Abstract
In today's world, there are hundreds of developments that are taking place in medicine and nursing. These advances are made possible through thorough research and verifications using clinical projects. The steps in propelling forward the field of medicine are made upon identification of an individual problem that gives researchers a basis for their research, or rather a problem statement. One of the problems that have been identified is the CLABSI (Central Line Associated Blood Stream Infections). Many patients suffer severe infections that arise during treatment of an initial infection. Most of these infections, especially when not handled appropriately lead to grave consequences for the patient, and sometimes create an even bigger problem.
Carelessness and failure of proper service delivery by doctors, nurses and other hospital caregivers are the primary factors attributed to Hospital Associated Infections (HAIs). However, patients also contribute to themselves and their fellow colleagues having HAIs in a significant way. The HAIs are absent during admission of a patient but in the course of his stay in the hospital, he acquires it and might even cause manifestations after being discharged. It is through proper hygiene standards, appropriate legislation, following instructions carefully, proper high-quality training of hospital staff and general responsibility on all parties that the complete eradication of HAIs can be made possible. For instance, the establishment of the national safety goals of patients has resulted in a considerable reduction in the hospital associated infections. A detailed clinical project concerning the best approaches to curbing CLABSIs has been used in this paper to show the essence of clinical projects in medical and nursing developments.
Keywords: HAI, catheters, caregivers, HAI, Joint commission, CLABSI.
Introduction to healthcare-associated infections
All hospitals, whether private or public, have in the recent past categorized patient safety as a significant issue of concern. The fact that patients can go for medication in a medical institution and come out of it in a worse state than they left it have made patients to be more sensitive to the kind of service they receive in the hospital. According to the Joint Commission, safe patient care can be instilled in different hospitals by reducing HAIs. Research has it that more than half a million cases of HAIs are reported on an annual basis. In 2011, for example, there was a record of 722,000 people suffering from HAIs. This number is too large to ignore. In the ICUs, there are not as many cases of HAI as in the general inpatient and outpatient records. This is a clear picture that it is as a result of staff reluctance that most HAIs occur (since in ICU doctors and nurses have to be there in the larger part of the healing period, and they provide the proper health care due to proximity to patients).
Normally, HAIs are so dangerous that a considerable fraction of the patients has to end up dying as a result of the same. HAIs have grave consequences in the cost of healing diseases. This fact is because the doctor is probably confused and unsure of the illness due to lack of constant manifestation, and inability to diagnose the said infection. Costs are added up to the initial infection, and they lead to deformities in the healthcare system owing to the fact that more attention (even financial) will have to be concentrated on HIAs rather than other problematic medical menaces. Some of the common HIAs in the US include pneumonia, GIT illnesses, primary bloodstream infections, UTIs and infections during minor and major surgical operations. According to Magill et al. (2014), the total number of pneumonia resulting as an HAI in a statistics carried out in 2011 was found to be around 157,500 cases. Additionally, gastrointestinal illness was reported in 123,100 cases and Urinary tract infections were observed in 93,300 cases while primary bloodstream infections accounted for 71,900 infection cases. In an effort to prevent HAIs, the Joint Commission (the body that accredits medical institutions in the US) has developed strict strategies by imposing many patient- friendly rules that help keep all medical practitioners on toes. In this paper, the best healthcare practices to improve healthcare have been recommended.
Prevention of Central line-associated bloodstream infections (CLABSI):
Many preventive strategies can be applied and are being implemented on CLBSI. Some of these are patient based, and others lead to changes in the hospital caregivers.
Establishing national patient safety goals.
Organizations should position the prevention of CLABSI as an essential institutional goal as well as collective patient safety goal as this has been found to be associated with reductions in CLABSI (Saint et al., 2014). To identify the problems of patients and look for a basis for their improvement, the national patient safety goals were established. These goals ensure that medical practitioners give the properly required care to patients, and the probability of HAIs is reduced through these preventive strategies. First is ensuring proper patient identification to ensure the right medication gets to the right persons. Secondly, the communication among staff, especially the dependent ones, should be timely and accurate.
The other non-ignorable patient safety goal is the proper uptake of medicine by patients. It is upon the nurse/ doctor/ caregiver to ensure that they have all information regarding the previous medicine by patients, convince them of the importance of being honest in medicine therapy, and ensure clarity of instructions during drug administration. Also, prevention of outright infection while in the hospital must be ensured. The patient must be made to observe proper hygiene since many diseases could be attributed to unhygienic practices. The patient should be given food in clean utensils and by clean people. Patients with special diet must also receive proper instructions from the nurse regarding snacks and drinks brought by visitors. For patients in ICU and theater, a lot of care must be taken when performing surgical operations and the medical equipment used should always be checked and their workability verified often.
Ensuring medical practitioners set control of CLABSI as one of their key goals.
Most companies and organization managers will do anything that will help them achieve their key aim. Medical institutions should also be always working hard to ensure they achieve their goal of eradicating CLABSI in their institution. This mentality of goal achievement ensures positive involvement of all staff and also patients, sometimes in the eradication of HAIs.
