Running head: CENTRAL VENOUS CATHETER RELATED INFECTIONS Central Venous Catheter Related Infections
Kelly Fuerst
Chamberlain College of Nursing
NR451 RN Capstone Course
Spring 2017 1 CENTRAL VENOUS CATHETER RELATED INFECTIONS
2
Preventing Central Venous Catheter Related Infections
Central nervous catheter placement is a practice that has become very common in the
healthcare sector; the only stumbling block has been the rise in the catheter related blood stream
infections emanating from a variety of reasons. Complications related to the infections are
attributed to increase in mortality, morbidity, medical treatment costs and lengthy stay in
facilities. Solutions proposed include; following strict catheter care protocols such as hygiene
training and staff education and training. For the purpose of this paper, staff education and
training is the strategy going to be discussed in details. According to Fraska (2010), migration of
skin organisms from place of insertion into cutaneous catheter tract is one avenue considered as
poor placement of the catheter device. Placement for longer than required periods and failure to
follow strict hygienic protocols such not using clensing agents are other reasons for infections.
The above identified issues can be properly resolved through training and education of staff. The
nursing focused plan would dwell on training nurses in areas such chlorhexidine gluconate
bathing, reevaluation of dressing techniques or re-evaluation of placement techniques.
Change Model Overview
The first phase of ACE Star model Evidence-Based Practice is discovery research;
several scholars have found that higher education levels among nurses directly translated to
better and safer care. According to study by Aiken, Clarke, Sloane & Silber (2003), an increase
in a nurse’s education degree translated to lower risk mortality rates among catheter related
cases. Additionally, experienced nurses were synonymous with low patient death suggesting
higher quality care (Blegen, Vaughn & Goode, 2001).
In another separate research, it was found that the experience of operators is essential;
this is because the risk of infection was inversely proportional to advanced operational skills TYPE SHORT TITLE IN ALL CAPS 3 (Fraska, D., Fizelier, C., & Mimoz, O. (2010). Education intervention in catheter insertion,
simulation-based training programs and programs for training nurses in long term catheter care
were also found to be very effective. Nurse staff reductions due to questionable
training/education and replacement of regular nurses with float nurses were other factors
identified as contributors to infection cases.
The various studies identified above suggest that a conscious effort should be made to
change both the training and education requirements to reduce the infections. For a smooth
translation into guidelines, stakeholders such as hospital administrators and independent health
institutions will have to be involved. Practice integration will require relevant stakeholders to
propose amendments to the already established guidelines. Outcome evaluation is process that
will have to be conducted overtime to see if the changes are working.
Define the Scope of the EBP
The practice issue is staff education and quality improvement programs. First of all, this
is a big problem since studies show that education levels and experience of nurses have a
significant effect on the rate of catheter related infections. A research conducted by Aiken etl.
(2003) came to a conclusion that for every 10% increase in nurses with higher degrees in the
field of central nervous catheter insertion, there was a decrease in mortality and morbidity rates
by 5%.
Also, facilities having nurses with superior education levels exhibited lower infections
levels because of better communication. Communication is mandatory especially during
replacement of regular nurses with as needed staff. According to Rinke et al (2012), education
intervention in catheter insertion and use of simulation-based techniques reduced infection cases
by about 30%. Increase in patient-nurse levels focuses on the quality aspect; one study conducted TYPE SHORT TITLE IN ALL CAPS 4 found that there was a four time increase in level of catheter infections when patient to nurse
ratio was doubled. Factors identified above mean that there is general deficiency in the level of
education since elements highlighted above are universal in healthcare system.
Stakeholders
Quality manager, head nurse, human resource manager, finance manager and
communication head.
Determine Responsibility of Team Members
The quality manager is supposed to oversee care provided by the nurses and ensure the
proposed changes are followed to the latter. The head nurse is there for consultation on the
proposed changes and guidance to junior staff. The human resource manager is there to oversee
the recruitment program; he/she would address patient-nurse ratio as well as implementation of
the new training procedures. The communication head is to ensure information on the proposed
changes reaches all the other relevant stakeholders. The finance manager is to receive proposals
regarding funding of the project.
Evidence
The strengths of this research are; information used came from various scholars hence
elements of bias are limited. Also, a majority of the studies were evidenced based experiments
enhancing their credibility.
Summarize the Evidence
A study by Kane, Shamlyiyan, Mueller & Duval (2007) found that increased levels of
nurses generally reduced levels of mortality and adverse patient events. Another study by Kane
(2007), found that low levels of nurse practitioners was synonymous with poor care delivery in
patients with catheter conditions. According to Seago (2001), cost cutting strategies like TYPE SHORT TITLE IN ALL CAPS 5 reducing levels of staff relative to patient number led to increased infections. A journal by Alslmi
& Kadium (2013) came to the conclusion that limited knowledge and experience in catheter
activities increased cases of infection. A research by Pronovost & Lipsett (2004) agreed with
most studies that replacement of regular nurses with float nurses impacts negatively on the care
of patients.
