Running head: AN ANALYSIS ON CLABSI 1

An Analysis on CLABSI

Nha Truong

MHA-5020- Health Administration Capstone

May 11, 2019

AN ANALYSIS ON CLABSI 2

Table of Contents
Executive Summary: ....................................................................................................................... 3
Introduction: .................................................................................................................................... 3
Statement of the problem: ............................................................................................................... 4
Background: .................................................................................................................................... 5
Client Needs Assessment: ............................................................................................................... 8
Expected Outcomes and Precise Performance Measurement: ........................................................ 8
Leadership Component: .................................................................................................................. 8
Timeline: ....................................................................................................................................... 10
References ..................................................................................................................................... 12
AN ANALYSIS ON CLABSI 3

Executive Summary:
The paper will explore the problems regarding the infection of CLABSI. This is a growing

infection that has become a worldwide problem nowadays. It is a serious infection as it develops

within 48 hours of the placement of central line. According to Nosocomial Infection Control

Consortium (INICC), the rate of Clubsi is about 4.1 per 1000. It has been researched that almost

80000 CLABSIs are occurred at the ICUs. It is to be discussed in this context that though Central

venous catheters are essential to save life but these are responsible for the bloodstream infection.

Besides, the prolonged hospital stay also causes this kind of infection that increases the mortality

rate.

The purpose of the project is to examine the problems of the infection including its causes

and probable measurements for prevention. In addition, the project would also explore the scope

for expected outcomes by providing the necessary steps. Apart from this, the project also seeks to

offer the effective leadership component to manage such situation of having the infectious patients.

Surveillance method will be used for the collection of data and it is primarily aimed for the adult

Medical Intensive Care Unit (MICU).

Surveillance method will help to observe the rate of people affected by this infection. This

is a kind of observance that will help to make the data more authentic. As the infection is more

prone to the adults, therefore the project is aimed to be done with the Adult Medical Intensive care

Unit.

Introduction:
I would like to examine the rate CVC (central Venous Cather-related) infection is increasing or

not. It is the major common cause of increasing length of ICU stay with the increasing rates of

mortality from septicemia. That mainly caused by cattle’s or domestic animals. ICU take care of
AN ANALYSIS ON CLABSI 4

the patients needing central catheterization for diagnostic evaluation and medication

administration. In the ICU, about thirty four percent of cases of CVC related infection has been

recorded and this rate continues to increase. (CLABSI) rates through the implementation of the

CLABSI management bundle in order to improve the overall health outcome of clients and reduce

the length of stay as well as the cost associated with CLABSI. Establishment of the Healthcare-

Associated Infections objectives for Healthy People reflects the commitment of the U.S.

Department of Health and Human Services (HHS) to preventing HAIs. These high-priority

objectives address central line-associated bloodstream infections (CLABSI). CLABSI had been

increasing and created a negative impact on healthcare organization because it contributes to the

healthcare-associated infection adverse events. Therefore the total performance of the hospital and

determines the effectiveness of the healthcare service provided by the hospital. Highest quality

healthcare service which added to prompt and effective infection control measures should be

promoted.

Statement of the problem:

The risk of bloodstream infection (CLABSI) could result in increased mortality, morbidity and

hospital length of stay. Central venous catheters (CVC) are life-saving and the majority of patients

in intensive care units (ICUs) required them for medicine and fluids resuscitations. However, the

use of these catheters can result in serious bloodstream infections. Adult ICU is a combined unit

of medical and surgical patients with a bed capacity. The infection control and adult intensive care

teams considered this an area for improvement and looked for measures to resolve this issue. A

multidisciplinary CLABSI team was created with an aim to improve compliance with the CL

bundle, and subsequently reduce CLABSI rates. Population included all Adult ICU patients who

required a central line insertion for treatment. CLABSI was defined according to the criteria of
AN ANALYSIS ON CLABSI 5

GCC Center for Infection Control Surveillance Manual. CLABSI patient may have fever and also

face the problem of redness in the skin. It is a serious infection that occurs when germs (usually

bacteria or viruses) enter the bloodstream through the central line. Healthcare providers must

follow a strict protocol when inserting the line to make sure the line remains sterile and a CLABSI

does not occur. In addition to inserting the central line properly, healthcare providers must use

stringent infection control practices each time they check the line or change the dressing.

