. Thus, even if the measures to be taken in a specific scenario have not been identified in the course of training, a nurse will be able to determine them on their own by relying on the values and the code of the nursing facility.

Conclusion: Addressing the Issue of Central-line Associated Bloodstream Infections as the First Step Toward Quality Improvement

Preventing the development of nosocomial infections, in general, and the ones that are linked to the CLABSI-associated processes, in particular, requires that not only the actual procedure but also the management of the available information should be improved significantly. Apart from the program that will help instruct nurses on the means of implanting the central line and provide direct instructions about increasing efficiency in the workplace, i.e., reducing the time taken and carrying out the crucial steps, the tools for efficient information transfer and processing will have to be included as well. Although seemingly insignificant, the reception of the necessary data and its further usage in carrying out the CLABSI process defines the success thereof to a considerable extent.

The use of the multifaceted framework as the means of addressing the subject matter should also be deemed as one of the most successful ideas. As stressed above, it is imperative to make sure that the external and the internal factors that affect patients’ well-being should be taken into account, which is only possible once the multifaceted approach is used. Pointing to the way in which different elements of the nursing environment interact, the framework serves as the foundation for determining every possible factor that may pose a threat to the patient’s well-being in the course of carrying out the CLABSI-related procedures.

Finally, the incorporation of EI-based strategies, as well as the active use of simulations for training purposes must not be overlooked as a crucial step in the progress of a nurse. Seeing that not all patients are capable of determining the actual source of their health concern and put it into the terms that will help a nurse diagnose the problem, it is crucial to be able to read the patients’ emotions and identify the on-coming issue within the smallest amount of time possible. As a result, the infection can be attended as fast as possible until it grows out of proportions and becomes a significant threat to the patient’s health. Furthermore, the approach also sheds light on the importance of developing an emotional connection between the patient and the nurse, thus, creating prerequisites for the latter to develop empathy toward the customer.

References

Agency for Healthcare Research and Quality. (2011). Eliminating CLABSI: A national patient safety imperative. A progress report on the national “On the CUSP: Stop BSI Project.” Web.

Agency for Healthcare Research and Quality. (2014).Appendix 4: Central line cart inventory. Web.

Centers for Disease Control and Prevention. (2016). Healthcare-associated Infections (HAI) progress report. Web.

Kaur, K., Sambasivan, M., & Kumar, N. (2015). Significance of Spiritual (SI) and Emotional Intelligence (EI) on the caring behavior of nurses. Journal of Community & Public Health Nursing, 1(101), 1-3. Web.

Liebrecht, C. M., & Lieb, M. C. (2016). Incorporating quality and safety values into a CLABSI simulation experience. Nursing Forum: An Independent Voice for Nursing, 1(1), 1-6. Web.

Lin, D. M., Weeks, K., Bauer, L., Combes, J. R., George, C. T., Goeschel, C. A.,… & Pham, J. C. (2012). Eradicating central line-associated bloodstream infections statewide: the Hawaii experience. American Journal of Medical Quality, 27(2), 124-129. Web.

Marsteller, J. A., Sexton, J. B., Hsu, Y. J., Hsiao, C. J., Holzmueller, C. G., Pronovost, P. J., & Thompson, D. A. (2012). A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units. Critical Care Medicine, 40(11), 2933-2939. Web.

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