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Use of Chlorhexidine Bath to Reduce Central-Line Associated Bloodline Infections (CLABSI)
The study on the impact of daily use of chlorhexidine bath on the outcomes of ICU adult patients with central-line associated bloodstream infection guided by the PICOT question: In adult patients in Intensive care units (P), does daily use of chlorhexidine bath (I) compared to the use of ordinary soap and water (C), decrease the central-line associated bloodline infections (O), in a period of six months?
An understanding of the effect that chlorhexidine bath can have on improving patients’ outcome is an impact to nursing care and can serve as evidence to nursing practices. Poor nursing practices have adverse effects on patient’s outcomes and results to long hospital stay duration, which is associated with more other risks and complications. Investigation of the best practices on CLABSI, a condition whose outcomes is greatly dependent care is an important thing as it will better the care practices.
The results of the inquiry are in tandem with the proposition of implementation of chlorhexidine bath as a means in washing intravenous ports to control CLABSI. Results of the study undertaken indicate a decline in rates of infections due to the use of chlorhexidine bath are significant evidence for its adoptions. In investigating the outcomes of the impacts of chlorhexidine, some studies were used, all of which gave valid evidence that indicated a positive result in adult CLABSI patients.
From the systematic reviews and other studies, it was reported that the use chlorhexidine bath in the management of infections is one of the most essential intervention. Systematic reviews linked the application of chlorhexidine bath as an approach of minimizing the level of HA-CLABSI as well as association health care and medication costs.
A systematic review (Karki, & Cheng, 2012), realized that use of non-rinse CHG application has a positive impact as it substantially lowers the risk of CLABSI, SSI, and colonization with VRE or MRSA. Another study (Kim et al., 2016), which was conducted to investigate the effect the effects chlorhexidine bathing in CLABSI also gave a similarly positive conclusion. Kim et al. carried out peer reviews and meta-analyses, which indicated that use of chlorhexidine on a daily basis reduced the incidences of CLABSI, MRSA, and VRE to a great extent (2016).
In addition, Kim et al. found out that the extended use of the approach improved patient outcomes. While conducting investigations using the same variables, a randomized controlled study on the effects of chlorhexidine bath interventions hospital-acquired infections, (Wong et al., 2013) gave positive findings linking the two. Wong et al., states that a daily use of washcloths impregnated with chlorhexidine protected patients from acquiring MDROs and central-line associated bloodstream infections.
Many other studies (Cullen et al., 2016; Denny 2016) reviewed gave additional evidence that supported the use of the intervention in reducing chances of the concurrence of hospital-based conditions and other conditions. The meta-analysis study conducted by (Cullen et al., 2016) found out that using 2 % chlorhexidine lowered the incidences of central-line associated bloodline infections. Moreover, by this mediation, this study reports that related costs of care are decreased by 10% as compared when there are no such interventions.
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The research will have positive results in the sense that it will provide pieces of evidence that will be used to trigger changes in health care practices. Findings from this study will be used to disprove poor practices which affect patients’ outcomes. As seen from some of the studies, besides improvement of patient’s outcomes, it is also evident that the intervention can improve the whole healthcare system as some of the unnecessary costs due to complex conditions, and increased hospital stay will be dealt with.
The effect of this intervention will imply that there will be decreased cases of CLABSI, BCC among other conditions. If this intervention is not practiced, then hospital stay duration for patients may be increased and an ultimate increase in the cost of their medication. Generally speaking, without the evidence-based practice, then CLABSI incidences will continue being high as well poor patient outcomes.
Strategy: Implementation and Challenges
The model can be used in the implementation is the Stetler model which is made up of five stages (Stetler et al., 2007; Aarons, Hurlburt, & Horwitz, 2011), all the parts in this model are designed to allow for critical thinking on the issue of implementation. The model is also a vital tool in minimizing errors in practice. Use of Stetler model in executing chlorhexidine bath will involve the following phases which will be crucial as a requirement of the design.
Phase 1 (preparation for implementation of Evidence Based Intervention): The aim of this approach could be sited as use of chlorhexidine bath in patients in various patient care settings with the aim of decreasing the rates of CLABSI. In this stage, activities that will be used in support of this evidence-based practice will involve the systematic review randomized studies, the quasi-experimental intervention study, and the prospective multivariate study. In the preparation stage, factors that have the ability of affecting the implementation process such as nurse commitment are needed for best practice.
