Running head: CENTRAL LINE INFECTIONS 1

Central Line Infections

Ann Puruleski
Ferris State University

CENTRAL LINE INFECTIONS 2

Central Line Infections
The purpose of this paper is to research ways to prevent central line catheter infections.
This literature review will show the evidence that influences the decisions that are made by
nurses in practice.
PICO Question
The PICO question being examined is; What is the best practice for reducing the
occurrence of central line-associated bloodstream infections (CLABSIs) in patients with a central
line catheter compared to reeducation to reduce the rate of infection? The population would be
patients who have a central line inserted. The intervention is the best practice method for
reducing the occurrence of infection. The comparison would be reeducation to reduce the
occurrence of central line-associated bloodstream infections. The outcome would be to reduce
the occurrence rate of central line infections
Research Findings
Hospital-acquired infections can be very costly and deadly, especially if the infection has
entered the body through the patients central line. Central line associated bloodstream
infections are of considerable concern to patients and healthcare providers (Richardson &
Tjoelker, 2012, p. 205). Hospital-acquired infections can impact the cost of care for a patient and
possibly impact the mortality and morbidity of the patient (Richardson & Tjoelker, 2012, p. 205).
Nurses have an important role in preventing hospital acquired infections in patients who have a
central line. An infection that results from the improper care of a central line will affect the
quality of the patients life and could lead to death (Richardson & Tjoelker, 2010, p. 206). To
prevent infection from occurring there are a series of steps that can be used. This series is
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referred to as a central line bundle (Richardson & Tjoelker, 2010, p. 206). This bundle consists
of five steps that can be used in practice to achieve a better outcome and lower the number of
central line-associated bloodstream infections. The recommendation is for hospitals to use this
bundle of steps to improve the outcome of patients. The steps include hand hygiene, contact
precautions for sterility, the use of chlorhexidine on skin prior to line insertion, deciding on
which site would be most appropriate to use on the patient for venous access, and reviewing
whether the patient needs the central line on a daily basis (Richardson &Tjoelker, 2010, p. 206).
This series of steps can be integrated into nursing practice to help prevent patients from
developing infections. Each of the previously stated steps plays an important role in preventing
the spread of infection. Hand hygiene and sterile technique are very important components of
making sure infection is not introduced into the patient since without these two, the patient
would acquire an infection. Nurses are advocates for their patients and can use interventions to
help prevent infections from occurring (Flodgren et al, 2013). Nurses collaborate with a team of
medical professionals to discuss what further steps will be taken to help the patient get better and
to prevent infection from occurring. A nursing leader will communicate with a medical
professional, such as a doctor, if they suspect the patient has acquired an infection. If the nurse
provides this information through communication with the doctor, the doctor may decide to have
labs drawn to determine whether there is an infection present. Since nurses are taking care of the
patient, they will be the ones to communicate with the doctor if they believe the patient is getting
worse or having a complication. A study that was done using a quantitative method of using pre
and post tests showed that the rate of infection had decreased after an educational intervention
had taken place (Parra et al, 2010, p. 965). This same study shows that reeducating people will
help prevent infection from occurring. They helped reduce the number of infections from 45
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episodes in 10, 661 patients, to 34 episodes of infection in 11, 582 patients (Parra et al, 2010, p.
964). In order to promote the use of the previously stated five steps bundle method or
reeducation in a healthcare setting, a nurse would need to present this research to make a policy
change, more evidence would be needed. There would need to be a few more studies to show
that there are safe and effective ways to make sure that the rate of infections does not increase.
Recommendations to Improve Quality and Safety
Nurses are the medical professionals who take care of and interact with patients who are
admitted to the hospital. To improve patient outcomes and reduce unreimbursed costs, one
objective of every health care facility should be to achieve and maintain a 0 CLABSI rate
(Royer, 2010). A CLABSI rate is the number of times an infection occurs in a particular hospital
(Royer, 2010). Obtaining a zero rate on this scale is the ultimate goal for hospitals (Royer, 2010).
In all Veterans Affairs critical care units, nurses are able to stop a procedure from being done by
medical professionals if they believe that the steps to minimize infection have not been followed
(Richardson & Tjoelker, 2010, p. 207). By allowing nurses to stop a procedure before it has been
done, nurses help prevent infections from occurring through communication. By making sure
that hospitals have specific protocols that correlate with evidence-based research, the quality and
safety will greatly improve in nursing practice. A statewide effort in Michigan that focused on
the use of this bundle showed a 66% reduction in CLABSI rates over an 18-month period
(Richardson et al, 2010, p. 207). As shown by this statement, using the five step method has
helped decrease infection rates in Michigan. By making sure the nurses are using clean technique
and sterile technique, the risk for infection can significantly lower. Hospitals can take this even
further and make sure they are reeducating medical professionals about the importance of hand
hygiene, evidence-based guidelines and infection control measures (Bakke, 2010, p. 612.) If a
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hospital were to have lectures about the importance of infection control, it can help prevent
infections from occurring (Parra et al, 2010, p. 965). To make sure the protocol is up to date,
more research would be needed. The articles that were used consisted of literature reviews, a
quantitative study and had a lower level of evidence. More research would be needed to make
sure that the most recent evidence-based practice could be established at the hospitals. Hospitals
should also be making sure that newly hired staff are educated on the hospitals protocols so that
new nurses will know what is expected from them.
Conclusion
These articles provide some research to show that both reeducation and following a
specific set of steps to help reduce the rate of central line-associated bloodstream infections. If
nurses and medical staff are not reeducated on the protocol, the way procedures are performed
can vary from person to person. If there is a lot of variety, this could lead to an increase in
infection rates if they dont follow the protocol. There are methods which should be used to
reduce the risk of infection and to keep the rate of infection low. Even if rates of infection
continue to decrease, these rates of infection should still be monitored by the hospital.
Richardson & Tjoelker (2010) state that, if we stop monitoring the results of the practice
change, we really cannot be completely confident that our improved results will continue
(p211). In the future more research might come out with more improved methods for evidence-
based practice. Nurses need to make sure they know the protocols when a patient has a central
line in order to make sure they do not increase the patients risk of developing an infection.

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References
Bakke, C. (2010). Clinical and cost effectiveness of guidelines to prevent intravascular catheter-
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Flodgren, G., Conterno, L., Mayhew, A., Omar, O., Pereira, C., & Shepperd, S. (2013).
Interventions to improve professional adherence to guidelines for prevention of device-
related infections. Cochrane Database Of Systematic Reviews, (3).
Prez Parra, A., Cruz Menrguez, M., Prez Granda, M., Tomey, M., Padilla, B., & Bouza, E.
(2010). A simple educational intervention to decrease incidence of central line-associated
bloodstream infection (CLABSI) in intensive care units with low baseline incidence of
CLABSI. Infection Control & Hospital Epidemiology, 31(9), 964-967.
doi:10.1086/655841
Richardson, J., & Tjoelker, R. (2012). Beyond the central line-associated bloodstream infection
bundle: the value of the clinical nurse specialist in continuing evidence-based practice
changes. Clinical Nurse Specialist: The Journal For Advanced Nursing Practice, 26(4),
205-211.
Royer, T. (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.
doi:10.1097/NAN.0b013e3181f8586b