Running Head: PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS
PICOT Question Central Line-Associated Infections
Courtney Pribonic
Kaplan University
3/5/2017
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PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS
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Introduction
Patients hospitalized in intensive care units (ICU) sometimes suffer from central lineassociated infections (CLAI). These illnesses are mostly caused by microorganisms which act
on the central venous catheters. As a way of eliminating this adverse effect, evidence based
care has implemented various intervention techniques most of which are grouped as a bundle
that comprises of various individual activities. This paper seeks to identify a suitable
evidence-based care intervention for preventing CLAI among adult patients hospitalized in
ICUs.
PICOT Question
In formulating and developing this research, a systematic review was mainly done on
Cochrane database on studies tackling care and maintenance of the CVC published between
2010 and 2017, Scopus, PubMed, and the web of science. This was founded on the PICOT
strategy question;
“What are the best CLAI-related preventive and intervention measures implemented
in adult patients who are hospitalized in an ICU?”
The outcomes of the research after analysis presented bundles which included
elements such as maximal barrier precautions and hand hygiene. Essentially, these were in
the form of multidimensional strategies and programs such as impregnated bandages and
catheters as well as the commitment of the staff to keeping facilities infection free (JC et. al.,
2011).
Treatment of critically ill patients depends on the Central Venous Catheters (CVC) by
a significant percentage. For instance, in intensive care units, techniques such as the use of
invasive devices and diagnostic procedures are utilized to trigger particular patient
PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS
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complications like the health associated infections (HAI). However, there is a significant
challenge in the ICU regarding prevention and control of nosocomial infections as a result of
microorganisms (Blot, et.al, 2014). These organisms are usually multiresistant and create the
need to use broad spectrum antibiotics. Therefore, the invasive procedures used in ICU to
some extent complicate the control of infections. In this regard, the central line-associated
infection (CLAI) is the major complication that incurs to the central venous catheters.
The current intervention procedures for CLAI are in the form of bundles which are
used wholesomely. This means that each package is implemented by carrying all the activities
included in it and not just selecting a few. One of the commonly utilized technique is the care
package. This bundle contains five elements which include; clean skin preparation with
chlorhexidine, hand hygiene, avoidance of femoral sites, elimination of unnecessary catheters,
and sterile barrier precautions during CVC. As per JC et al. (2011) methodology, the bundle
was implemented along with a strong safety culture, education, and organizational strategies.
Moreover, during implementation, information was collected for calculating the rates of
infection and monitoring the level of adherence to hygiene. The results obtained a 2.d level of
evidence.
Another intervention is the quality technique which comprises of two different
bundles. This particular response also has a strong focus on hand hygiene, and the two bundles
included are the CVC insertion and CVC maintenance (Blot, et.al, 2014). CVC insertion has
these elements; femoral vein avoidance, skin preparation with chlorhexidine, and maximal
sterile barrier. On the other hand, the CVC maintenance bundle comprises of daily checks to
ascertain the needs of CVC insertion, connection checking and assessment without the use of
needles, and suitable bandage replacement techniques. Blot, et.al (2014) while implementing
these interventions, he coupled the elements with educational programs which were
PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS
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disseminated via teaching videos, conferences, and surveillance processes. The evidence level
attained was 2.d.
The study by the Institute for Healthcare Improvement (IHI) as stated by Perin et.al
(2016) focused on the significance of implementing all significant elements that are included
in all bundles. In this regard, the study proposed that a list is used to monitor and evaluate the
applicability of the elements in caring for ICU adult patients. From the study’s finding, it was
found that when compliance and adherence to efficient implementation of all items of a bundle
is high, the rates of infection within adult patients in ICU reduces significantly. The EBP level
of evidence of this research was 3e. This technique is similar to the use of multidimensional
approach in preventing CLAI in ICU patients. This includes combining elements from various
bundles and applying them at once (Berenholtz, et.al, 2014). In practice, the elements
considered most includes combining a bundle of intervention, outcome surveillance,
education, infection and feedback rates, performance feedback, and process surveillance.
Their level of evidence is often 2.c.
