1. Anti-Microbial Capped Central Line and Infection Control.
Ferris State University
NURS 450
By:
Adetunji TJ Ojo RN
Research question
Does Anti-microbial port protector on a central line cap after placement versus central line cap alone reduce central line infection in acute care setting?
The need for research
“Although more hospitals have policies and procedures for infection control, the issue of hospital acquired infection (HAI) continued to be a major problem impacting patient safety care. The Joint Commission response to this problem includes the inclusion of infection control in National Patient Safety Goal (NPSG, 2014). NPSG requires the use of proven guidelines to prevent infection of the blood from central lines ( Central line associated blood stream infection (CLABSI) continue to be a problem; other measures other than hand washing and aseptic technique are needed to promote patient safety.
Studies by Danielson, et, al. and Wawrzynisk, et, al. both concluded that the use of alcohol impregnated (anti-microbial) port protector and disinfectant caps on all central lines has led to 68% reduction in central line associated bloodstream infections, and it is therefore necessary to promote the use of anti-microbial port protector for all central lines for patient safety.
Study design and data collection
This study will be a chart review, followed by a case study research using the adult intensive care unit of a local acute care hospital.
The standard data will be pulled from chart review and CLABSI reported to Center for Disease Control (CDC) via the National Healthcare Safety Network (NHSN) for the last 12 months.
The control data will be limited to CLABSI reporting to CDC for the next 12months after the introduction of anti-microbial port protector for central line immediately after insertion.
Compare the data of 12 months before and 12 months after the introduction of antimicrobial port protector in central lines (CLABSI per 1000 patient days).
Study participants
The study participants will include all patients admitted after the introduction of anti-microbial port protector. The Infection Control Coordinator will be responsible for monthly data collection, analysis, and reporting.
Population-Acute care settings
Intervention-Use of anti-microbial port protector after central line insertion. Control- All central line placed with anti-
microbial port protector.
Outcome-Pre and post use of anti-microbial port protector data analysis.
Potential problems (variations, limitations, etc.)
Ethical Conduct:
This is not a problem, since the research is non-invasive, and as a case study to support proven guideline, will not require patient’s consent.
Limitations:
The total patient days and average daily census need be consistent with number of central lines inserted to provide a useful comparison.
The possibility of staff members excessive reliant on antimicrobial port protector as the major prevention of central line associated blood-stream infection (CLABSI). Other major preventive measures must be promoted during study.
Importance of research and how can it change current practices
The protection of central lines, before and after insertion, when in use, and after use has been the major focus of initiatives for preventing infections.
Other safety measures identified in prevention of hospital associated bloodstream infection related to central lines includes hand hygiene, scheduled dressing change, alcohol or chlorhexidine wipe scrub, and flushing with normal saline (Hadaway, 2006)
Importance of research cont’d:
When central lines are not in use, the patients environments could pose a risk to the central line when not protected., this includes dragging the lines around a soiled bed, skin area colonization by pathogenic bacteria, and exposure during shower.
It is important to prevent bacteria from colonizing the central line cap, and this is the main purpose of the anti-microbial packed port protector for central line. Other benefits of this device in acute care settings includes:
Decreased antibiotic use due to decreased bloodstream infections.
Reduced patients length of stay in the hospital.
Increased nursing staff satisfaction.
Reduced overall healthcare cost.
Staff education and increased awareness of infection control.
References:
Hadaway, L.C, (2006). 5 steps to prevent catheter-related bloodstream infections. Journal of LPN, 2(5), 50-55
2014 National Patient Safety Goals. Retrieved from:
Wawrzyniak, M. M., Parada, J., Lewis, K., Mallek, A., Suarez-Ponce, S., Trulis, E., & ... Tomich, A. (2014). Significant Improvement in CLABSI Rates Following Routine Use of Disinfection Caps on All Access Ports: Better Safety, Better Resource Utilization. American Journal Of Infection Control, 42S15-6. doi: /j.ajic
Danielson, B., Williamson, S., Kaur, G., & Johnson, N. (2014). A Significant Decline in Central Line-associated Blood Stream Infections Using Alcohol-impregnated Port Protectors at a Large Non-profit Acute Care Hospital. American Journal Of Infection Control, 42S16. doi: /j.ajic