Evidence-Based Practices – Infections Example

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"Evidence-Based Practices" is a great example of a paper on infections. The article focuses on the guidelines used in medical institutions in reducing central line-associated bloodstream infections (CLABSI) by implementing the central line bundle. The morbidity and mortality of patients increase when they acquire CLABSI. Most of these infections are preventable through intervention in the patient's care by applying evidence-based practice (EBP). The practices assist the hospitals in saving resources as the numbers of hospital-acquired infections reduce. It is clear that the institution must put in place a process that efficiently and effectively translates the evidence present into clinical practice (Bliss-Holtz, 2007).

Some of these health care organizations are already promoting ‘ zero tolerance’ to eliminate these infections in hospitals. The guidelines in these practices originate from organizations such as CDC, Infusion Nurses Society, APIC, and IHI. Every medical institution should act to achieve an objective of zero CLABSI by implementing the IHI central line bundle. The main factors in the IHI CLB will limit infection during insertion and daily checkup of the lines for any problems. The CLB is a combination of evidence-based interventions that assist in improving outcomes in patients after implementation.

The results of using the combination of these evidence-based interventions are better than individual implementation. The IHI CLB does not lead to attaining zero CABSI in some facilities hence the need to implement additional central care to the patient using contributions of the vascular access team (VAT). There are further practices that ensure the infections reduce with some being facility-based to meet specific needs. These additional practices have less support from evidence but get support from various studies. Effective VATs implement CLB and further investigation on the improvement that will lower catheter complications. Summary The article uses the investigation that establishes VAT in an acute care unit with a 350-bed facility.

The VAT members were from different medical fields with the nurse manager as VAT director. The vascular access team first implements IH CLB while having evidence that vascular infections are preventable. The CLB interventions that limit CLABSI include maximal barrier precautions, hand hygiene using chlorhexidine as a skin antiseptic, optimally selecting catheter site, and daily assessment of line the necessitate removal of lines when indicated.

The use of the bundle does not fully eliminate central line bloodstream infection but promote collaboration of healthcare providers (Timothy, 2010). The VAT members supervised the practices including the insertion of the catheters and maintained central lines and peripheral vascular catheters. Besides, the VAT members educated healthcare providers in implementing CLB. The review of infected blood was from both VAT and infection control teams.   They tracked infection using the National Healthcare Safety Network definition and national nosocomial surveillance system. The result of the practices of the VAT team shows a decrease in CABSI.

It was further clarified in 2005 that neglecting even one component of CLB such as maximal barrier precautions in the practices could lead to the rise of CABSI. The revelations lead to massive continuous education on providing healthcare using best practices. The five components of CLB provide ways of limiting infections in the hospital. Hand hygiene by washing with antiseptic-containing soap or alcohol-based gels and foams is vital in preventing infectious organisms. Washing of hands is a requirement before and after handling any operation by the nurses.

The maximal barrier precautions depend on the patients and the healthcare provider. Chlorhexidine skin antisepsis ensures the disinfection of the skin before insertion of the catheter. The nurse should appropriately select the site for placing a catheter that reduces the risks of infections that may depend on the situation. Lastly, healthcare providers need to review the patient’ s central lines daily. The review looks into reducing the risk of infection by removing the catheter. The results show a reduction in nosocomial infection after the implementation of the CLB. The main cause of CABSI is inserting CVCs unsafely and improper care.

Other practices by the VAT with the aim to reduce infection like using needleless connectors resulted in a further decrease in infections. The combination of these components ensured the reduction of infections to the minimum level. It is also clear that implement all the components of CLB together resulted in lower infection than implanting each individually (Hung-jen et al. , 2014). Besides using CLB, the hospital focused on maintaining CVCs and introduced many additional interventions to obtain zero CABSI rates. Steps in developing and implementing EBP There are six steps involved in the implementation of EBP.

The first step involves assessing the need to change. The second step is locating the best evidence for the situation. The third step in implementing EBP is synthesizing evidence followed by designing the change step to meet the needs in reducing infections. Implementation and evaluation of the changes follow to see if it was effective. The healthcare institutions finally need to integrate and maintain the changes. Integration and maintenance of changes may require continuing education of healthcare providers (Huett & MacMillan, 2011). Application of information The information in the article clearly states the benefits of implementing EBP.

Using EBP as a nurse is beneficial in limiting the transmission of infection and the resources used. EBP provides guidelines that improve the quality of healthcare services to patients. Leaving any of the components of EBP in practice has a great negative effect on the health of the patients leading to the use of more resources. Besides, there is a need for other interventions that can lead to further improvement in patients’ health. Conclusion Implementation of EBPs requires strategic steps and follow-ups to ensure it is effective.

Healthcare institutions play a great role in implementing EBPs and additional interventions. These EBPs are crucial in improving the quality of healthcare to the patients. However, EBPs need additional interventions to ensure the patients receive the best care. Implantation of CLB together with other interventions resulted in zero rates of CABSI in the research.  

References

Bliss-Holtz, J. (2007). Evidence-Based Practice: A Primer for Action. Issues In Comprehensive Pediatric Nursing, 30(4), 165-182. doi:10.1080/01460860701738336

Huett, A. & MacMillan, D. (2011). Evidence-based practices. UNA Center for Writing Excellence. Retrieved from: https://www.una.edu/writingcenter/docs/Writing-Resources/Evidence-Based%20Practice.pdf

Hung-Jen, T., Hsin-Lan, L., Yu-Hsiu, L., Pak-On, L., Yin-Ching, C., & Chih-Cheng, L. (2014). The impact of central line insertion bundle on central line-associated bloodstream infection. BMC Infectious Diseases, 14(1), 1-12. doi:10.1186/1471-2334-14-356

Timothy, R. (2010). Implementing a better bundle to achieve and sustain a zero central line-associated bloodstream infection rate. Journal of infusion nursing, 33(6), 398-406

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