Evidence Based Practice for Patients with CRBSIs
EBP PROJECT PAPER 1
EvidenceBased Practice for Patients with CRBSIs
EvidenceBased Practice for Patients with CRBSIs
Human beings will encounter a broad range ofinfections, disease or conditions in the long course of their lives.At times, to treat or counter such conditions, a central venouscatheter might be applicable. A number of medical reasons might alsonecessitate the need for using a CVC. A central venous catheter is aflexible thin tube that is mostly applicable to providing patientswith medication, food, water, nutrients, blood products or anynecessary fluids. The tube is normally inserted in the chest, neck orarm. It is threaded through a vein until it reaches a large vein nearthe heart. Despite the many medical reasons behind the usage of CVCs,some complications such as CRBSIs may arise[ CITATION Gah14 l 1033 ].CRBSIs represents the Central-venous-catheter-related bloodstreaminfections, which indicates a bacterial presence arising from thecatheter. However, depending on the handling of patients relying onCVCs, the infections may be monitored. This paper will consider theCVCs patients, pinpoint some necessary mechanisms, which can reduceor eliminate the CRBSIs, and highlight how the selected techniqueswill reduce the time needed before the patient stops relying on thesemedical tools.
ResearchQuestion: In patients withCRBSIs (P),proper catheter care and elimination of risk factors (I),for inpatient and outpatient who will be exposed to full or partialinterventions mechanisms respectively (C),will lead to a quicker removal of the catheter, faster patients’recovery and a reduced prevalence rate or complete elimination ofCRBSIs.
Medical scholars associate CRBSIs with severalcomplications. Most of these infections will have an adverse effecton the patients’ health. Risk factors make it easy for thesecomplications to arise[ CITATION Bec16 l 1033 ].The risk factors for CRBSIs are inclusive of an existing disease, themethod applied to insert the catheter, the region where the CVC isinserted, the objective of inserting the catheter, and the durationof the catheter in the body. Administering parental nutrition viacatheter also increase the risk for infection. Other major riskfactors are inclusive of poor hygiene, poor transparent dressing, andeven contaminations, which would support bacterial colonialization.
I serve as a nurse and considering some of theaspects of my workplace environment I would say that some of theidentified risks factors do exist. Most of the patients we treat areold and normally require hemo or peritoneal dialysis. The dialysis isone of the risk factors since we have to use a catheter to administermedication and necessary fluids to patients[ CITATION Mur14 l 1033 ].We serve a high number of patients meaning that at times the dialysisequipment is inadequate so has to be reused.
The other risk of contagious contamination thatcould support bacterial colonization is the fact that despite themany patients we serve, there are only two exit/entry pathways.Considering that we are located on the third floor, it mean thatventilation is not as expected, thus we have to rely on fans as amechanism of cleansing air. This means that the risk of a bacterialcolonization is high. Since most of the patients rely on wheelchairsor need ambulating assistance, it means there are many interpersonalinteractions. In the case of a contagious infection arises, infectingothers would be fast. Lack of proper handwashing mechanisms in thisfacility also puts everyone at the risk of spreading any infection.Most of the infections are bacterial, viral, parasitic or fungal.
Most of the inventions that we will input inplace will rely on directly dealing with the risk factors. This, inturn, will lower the risk of contracting the infections or reduce thetime that patients spend with a CVC. We will present a formal requestto the ministry of health to have the number of dialysis equipmentallocated to this facility increased. We will invest in antibioticsand lock therapy, which will sterilize the equipment, while at thesame time counter some of the existing CRBSI infections[ CITATION Van15 l 1033 ].The lock therapy will entail adding an extremely concentratedsolution containing important antibiotics, into the intravascularlumen. We will also petition for implementation of an escalator,which will add more entry/exit pathways into the building whileupgrading the current ventilation systems.
We will also ensure that physicians administerproper care via advanced catheter insertion and maintenance methods,and adequate hygienic measures such as handwashing. Regular Catheterflushing is one of maintenance methods that we will apply to preventline blockage[ CITATION Zak16 l 1033 ].Considering the high number of interpersonal interactions, we willimplement policies to enforce the wearing of one-time-use, butsterile materials such as gowns, gloves, and masks to prevent crossinfection. The nurse and other caregivers will be endowed with theresponsibilities of performing a regular check on patients with CVCs.This will enable them to identify shits and kinks to forrepositioning or replacements of catheters if the need arises.
We will use the intervention mechanism on avarying scale. This means that we will apply the techniques eitherpartially or fully. The administration of these techniques willmostly depend on the patients` category i.e. whether inpatient oroutpatient. The inpatients will receive full intervention mechanismswhile the outpatients will only receive partial mediations. Some ofthe patients will only receive advanced care such as regular catheterchecks while other will receive the antilock therapy. If the patientsstart improving, the care providers will eventually remove thecatheters but continue providing medical assistance until fullrecovery.
After inputting the necessary interventionmechanisms, we will except see several changes, which will determinethe success or failure of our techniques. One of the expectations isthat the time patient spends with catheters will significantly reducethus reflecting a quicker recovery period. We also expect the numberof cross infections to reduce as the new ventilation system will takecare of that. The prevalence of CRBSIs should go down since it isimpossible to eliminate it.
Bech, L. F.-J. (2016). Environmental Risk Factors for Developing Catheter-Related Bloodstream Infection in Home Parenteral Nutrition Patients: A 6-Year Follow-up Study. Journal of Parenteral and Enteral Nutrition, 40( 7), 989-994.
Gahlot, R. C. (2014). Catheter-related bloodstream infections. International Journal Of Critical Illness And Injury Science, 4(2), 162.
Murea, M. K. (2014). Risk of catheter-related bloodstream infection in elderly patients on hemodialysis. Clinical Journal of the American Society of Nephrology, 9(4), 764-770.
Vanzo, C. A. (2015). Antibiotic-Lock Therapy in Pediatric Oncology Patients. Journal of Pediatric Infectious Diseases, 10(02), 039-044.
Zakhour, R. A.-M. (2016). Catheter-related infections in patients with haematological malignancies: novel preventive and therapeutic strategies. The Lancet Infectious Diseases, 16(11), e241-e250.
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