Proper use of catheters
Catheters are small thin tubes that are inserted into the body of patients during surgical procedures or for other purposes in disease healing. Patients should not share catheters or other sensitive medical equipment that can be used to transmit infections, even if there is a deficiency. Catheters are highly prone to microbial attack and should often be disinfected. The point of insertion of the catheter should also be taken good care of. I.e. by keeping it clean and not pierced. It is important for clinicians to make sure there is appropriate catheter use before insertion. Some strategies that might work to ascertain the appropriateness of an indication for catheter use is collaborative, bladder scanners, catheter aide memoire or stop orders or nurse-commenced termination.
Recurrent use of these strategies in Michigan hospitals was linked with a 25% decrease in the catheter-associated infections compared to only 6% observed in the hospitals outside Michigan where the prevention methods were not used (Saint et al., 2013). Schulman and colleagues assessed the effectiveness of insertion and maintenance bundles among the 18 regional referral neonatal intensive care divisions in New York. There was a 67% decrease in CLABSI from 6.4 CLABSIs for every 1000 central-line days up to 2.1 CLABSIs for every 1000 central line CLABSIs (Schulman et al., 2011).
Nurse- patient ratio
One of the reasons that patients do not receive proper care in different places is due to the small number of nurses taking care of them. Normally, the lowest nurse to patient ratio should not be more than 7: 1 (Zimlichmany et al.2013) This small ratio helps in close monitoring of patients at an individual level. Unfortunately, there are few nurses and they have to cover more than five times as much the wok that they cover usually. Since they are not robots, at one time they get tired and perform lower quality jobs than when in the right patient population. Government bodies and educational institutions should team up and provide a platform through which more nurses are welcome into the nursing sector.
Other preventive bundles
The bundle consisted of five evidence-based practices, including hand hygiene, the usage of full barrier precautions, not placing a line at femoral site, site cleansing with chlorhexidine, and removal of unnecessary lines. The intervention reduced CLABSI in the intervention group by 81% compared the 69% reduction in the intervention group (Marsteller et al., 2012).
The effectiveness of two prevention bundles among pediatric patients was once compares. On one end, they had two central line care bundles (that is the insertion and maintenance bundles), while on the other, they had two additional interventions; chlorhexidine scrub as well as chlorahexidine-impregnated sponges. They found that CLABSI rate reduced from 5.2 cases per 1000 line days to 2.3 for every 1000 line days. They did not see any significant difference in the reduction of infections between the standard bundle and the bundle with the additional practices (Miller et al., 2011). The success of the use of intervention bundles is highly dependent on the level of training of all the cases involved. Patients and medical practitioners should all be trained separately using different methods, including face to face training, conferences and seminars.
Discussions
Prevention of CLABSIs should begin from the point when considerations are being made for catheterizations and proceed throughout the maintenance. An example of a typical practical catheterization is urinary catheterization. In this, the urinary bladders are defective and one cannot urinate. A catheter is therefore inserted into the body so as to drain away urine before a surgical operation or any healing is performed. Before such an operations, many considerations should be made, including the possibility of performing a simpler operation to serve the place of a catheter. If a catheter has to be used, there have to be considerations on the most appropriate or most harmless opening through which it will be inserted. Cardiac catheterization is used to check how the heart is functioning. The heart is an incredibly sensitive organ and tampering with it can have grave consequences on your health. Therefore, cardiac catheterization should be done if all the other possible replacement options have been tried unsuccessfully.
In the recent past, it has been noted that catheters are being placed in people for unnecessary reasons. Problems that can be easily curbed using more appropriate ways should not be directed to catheterization. The aged people especially those above sixty five years have been exposed to a lot of catheterization because of very simple reasons. A blockage in the urinary tract could be even temporal but the doctor might insist on catheterization, even when more appropriate chemotherapy with less side effects can serve the purpose.
Evidence-based bundles are known to reduce rates of CLABSIs in hospitals. For more effective management of CLABSIs, a checklist should accompany the use of prevention bundles, for monitoring the implementation of the bundle to ensure that all the practices are observed (Saint et al., 2011; Schulman et al., 2011). Most of the training and workshops offered help the trainees to use preventive- bundles appropriately. It is through these training sessions that nurses get new information about CLABSIs and know about new strategies they set up in the control of CLABSIs. However, each state has its prevention bundles that must not be necessarily applicable to other regions.
Conclusion & Recommendations
Health care organizations should cultivate within their staff the idea that prevention of CLABSIs is an institutional goal that all should work towards. There is a need for complete unity among the staff of health institutions in the fight against all CLABSIs. The members of staff i.e. nurses and other medical practitioners should take it upon themselves that the goals of the organization towards eradication of CLABSIs as their personal goal.
There is need to adopt a formalized, standardized CLABSI prevention bundle. Since fighting against CLABSIs reflects almost directly on the output (in patients), it should be made the principal purpose of all medical institutions. Among the many CLABSI prevention bundles, one of these bundles should be specialized in by an organization, formalized and made a norm by every member of the organization.
This means that clinical researchers need to do more research to develop a standardized CLABSI prevention and reduction bundle that may be adopted by hospitals across the country.
Before a standardized CLABSI prevention bundle is developed, hospitals should develop their evidence-based bundles to help in the prevention of CLABSIs.
Hospitals should organize educational and training workshops for the use of CLABSI prevention bundles. The training and educational workshops (including professional) training should be organized by varying health organizations, for it is due to the removal of ignorance that people become more open minded in dealing with problems.
The execution of all these recommendations and other clinical projects will undoubtedly improve nursing practices in our health institutions.
References
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