Translation
Action Plan
Implementation of the project isn’t going to be a walk in the park but through these steps,
the process will be expedited;
Step 1: creation of urgency
This step is meant to spark initial motivation by enlightening affected staff why implementing
these changes is important and how it will benefit the system.
Step 2: Form powerful coalitions
This will achieved through selection, gaining the trust and working with stakeholders
such as HR manager, finance manager and procurement officer.
Step 3: create a vision for change
This step would allow members of the organization to realize why changes proposed are
required.
Step 4: communicate the vision
This helps eliminating instances of resistance as all the relevant staff will access
information on why the changes are required. Departmental meetings, notices and face to face
interactions are some of the media to be used for this purpose.
Step 5: removal of obstacles and creation of short term wins TYPE SHORT TITLE IN ALL CAPS 6 Obstacles such as resistance can be eliminated through reward programs. Short term wins
are achievements accomplished within a short period; this can be done through recognition of
individual members or groups such as departments.
Step 6: anchor the changes in corporate culture and evaluation of outcomes and method to
report the results.
The above step makes the changes part of organizational values. Evaluation of outcomes
allows for measuring of the whole project to gauge progress.
N/B, this action plan should take 6 month-1 year to be fully functional.
Process, Outcomes Evaluation and Reporting
Desired outcomes should include; having nurse practitioners with high level education,
improving patient-nurse ratio, eventual reduction in catheter related infections through properly
trained nurses and enhancing patient care through better regular-float nurse transitions.
Reduction in catheter related infections can be measured via monitoring of patient records after
full implementation of the plan. Education levels of staff can be measured through analysis of
certification. Patient- nurse ratio can be evaluated through evaluation of records in the
information system.
Presentation to stakeholders
The results will be reported to the stakeholders through verbal presentations; to enhance
this communication, the session will take 45 minutes and will use PowerPoint slides and
handouts.
Identify Next Steps
The changes earmarked are not only restricted to the catheter related segment. For
example ensuring that nurses get higher education can be applied to other areas. Also increasing
the number of nurses such that the quality of care isn’t compromised can also be applied to other TYPE SHORT TITLE IN ALL CAPS 7 areas. Institutionalizing of evidenced based research is a strategy that can also be implemented in
other areas of the facility. The only way of ensuring the changes are permanent is by anchoring
the changes into corporate culture by including them in the vision and mission plans.
Disseminate Findings
Findings will be disseminated through various avenues; for internal purposes the media
used will be; emails, notices, organization newsletters/magazines and organization meetings. For
external purposes; social media, newsletters, print media and notices will be used.
Conclusion
Central nervous catheter infections is definitely a concerning issue in healthcare. It does
not only reflect on the poor patient care but also the quality of the care provided. Staff education
and quality improvement is one way that would solve the problem. The strategy is an
organizational change hence it is going to face challenges such as resistance. Developing
techniques to fight this would be imperative as the eventual outcomes will have a strong impact
in the health sector as whole. TYPE SHORT TITLE IN ALL CAPS 8 References
Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational
levels of hospital nurses and surgical patient mortality. Jama, 290(12), 1617-1623.
AAHS, (2010). Acer star model. Retrieved from: http://www.aahs.org/aamcnursing/wpcontent/uploads/The-ACE-Star-Model.pdf
Blegen, M. A., Vaughn, T. E., & Goode, C. J. (2001). Nurse experience and education: effect on
quality of care. Journal of Nursing Administration, 31(1), 33-39.
Berenholtz, S. M., Pronovost, P. J., Lipsett, P. A., Hobson, D., Earsing, K., Farley, J. E., ... &
Dorman, T. (2004). Eliminating catheter-related bloodstream infections in the intensive
care unit. Critical care medicine, 32(10), 2014-2020.
Frasca, D., Fizelier, C. & Mimoz, O. (2010). Prevention of central nervous catheter-related
infection intensive care unit. Retrieved from:
https://ccforum.biomedcentral.com/articles/10.1186/cc8853
Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2007). The association of
registered nurse staffing levels and patient outcomes: systematic review and metaanalysis. Medical care, 45(12), 1195-1204.
Kane, R. L., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. J. (2007). Nurse staffing and
quality of patient care. Evid Rep Technol Assess (Full Rep), 151, 1-115.
Seago, J. A. (2001). . Nurse Staffing, Models of Care Delivery, and Interventions. Making health
care safer: A critical analysis of patient safety practices, 40, 423.

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