Chapter 2: Literature Review

Chapter 2: Literature Review

Introduction

The Purpose of this study project is to explore the problem of CLABSIs and examine available measures to prevent, control and reduce incidences. In particular, this project proposes teaching proper CVC maintenance as the intervention to prevent CLABSI. In addition to the educational interventions, evidence-based practices such as care bundles which include elements such as using chlorhexidine for proper clean-up of the sight of insertion, proper hand hygiene, and ensuring that the catheter is removed as soon as it is no longer needed. Another intervention proposed in this project is monitoring and appropriate inspection of all procedures around CVC processes. With this in mind, this literature review section will sample various studies which have been done with regard to prevention of CLABSI. Past studies which have been done in this area will be analyzed with more attention being paid to the methodology used, the results, and the solutions they proposed. This section of the project will analyze the theoretical foundations of the approach used, the review of literature, and the key themes which will guide the projectstudy. After choosing the topic, the databases from which the searches will be conducted were identified. The searches were then conducted with the key words being “management and prevention of CLABSIs.” The references and bibliographies of research studies found were used to locate others. Comment by Kathryn Flynn: Educational sessions are not enough for a DNP project, per AQR. EBP interventions should be used to support project.

A total of 200 articles with researches and findings about CVCs, their risk factors, CLABSIs, interventions, and the benefits of preventive measures when handling ICU patients with CVC insertions were identified to be used as references for this project. were established to talk about the CVCs, CLABSIs, risk factors, intervention, and benefits of preventive measures. Through inclusion and exclusion criteria many journal articles were left out because of being written in other languages rather than English. Therefore, the use of the English language index the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was used to search related journal articles. Other search tools include The National Center for Biotechnology Information (NCBI) – PubMed. Studies older than five years were excluded to ensure that the research project remained current and up to date. Using real-time cases or conditions helps to improve the quality and validity of the resulted studies. Comment by Kathryn Flynn: Fix sentence Comment by Kathryn Flynn: clarify

 

 

Background

Central Line-Associated Bloodstream Infection (CLABSIs) iins a fatal infection that results from bacteria or viruses entering the bloodstream through the central line. A central line, also known as a central venous catheter (CVC), refers to a tube used by doctors to administer medication, fluids or to collect blood from the body of a patient (Deason & Gray, 2018). CLABSIs are among the leading causes of deaths each year in different countries across the globe. These types of infections have been an area of interest for many healthcare researchers representing a diverse body of knowledge about the infection while still expanding on what is already known. This section of the research project is an analysis of articles related to CLABSIs with the significant themes of concern to the authors including risk factors, interventions, CLABSIs and Hospital Acquired Infections (HAIs), benefits of the preventive measures and the common symptoms of CLABSIs. Several interventions have been suggested for prevention of CLABSIs, but practitioners do not seem to apply the interventions appropriately. This explains why there are still a significant number of infections despite the interventions. This project seeks to bridge this gap by introducing educational interventions and evidence-based practices. A quick survey of the literature indicates that many scholars have investigated various prevention measures but none has explored training on CLABSIs maintenance bundle as a preventive measure. This is the gap that this project seeks to fill. Comment by Kathryn Flynn: sp Comment by Kathryn Flynn: delete; don’t incriminate yourself

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
Introduction (to the Chapter) and Background (to the Problem) This section describes the overall topic to be investigated, outlines the approach taken for the literature review, and defines the evolution of the problem based on the gap or need defined in the literature from its origination to its current form.	2	21	You’ll develop this section according to feedback in Chapter one when you submit it. Keep lit review focused on project specifics, not just infection in general.
Introduction states the overall purpose of the project.	2	21
Introduction provides an orienting paragraph so the reader knows what the literature review will address.	2	21
Introduction describes how the chapter will be organized (including the specific sections and subsections).	2	1
Introduction describes how the literature was surveyed so the reader can evaluate the thoroughness of the review.	2	1	Please do this
Background provides the historical overview of the problem based on the gap or need defined in the literature and how it originated.	2	21	Develop specifics according to Ch 1 modifications
Background discusses how the problem has evolved historically into its current form.	2	1	Develop; say why project is needed. They are not preventing infections now?
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	2	2
NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

 

Theoretical Foundations

The Quality Health Outcomes Model (QHOM) is used to study healthcare quality and outlines relationships existing betweeen interventions, characteristics and outcomes of patients, and the characteristics of the healthcare system. This model/framework has been used by various researchers to test the effectiveness of infection prevention measures, for instance by Gilmartin and Sousa (2016). The QHOM theoretical framework has been increasingly forming the conceptual framework for projects projects which assess quality and system interventions for care improvement. Providing high quality healthcare services is the interest of every health care provider. Even ancient renowned philosophers such as Plato and Aristotle identified quality as one of the “great ideas.” The question of how quantity can be quantified has been under discussion for a long time. The QHOM is one of the models proposed to quantify the quality of healthcare (Mitchell & Lang, 2004). The model can be used to show the relationship between adherence to CLABSI prevention interventions as demonstrated by Gilmartin and Sousa (2016). This model will effectively be used by the researcher to answer the fundamental question asked in this studyproject: How does staff training of proper CVC maintenance and the use of evidence-based care bundles which include elements such as using chlorhexidine for proper clean-up of the sight of insertion, proper hand hygiene, and ensuring that the catheter is removed as soon as it is no longer needed, monitoring and appropriate inspections reduce the incidence of CLABSIs? Comment by Kathryn Flynn: Need to include specifics on how you will integrate into your project Comment by Kathryn Flynn: Be used by the researcher to.. Comment by Kathryn Flynn: EB best practice Comment by Kathryn Flynn: Delete; subjective