Background:
Douglas, M. (2015). The journey to zero CLABSI: Impact of unit-based CLABSI prevention

program. Journal of The Saudi Heart Association, 27(4), 309. doi: 10.1016/j.jsha.2015.05.206

The treatment of CLABSI very much depend on the prevention strategy of CLABSI

(Douglas, 2015). The article focuses on the prevention strategies that could effectively contribute

to morbidity. It is evident in patients of ICU. The National Healthcare Safety Network (NHSN)

has set a benchmark to reduce CLABSI by providing recommendations regarding this issue. The

author is more concerned with the strategies as the infection is more prone to the medical sector

such as the prolonged stay in the hospital. Besides, effective education is also needed as invoked

by the author in this article to reduce the prevalence of this infection.

Shah, P., Hachem, R., Chaftari, A., Hussain, A., Hamal, Z., &Yousif, A. et al. (2016).

Changing Epidemiology of Central Line-Associated Blood Stream Infections (CLABSI) in

Cancer Patients: Onset After Insertion. Open Forum Infectious Diseases, 3(1). doi:

10.1093/ofid/ofw172.271

According to Shah et al. (2016), gram microorganisms act as a prevalent pathogens in

CLABSI. The article describes how this gram microorganisms help to spread CLABSI. The article

at the same time illustrates how gram negative organisms converted into predominant etiologic
AN ANALYSIS ON CLABSI 6

organisms for patients with CLABSI and cancer simultaneously. The article goes on to the extent

of providing data where it uses two cohort to compare the dissemination of etiologic organisms in

cancer patients at a particular hospital between two cohorts that is distinguished by more than a

decade to evaluate whether the epidemiology has changed and whether the empiric guidelines are

to be reconsidered in that particular patient population.

Theodoro, D., Olsen, M., Warren, D., McMullen, K., Asaro, P., (...) & Henderson, A. (2015).

Emergency department central line-associated bloodstream infections (CLABSI) incidence

in the era of prevention practices. Academic Emergency Medicine, 22(9), 1048-1055. doi:

10.1111/acem.12744

According to Theodoro et al. (2015), CLABSI is mainly caused by the central venous

catheters (CVCs) that is inserted in the emergency department. The article also points out the

impact of CVC bundle that is inaugurated by the infection prevention department to reduce the

rate of CLABSI especially in the surveillance period. The research was held by the method of

prospective observational study. The research finally illustrates with its data that the rates of

CLABSI is much high for the emergency department along with the ICU.

Atilla, A., Doğanay, Z., Çelik, H. K., Tomak, L., Günal, Ö., & Kılıç, S. S. (2016). Central line-

associated bloodstream infections in the intensive care unit: importance of the care bundle.

Korean journal of anesthesiology, 69(6), 599.

According to Atilla et al. (2016), Central venous catheters (CVCs) are now extensively

used in the world of modern medicine. However, this is also responsible for causing the infection

called CLABSI which has become one of critical infections nowadays. The article illustrates the

significance of care bundle in preventing CLABSI. It also describes how infectious problems are
AN ANALYSIS ON CLABSI 7

necessarily related to placing a central venous catheter (CVC) in patients that is done in the

intensive care unit (ICU). The article provides how the catheterization duration was prolonged in

the CLABSI patients and how the femoral access was observed frequently in them.

Valencia, C., Hammami, N., Agodi, A., Lepape, A., Herrejon, E. P., Blot, S., ... & Lambert,

M. L. (2016). Poor adherence to guidelines for preventing central line-associated

bloodstream infections (CLABSI): results of a worldwide survey. Antimicrobial Resistance

& Infection Control, 5(1), 49.

The article says that CLABSI is the reason of huge mortality and it can be prevented

effectively. A research work has been carried out regarding CLABSI and the results are described

in this article. A question-answer based session has been carried out in this research in order to

understand various aspects of CLABSI. The main responders were the medical professionals such

as doctors and nurses. The target destinations were the countries which are segregated based upon

the financial capabilities.

