Preventing Central Line-Associated Bloodstream Infection

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Preventing Central Line-Associated Bloodstream Infection

Methods

Study Design

This study was conducted using a quasi-experimental design. The qualitative data derived from the academic literature was used to develop several interventions to be tested. The five studies reviewed in the scope of this research suggest two different approaches to reducing CLABSI among patients: by either providing lecture-based training (Hanson, 2017; Williams, 2015), or practice-based training (Gerolemou et al., 2014). In the scope of this study, we will compare the effectiveness of these two interventions in a clinical setting.

Population

The population for this study was estimated based on the design of the researchers performed by Gerolemou et al. (2014) and Williams (2015). In their respective studies, they utilized 47 participants for practice-based training and 73 nurses for lecture-based training. Equalizing the number of participants for both groups results in N=73+73=146.

Sampling Methods

The study uses a convenience sampling method in order to select nurses willing to participate in the study and possessing the background and skills that fit the inclusion/exclusion criteria. Participants will be randomly split in two (n=73) and assigned to practice-based or lecture-based practice groups. All nurses have to work in a single hospital in order to preserve the integrity of the study, as the patient-per-nurse ratio will be approximately equal. As discovered by Aloush and Alsaraireh (2018), high patient-per-nurse rates correlate with reduced compliance with bloodstream infection prevention guidelines.

Inclusion/Exclusion Criteria

Inclusion criteria: Registered nurses working full-time in the ICU, with at least 1 year of experience. No experience of practical simulation (Gerolemou et al., 2014).
Exclusion criteria: Nurses with less than 1 year of experience (Aloush & Alsaraireh, 2018). Previous experience in practical simulation.
For patients participating in the research, inclusion/exclusion criteria are as follows: adult cardiac ICU patients aged 18 or older, had current inpatient status and had a central line catheter inserted during their hospital stay (Hanson, 2017).

Study Setting

The research must be conducted in a hospital with 504 (+-50) beds for long-term care (Keleekai et al., 2016). The hospital must have a simulation laboratory and support simulation practices as part of its procedural policies (Gerolemou et al., 2014). The study will utilize rooms and training facilities presented in the clinical setting. Two rooms will be used as study halls in order to conduct lectures for the nurses. One additional room will be utilized as a simulation laboratory. The patients will be treated in a standard ICU setting present in the hospital.

Materials

The study will utilize a wide assortment of educational and practical material. Educational material will include current CDC definitions and materials on CLABSI, guidelines on PICC maintenance (Hanson, 2017), overview materials of CVC and PICC, insertion guidelines, methods for CLABSI reduction, methods of monitoring for CLABSI, and comprehensive reviews of new methods and protocols implemented in the scope of this study (Williams, 2015). Additional materials include electronic health record solutions (Quan et al. 2016).

Practical materials would include several Laerdal SimMan mannequins or similar simulation tools, patient monitors, supply carts, handwashing stations, waste receptacles, procedure carts, sterile gowning, gloving, draping, syringes with anesthetic, scalpels, sterile needles and catheters, guide wire, and other necessary surgical materials (Gerolemou et al., 2014). Documentation materials will include informed consent forms, personal information forms, and electronic patient records.

Procedure/Intervention

The intervention will take place between August 2018 and October 2019. It will be conducted in three phases. First, all nurses participating in the study will undergo an assessment period of 1 month (August-September 2018) in the simulation laboratory. It will help identify the levels of current knowledge and standards of practice. The second phase (September-October 2018) will involve theoretical and practical training with the two respective groups. The follow-up observational period of 12 months (October 2018-October 2019), will study the changes in the rates of catheter-related bloodstream infections in the chosen clinical setting.

References

Aloush, S. M., & Alsaraireh, F. A. (2018). Nurses compliance with central line associated blood stream infection prevention guidelines. Saudi Medical Journal, 39(3), 273-279.

Gerolemou, L., Fidellaga, A., Rose, K., Cooper, S., Venturanza, M., Aqeel, A.,& Khouli, H. (2014). Simulation-based training for nurses in sterile techniques during central vein catheterization. American Journal of Critical Care, 23(1), 40-48.

Hanson, D. (2017). Reducing central line-associated bloodstream infection rates in the context of a caring-healing environment. Journal of Infusion Nursing, 40(2), 101-110.

Keleekai, N. L., Schuster, C. A., Murray, C. L., King, M. A., Stahl, B. R., Labrozzi, L. J., & Glover, K. R. (2016). Improving nurses peripheral intravenous catheter insertion knowledge, confidence, and skills using a simulation-based blended learning program. Simulation in healthcare, 11(6), 376-384.

Quan, K. A., Cousins, S. M., Porter, D. D., Obrien, M., Rudkin, S., Lambertson, B.,& Huang, S. S. (2016). Electronic health record solutions to reduce central line-associated bloodstream infections by enhancing documentation of central line insertion practices, line days, and daily line necessity. American Journal of Infection Control, 44(4), 438-443.

Williams, D. W. (2015). Use of a policy-driven education program to reduce central line-associated bloodstream infection rates. Journal of Infusion Nursing, 38(1), 63-68.

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