This study shows that different types of care bundles can be used as EPB Interventions
for Prevention of central line-associated infections in ICU/CCU. However, both of them
revolve around having high levels of hygiene. This means that microorganisms responsible
for causing various central line-associated infections in ICU such as complications of the
central venous catheters are propagated via unhygienic practice (Latif, et.al, 2015). However,
it is evidence that the care bundle comprises of elements which are vital for preventing these
infections. However, the elements on their own are not highly efficient, and they need to be
coupled with strong safety culture, education, enabling organizational strategies, strong staff
engagement, and surveillance processes.
PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS
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Conclusion
The three studies made offer ways to prevent central line-associated infections among
patients hospitalized in ICUs. Two of the studies showed that implementation of good care
practice leads to a reduction in rates of central line-associated infections in ICU/CCU. In this
regard, the best care measures come from the bundle which includes CVC maintenance and
insertion and vital strategies such as engagement and education of the staff, surveillance
process, and safety culture. These are features associated with the care bundle. Therefore, it
is evidence that the care bundle which comprises insertion cleaning with chlorhexidine,
femoral site avoidance, strict hand hygiene, and catheter removal as soon as it becomes
unnecessary is the best intervention for preventing CLAI among adult patients hospitalized in
intensive care units.
References
Berenholtz, S. M., Lubomski, L. H., Weeks, K., Goeschel, C. A., Marsteller, J. A., Pham, J.
C., ... & Yang, T. (2014). Eliminating central line–associated bloodstream infections:
a national patient safety imperative. Infection Control & Hospital Epidemiology,
35(01), 56-62.
Blot, K., Bergs, J., Vogelaers, D., Blot, S., & Vandijck, D. (2014). Prevention of central line–
associated bloodstream infections through quality improvement interventions: a
systematic review and meta-analysis. Clinical Infectious Diseases, ciu239.
JC, O., GL, S., N, S., O’Horo, J., Silva, G., & Safdar, N. (2011, January 1). Anti‐infective
locks for the treatment of central line‐associated bloodstream infection: A systematic
review and meta‐analysis (Provisional abstract). Retrieved March 6, 2017, from
http://onlinelibrary.wiley.com/o/cochrane/cldare/articles/DARE12011007506/frame.html
PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS
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Latif, A., Kelly, B., Edrees, H., Kent, P. S., Weaver, S. J., Jovanovic, B., ... & Berenholtz, S.
M. (2015). Implementing a Multifaceted Intervention to Decrease Central Line–
Associated Bloodstream Infections in SEHA (Abu Dhabi Health Services Company)
Intensive Care Units: The Abu Dhabi Experience. infection control & hospital
epidemiology, 36(07), 816-822.
Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016). Evidence-based
measures to prevent central line-associated bloodstream infections: a systematic
review. Revista Latino-Americana de Enfermagem, 24.
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Initial post
timeliness
Inappropriate
Below Average
Average
Above Average
1
2
3
4
Provides an
initial post on or
after Sunday.
Score
Weight
Final
Score
N/A
N/A
Provides an initial post by
Saturday.
15%
0,00
Does not post
responses to
others.
Posts one comment
per Discussion topic.
Posts 2 comments per
Discussion topic on
separate days. At least
one comment includes
a citation.
Posts more than 2 comments
per Discussion topic on
separate days (resulting in
total participation on three
different days throughout the
discussion). At least two
comments include a citation.
10%
0,00
N/A
Participates, but
does not post
anything that
encourages others to
respond to the
posting.
Attempts to motivate
the group discussion.
Frequently attempts to
motivate the group
discussion.
5%
0,00
Submission does
not relate to the
topic.
Answers some
question/topics with
some clearly stated
opinions. Supports
post using text only.
Answers all questions
with opinions and ideas
that are stated clearly.
Supports post using
text and at least two
peer-reviewed sources.
Answers all questions with
opinions/ideas creatively and
clearly. Supports post using
several outside, peerreviewed sources.
35%
0,00
APA Format
Major errors or
no APA format
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Minor errors with
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format.
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10%
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10%
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Length
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N/A
The initial post is at least 200
words. This does not include
repeating the DB question or
the citations and references.
15%
0,00
100%
0,00
0
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Additional
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Content Quality
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Final Score
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4
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enter scores (between 0 and 4) into yellow
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Low
Rubric Score
High
3,5
4,0
2,5
3,49
1,7
2,49
0,0
1,00
Grade points
Low
0
0
0
0
Percentage
High
0
0
0
0
Low
90%
80%
70%
0
High
100%
89,99%
79,99%
69,99%
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