Zeneli, A., Mezzadri, S., Bertozzi, L., Resi, D., Golinucci, M., Dodi, S., & Prati, E. (2017). A

surveillance system model for central line-associated bloodstream infections (CLABSI)

coordinated at the regional level: a pilot feasibility study. Le infezioni in medicina: rivista

periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive,

25(2), 108-115.

This article mainly focuses upon the surveillance system model for completing the analysis

of the CLABSI. The name of the study that has been carried out is known as pilot feasibility study.

Various aspects of CLABSI has been discussed in this article with proper justification. Three

hospitals were associated to make the study complete successfully and the accuracy of the study
AN ANALYSIS ON CLABSI 8

have been carried out with great effectiveness. It has been concluded in the article that the study

was feasible with the help of proper source and other supporting materials.

Client Needs Assessment:

In this study proper study will be carried out on the patients of the CLABSI. The durability

of staying in hospitals will be counted in this research process. The nature of the infection is one

of the most important thing to be studied about. The surveillance system would help the researcher

to keep watch upon the patients who are affected by CLABSI. The CVC rate is another important

aspect for this study process, and the effective measures will be come out with the help of the CVC

rate. The preventive measures are the important thing which is to be followed in order to avoid the

disease especially for the adults.

Expected Outcomes and Precise Performance Measurement:

At first the age and the gender of each of the patients will be collected. The age of the people will

be categorized into five section, age 10 to 20 years, 20 to 30 years, 30 to 40 years, 40 to 50 years

and 50 to 60 years. After that the nature of the blood and the count of the RBC, WBC and platelets

will be carried out with proper effectiveness. The symptoms of the patients will be taken into

consideration. The physical condition of each of the patients will be counted for a time duration of

six weeks and at every 7 days interval the condition of the patients will be recorded. The visual

record will be stored in the form of graph and pie chart.

Leadership Component:
As a responsible as the leader of the team along with the Director of Infection Prevention

and Control and the Infection Control. The other members included Infection Control Practitioner

who acted as the coordinator of the team to organize team meetings, ICU team leader, ICU doctors,

and ICU nurses. To central line bundle to measure the practice of central line usage including the
AN ANALYSIS ON CLABSI 9

daily review of central line necessity. Educational sessions were conducted for all healthcare

workers in the ICU especially nurses and physicians before implementation of the central line

bundle. The educational sessions included the details of all elements of the bundle and the scientific

evidence to show its effectiveness of preventing the central line infections. Special treatment

policy should be conducted for nursing group, doctors and the leader should monitoring the process

of central line insertion and completing the central line. The associative CLABSI Elimination

Team should regularly to review the CLABSI events and discuss any issues with implementation

of central line bundle and compliance to its elements. Any new scientific evidence or research

relevant to the project was disseminated amongst the team members.

For NCHL competency we need annalistic thinking in transformation for CLABSI like

what are the causes for this infections or it is causing by caused by organisms other than

Staphylococcus micrococcus species, Propioni bacteria, fungi, or mycobacteria. The root of the

infection must be study in prescribed format. After then domain of people under human resource

management is vital for conducting of the treatment process of CLABSI where number of doctors,

nurses and other stuff members are needed for quality and top notch treatment. To ensure the best

possible outcome there are few points should be kept in mind use appropriate hand hygiene and

maintain safe protocol by the members who are dealing with the infections, right equipment’s and

antibiotics should be handy therefor human resource must be need. The last steps should be

initiative in the domain of execution it where all prevention process take place according to

treatment Parenteral vancomycin, if methicillin resistance in staphylococci (MRSA) is prevalent,

otherwise a parenteral anti-staphylococcal penicillin or cephalosporin such as nafcillin or cefazolin

would suffice. If MRSA isolates are exhibiting a minimum inhibitory concentration of > 2 mg/mL.

Antibiotics active against gram-negative bacilli should be preferably based upon local
AN ANALYSIS ON CLABSI 10

susceptibility patterns; usual choices include a beta-lactam/lactamase inhibitor combination,

cefepime, and carbapenem with or without an aminoglycoside. Agents against Pseudomonas

aeruginosa are required in the setting of neutropenia, severe illness, or known prior colonization.