Phase two (validation): All the evidence and studies chosen to support evidence will be analyzed individually to confirm their suitability and credibility to use in enhancing the use of disinfection caps in the management of CLABSI. This process will be essential for determining the strength of the evidence and will be used in finding whether or not to use evidence from such sources for the preparation of the evidence-based practice.
Phase Three (Comparative evaluation): From in depth study of the various articles chosen for this research, it was noted that they have a great index of resemblance, considering the contents of PICO question. Though different designs were used, they managed to measure the impact of chlorhexidine bath on the incidences of CLABSI. Moreover, study population addressed was the adults. At this juncture, the possibility of the intervention will be chosen by use of triple ‘r’ Stetler’s concept in which provision of necessary resources, risks and willingness of other stakeholders such as nurses and doctors will be considered before launching on the evidence-based intervention.
Phase Four (Translation): This will involve a process that is written down on how the implementation process of using chlorhexidine bath will be used to promote the control of CLABSI.
Phase Five (Evaluation): The results of the evidence-based practice will be assessed in various ways. In most cases, this will be achieved by records or a realization of a decreased number of CLABSI and associated conditions.
The preferences and values of other persons including nurses and patients may accelerate or hinder the process. It is as indicated in the Stetler’s model of EBP in third phase where r’ r’ r’ concept is applied. The Evidence-based practice will not be achieved if the resources (R). Also, if other stakeholders are not ready(R) to adopt the approach, then it will not be easy for it to take root.
Lack of enthusiasm from both nurses and patients may pose as a challenge to the project in that clinicians are required to aid in executing it, so that when they object, they will adhere to their standard practice. Some patients have autonomy rights that prompt them to decline some forms of medical procedures. Therefore, the best way of overcoming implementation challenges will include convincing other healthcare workers and ensure that the practice is well funded and supported by stakeholders.
This research entails collection of evidence that will be used to guide practices in nursing and healthcare as a whole. It focuses on investigating the impact of using chlorhexidine baths to reduce incidences central-line associated bloodstream infections and others conditions that are hospital-based. The project examines different types of researches, be it single-quantitative researches, systematic reviews, meta-analyses and other types of evidence.
To complete this project, research will be limited to the PICOT research question: In adult patients in Intensive care units (P), does daily use of chlorhexidine bath (I) compared to the use of ordinary soap and water (C), decrease the central-line associated bloodline infections (O), in a period of six months?.
Others studies carried on CLABSI, which will not address all these components will not be used as evidence to validate or disprove the intended intervention. Evidence will be gathered from studies that involve adult patients under intensive care or other high risks levels of care. In carrying out this inquiry, outcomes will be compared against that of patients who will not be under intervention programs.
Carrying out this survey is an important thing to healthcare practices in the sense that it will collect enough evidence that will be used to guide care practices so that there is an ultimate improvement in patient outcomes. Further, this research intends to find valid information that will be used to reduce the standard practices such as the use of water and soap, which have proved hurtful to patients’ outcomes.
Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4-23. Retrieved from http://link.springer.com/article/10.1007/s10488-010-0327-7.
Climo, M. W., Yokoe, D. S., Warren, D. K., Perl, T. M., Bolon, M., Herwaldt, L. A., & … Wong, E. S. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. The New England Journal of Medicine, 368(6), 533-542. doi:10.1056/NEJMoa1113849
Denny, J. (2016). Chlorhexidine Bathing Effects on Health-Care-Associated Infections. Biological Research for Nursing.
Karki, S., & Cheng, A. C. (2012). The impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. The Journal of Hospital Infection, 82(2), 71-84. doi:10.1016/j.jhin.2012.07.005
Kim, H. Y., Lee, W. K., Na, S., Roh, Y. H., Shin, C. S., & Kim, J. (2016). The effects of chlorhexidine gluconate bathing on health care-associated infection in intensive care units: A meta-analysis. Journal of Critical Care, 32126-137. doi:10.1016/j.jcrc.2015.11.011.
Shah, H. N., Schwartz, J. L., Luna, G., & Cullen, D. L. (2016). Bathing With 2% Chlorhexidine Gluconate: Evidence and Costs Associated With Central Line-Associated Bloodstream Infections. Critical Care Nursing Quarterly, 39(1), 42-50. doi:10.1097/CNQ.0000000000000096
Stetler, C. B., Ritchie, J., Rycroft-Malone, J., Schultz, A., & Charns, M. (2007). Improving the quality of care through routine, successful implementation of evidence-based practice at the bedside: an organizational case study protocol using the Pettigrew and Whipp model of strategic change. Implementation Science, 2(1), 1. Retrieved from https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-2-3.
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