Criterion	Learner Score (0, 1, 2, or 3)	Chairperson Score (0, 1, 2, or 3)	Comments or Feedback
theoretical Foundations This section identifies the theories or models that provide the foundation for the project. This section should present the theories or models(s) and explain how the problem under investigation relates to the theory or model. The theories or models(s) guide the clinical questions and justify what is being measured (variables) as well as how those variables are related.	2	2
This section identifies and describes the theories or models to be used as the foundation for the project.	2	1	Develop how/ why you’ll use it
This section identifies and describes the seminal source for each theory or model.	2	1	Develop; seminal means first. Who devekoped theory and for what?
This section discusses how the clinical question(s) align with the respective theories or models.	2	21	develop
This section illustrates how the project fits within other evidence-based on the theory or model.	2	11	develop
This section reflects understanding of the theory or model and its relevance to the project.	2	1	clarify
This section cites references reflecting the foundational, historical, and current literature in the field.	2	11	Need more than one
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	22	21
NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

 

Review of the Literature

Kadium (2015) inquired into how the education program for one month, based on the evidence-based guidelines recommended by CDC, will improve registered dialysis nurses’ knowledge regarding CVC maintenance care. Other researchers who have focused on how education, experience, and workshops enhance prevention or reduction of CVC infections include; El-Sol and& Badawy (2017), Leistner, et al. (2016), and Soffle, Hayes, &and Smith (2018). Dougherty (2015) highlights the potential of careful setting an organizational culture that cares for the patients. They suggest that a strong organizational culture that stresses care for the patients is key in reducing CLABSIs cases. Further, these researchers propose that education, simulated training, experience, and knowledge are critical aspects in the management of CLABSI infections. Comment by Kathryn Flynn: ‘and’ for multiple authors in narrative. & in ( ) Comment by Kathryn Flynn: I would add all these to your interventions and this article would justify use. In fact, say it here. Comment by Kerry Murphy: Sorry, I missed this – I beg your pardon please Comment by Kathryn Flynn: Ok, say here’ the research note will be the basis for project interventions…’

Studies by Xu, and& Wu (2017), Commonwealth of Australia (2015), Kadium (2015), Morrison, Raffaele and& Brennaman (2016), Tomar, et al. (2016), Lin, et al. (2015), and Esposito, Guillari and& Angelillo (2017) all concur with O’Grady, et al. (2015) underscored the importance of establishing the role of monitoring and appropriate inspection of the CVC site in studies regarding CLABSI. Various researchers have investigated the CLABSI-related preventive measures implemented among adult patients hospitalized in an ICU setting. These include studies by Perin, et al. (2016), Jones, et al. (2017), Masse, Edmond, and& Diekema (2018), and Oliveira, et al. (2016). Basinger (2015) investigated the use of comprehensive unit-based safety programs (CUSP) in improving the safety culture within ICUs and achieve the goal of reducing or eliminating CLABSIs. In Basinger’s report, the cases of CLABSIs reported were recorded before and after the introduction and execution of the CUSP program. The CUSP is a program designed to teach and enhance patient safety awareness as well as the quality of nursing care. This program is implemented in a five-stage process that starts with providing education on safety science, followed by the identification of weaknesses and risks in patient safety, then the partnering of senior executive with a unit, learning from the flaws, and the execution of communication and teamwork tools (Basinger, 2015). From the project, it was observed that the number of CLABSI cases reduced after the implementation of CUSP as an intervention measure. Other studies such as in Kadium (2015) and Powell (2018) have investigated the effect of knowledge and education of the family and patient in CLABSIs prevention. Preventive measures are a core motive as to why the studies in CVC and CLABSI are conducted. Comment by Kathryn Flynn: . All Comment by Kathryn Flynn: Add this to your interventions Comment by Kathryn Flynn: Explain more about the program

Theme 1: Risk Factors Associated with CLABSIs.

Subtheme 1: Contamination on Insertion . This is related to my intervention in the sense that maintenance bundles are applicable in every step of handling the CVC, including the insertion stage. Duly observation of all the elements described in the maintenance bundle will reduce or eliminate contamination on insertion. The catheter may gain entry into the bloodstream during the insertion of the line into the body of the patient. The rate of infections during insertion is substantially dependent on the hygiene levels that are put in place by the health care providers (Dick et al., 2015). In the project by Dick et al., (2015), there are no clear clinical questions. The projectstudy used Medicare data combined with healthcare-associated infections for the prior five years. It was found that healthcare-associated infection prevention programs which are multifaceted are cost-effective. In the study, it is also noted that contamination on insertion is one of the biggest risk factors associated with CLABSI infections. Comment by Kathryn Flynn: Explain how this relates to your intervention. You decided to take the insertion part out, so if you are leaving this review in, show why it is significant to your project. Comment by Kathryn Flynn: What involved?

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