All this three domain are interlinked with each other from annalistic thinking, human resource and

initiative all this will result in excellence treatment for CLABSI. Into my notes of accounts it will

create a positive impact in reducing this infection and it will evidence-based guidelines show that

by adhering to protocols, one can reduce the rate of CLABSI. However, to ensure compliance,

audits of doctors who insert the central lines and nurses who monitor the lines for infections is

vital.

Timeline:
Tasks to Complete the Date
Capstone Due Date for Responsible
Milestone. Completed
Project Individual Party or
and
Milestones (Please add subtasks) Tasks Parties
Outcome
Week 4 Client approval and 5/04/19 Nha Truong
signature. Integrate
revisions.
Week 5 Begin data analysis. 5/9/19 Nha Truong
Complete the leadership
self-assessment.
Week 6 Continue with data analysis. 5/17/19 Nha Truong
Week 7 Continue with data analysis. 5/25/19 Nha Truong
Develop evidence-based
recommendations and
conclusion.
Develop the final report
outline presentation.
Week 8 If needed, continue 06/01/2019 Nha Truong
wrapping up data analysis.
Prepare the final report draft
and summary poster or
presentation.
AN ANALYSIS ON CLABSI 11

Tasks to Complete the Date

Capstone Due Date for Responsible
Milestone. Completed
Project Individual Party or
and
Milestones (Please add subtasks) Tasks Parties
Outcome
Week 9 Submit the final capstone 06/08/2019 Nha Truong
data review project in
outline
Week 10 Identify project insights and 06/16/2019 Nha Truong
obstacles.
Reflect on one’s leadership
competencies.

Statement of Confidentiality
I, Nha Truong agree to abide by all applicable employment and workplace laws, including
HIPAA, and I agree not to disclose proprietary information before, during, or after my data
review project, without prior written consent from my proposal reviewer’s organization.

Signatures:
____________________________________________________________________________
Proposal Reviewer’s Signature and Date
____________________________________________________________________________
Reviewer’s Title and Organization
____________________________________________________________________________
Learner’s Signature and Date
AN ANALYSIS ON CLABSI 12

References
Atilla, A., Doğanay, Z., Çelik, H. K., Tomak, L., Günal, Ö., & Kılıç, S. S. (2016). Central line-

associated bloodstream infections in the intensive care unit: importance of the care bundle.

Korean journal of anesthesiology, 69(6), 599.

Douglas, M. (2015). The journey to zero CLABSI: Impact of unit-based CLABSI prevention

program. Journal of The Saudi Heart Association, 27(4), 309. doi:

10.1016/j.jsha.2015.05.206

Shah, P., Hachem, R., Chaftari, A., Hussain, A., Hamal, Z., &Yousif, A. et al. (2016). Changing

Epidemiology of Central Line-Associated Blood Stream Infections (CLABSI) in Cancer

Patients: Onset After Insertion. Open Forum Infectious Diseases, 3(1). doi:

10.1093/ofid/ofw172.271

Theodoro, D., Olsen, M., Warren, D., McMullen, K., Asaro, P., (...) & Henderson, A. (2015).

Emergency department central line-associated bloodstream infections (CLABSI) incidence

in the era of prevention practices. Academic Emergency Medicine, 22(9), 1048-1055. doi:

10.1111/acem.12744

Valencia, C., Hammami, N., Agodi, A., Lepape, A., Herrejon, E. P., Blot, S., ... & Lambert, M. L.

(2016). Poor adherence to guidelines for preventing central line-associated bloodstream

infections (CLABSI): results of a worldwide survey. Antimicrobial Resistance & Infection

Control, 5(1), 49.

Zeneli, A., Mezzadri, S., Bertozzi, L., Resi, D., Golinucci, M., Dodi, S., & Prati, E. (2017). A

surveillance system model for central line-associated bloodstream infections (CLABSI)

coordinated at the regional level: a pilot feasibility study. Le infezioni in medicina: rivista
AN ANALYSIS ON CLABSI 13

periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie

infettive, 25(2), 108-115