1 PICOT Statement PICOT Statement Laura Kilmer Grand Canyon University: NRS-490 December 23, 2018 2 PICOT Statement PICOT Capstone Project According to the Centers for Disease Control and Prevention (CDC) there are 80,000 central Line-associated Bloodstream infection (CLABSIs) every year exclusively in Intensive Care Units (ICU). This estimate rises to 250,000 CLABSIs every year when entire hospital values are incorporated (CDC, 2011). CLABSIs have been observed to be the second most fatal type of hospital acquired infection. CLABSIs are a predominant and expensive issue in human services and are a preventable contamination. The effects of Chlorhexidine Gluconate (CHG) bathing on decreasing infection rates of central venous catheter (CVC) has heightened showing healthcare-related infections prompt mortality and restorative expenses. In the United States alone, each year 75,000 individuals with hospital acquired infections die (Zimlichman et al., 2013). The purpose of this paper is to present PICOT statement related to prevention of infection by implementation of daily CHG baths in patients with central lines. PICOT Does Using CHG baths prevent Central line infections performed daily during hospitalization compared to patients that received typical bath daily? Population: Patients with Central lines Intervention: Give CHG wipe bath with proper technique daily during hospitalization Comparison: Patients not receiving CHG baths or receiving them improperly Outcome: Decrease in Central line infections Timeline: 5 weeks Evidence-Based Solution 3 PICOT Statement Evidenced-based interventions can be implemented with a specific end goal to decrease CLABSIs, such as daily CHG baths. Musuuza (2017) noted that “Healthcare associated infections (HAIs) lead to increased morbidity, mortality and medical costs. “In the United States alone, about 722,000 people get a HAI every year and 75,000 people with HAIs die.” There is a substantial need for a daily chlorhexidine bath to be established as an economic and preventative practice to support the innovation’s permanence (Musuuza et al., 2017 p. 1). According to (Musuuza et al., 2017) questions such as • How does a nurse communicate that CHG baths were completed during the shift? • What do you know about the policy for CHG bathing? informs logical components that affect execution and maintainability of the intervention. Nursing Intervention Mandatory daily CHG bathing encounters many nursing practice challenges. Research has demonstrated that chlorhexidine prevents infection, yet there is conflicting evidence on CHG bathing preventing CVC infections better than customary bathing techniques in these articles. Although, these studies provide considerable amounts of evidence supporting obstacles in compliance, decreased CVC rates were also indicated. Musuuza et al., (2017) identifies factors such as • Nurse burn out related to patient load • Delegation • Communication deficiency • Supplies • Patient compliance • Perception of CHG impregnated wipes 4 PICOT Statement • General hygiene of the patient have a direct effect on whether the CHG bath is proven effective. Each of these factors proposed its own set of dilemmas. Although the barriers where widely assessed and documented, “Daily use of CHG in the ICU has been shown to be effective in reducing the rate of MRSA and VRE acquisition and bloodstream infections associated with these organisms” (Lowe et al., 2017 p. 256). Chlorhexidine has been reported to have few negative consequences and showed inconclusive evidence of decreasing CVC infections related to CHG bathing. The CLABSI rates decreased among the neonates receiving CHG baths (Quack et al., 2014). Patient Care All patients with CVC will bath daily utilizing moistened CHG wipes. A few studies have shown an extreme decline in CLABSIs from every day utilization of CHG washing. Lowe et al., (2017) reported that, “Despite daily CHG bathing compliance of 58%, rates of hospital-associated MRSA and VRE were significantly reduced compared with bathing with soap and water” (p. 257). Thus, research supports the nursing care; utilization of CHG showering over soap and water. Health Care Agency This Capstone Project will Utilize BayCare Health System Inpatient hospital. This facility is not for profit center that serves the community. St. Joseph’s Hospital has been a part of the community since 1934. The research will be performed in the Pediatric population of this hospital. Nursing Practice PICOT Statement Being that the CDC creates central line infection guidelines and one of the recommendations outlined is CHG bathing in patients with central lines I think it is safe to say daily chlorhexidine impregnated wipes should be utilized for all patients with central venous access that meet the guidelines of administration. 5 6 PICOT Statement Reference Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining nurses’ perspectives and experiences. BMC Infectious Diseases, 17(1). doi:10.1186/s12879-017-2180-8 Karki, S., & Cheng, A. C. (2012). Review: Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multiresistant organisms: a systematic review. Journal of Hospital Infection, 82, 71– 84. https://doi-org.lopes.idm.oclc.org/10.1016/j.jhin.2012.07.005 Quach, C., Milstone, A. M., Perpête, C., Bonenfant, M., Moore, D. L., & Perreault, T. (2014). Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections. Infection Control & Hospital Epidemiology,35(02), 158-163. doi:10.1086/674862 Zimlichman E, Henderson D, Tamir O, et al. Health care–associated infections: A meta-analysis of costs and financial impact on the us health care system. JAMA Intern Med. 2013;173(22):2039–46.
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