For this assignment students are required to continue the development of their EBP project proposal In Critically Ill Patients, Does Use of Chlorhexidine Dressing, as Compared to Those who do not have Chlorhexidine Dressing, Aid in Reducing CVC Line Infections?
by adding the new sections of:
Evidence Table Focused Question: In Critically Ill Patients, Does Use of Chlorhexidine Dressing, as Compared to those who do not have Chlorhexidine Dressing, Aid in Reducing CVC Line Infections?
Purpose of the research
Research design and sample
Data collection methods
Strengths and limitations.
Popovich, Hota, Hayes, Weinstein, &
Raad, Hanna, & Maki, (2007)
O’Grady et al., (2002)
Safdar, Kluger, & Maki, (2002)
This research investigated the relationship between use of chlorhexidine dressing and reduction of CVC line infection of critically ill patients.
The purpose of this study was to describe whether critically ill patients can use chlorhexidine dressing in CVC line infection reduction or not.
Design: convenience sample, correlation study.
Sample: A 21-bed medical intensive care unit (MICU) at Rush University Medical Center from September 2004 to October 2006.
601 patients from two medical intensive care units at a university hospital between January 2004 and January 2006
New born babies admitted to study units requiring CVC for a duration of 48 hours.
In the research for 601 Patients admitted in the 2 high dependency at a university hospital for chemotherapy procedure received chlorhexidine dressing for CVCs under standardized conditions and were randomly picked to the units receiving a chlorhexidine dressing or a standard sterile dressing. Daily course of action included clinical evaluation of the insertion site (inflammation, pain, and color change), temperature, white blood count and C-reactive protein. Catheters remained intact until they were no longer needed or when a CVC-related infection was suspected. Infection was confirmed with blood cultures through the catheter channel and peripheral blood cultures according to the time-to-positivity method.
Infants were randomized. On one, 10% povidone-iodine was rubbed on skin, and the second, 70% alcohol skin rubbing then placing of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane dressing was site in both research.
Use of Chlorhexidine Gluconate showed a drop in the rate of CVC-related infection statistically (from 5.31 to 0.69 cases per 1,000 CVC patient-days; P = .006)
For 601 patients, the control group showed 11.3% that is (34 of 301) CVC-related infections and 6.3% translating to (19 of 300) and chlorhexidine-impregnated wound dressing group.
Infants under chlorhexidine-impragnated disk were less likely to get CVC as compared to those not under povidone iodine ( 15% vs 24%
Limitation: Results cannot be generalized due to small convenience sample in America.
Strength: easy application of the result on the general population.
Limitation:The result was not hundred percentage. Some patients did not respond to the chlorhexidine positive. That is, it did not work in them. Thorough out the research studies
Strength: Most of them responded positively statistically.
Patients that stay for a long time in hospitals especially in the intensive care unit are susceptible to CVC related infection (Fishman & Calfee, 2012). This scenario is due to a catheter that is passed through the veins in the chest, arm or groin to carry either nutrients or medication to the predetermined part of the body due to the inability of the body to perform the task naturally.
The catheter results to infection which end up sometimes prolonging the days of the patients in the hospital than the intended days.
According to Beekmann & Henderson (2010), the clinical infection can be prevented by several measures such as washing hands when handling a catheter, making sure anything they touch during the procedure is sterile and covering the catheter tube with gauze or clear plastic tape once it is in place. Though proper measures, satisfying results have not been yielded yet in the reduction and prevention of CVC line infection. Thus the use of chlorhexidine dressing, thanks to unceasing research on CVC related infections which has proven prudent in the reduction of the infection.
The use of chlorhexidine dressing reduces the occurrence of CVC line infections in a significant manner in patients receiving chemotherapy and those in the medical intensive care unit. Also, little or zero adverse effects standing in relation to the intervention were observed (Popovich, Hota, Hayes, Weinstein, & Hayden, 2009).
Another research on neonates proved that those that chlorhexidine dressing was applied on them had a positive response in the reduction of CVC related infection compared to those who povidone iodine was used on them to reduce CVC line infection (O'Grady et al., 2002). Although more research is coming up in this area, the proven results show that using chlorhexidine dressing on critically ill patients prone to CVC line infection is proving circumspect as compared to patients who do not use.
With increased knowledge and research, new information precisely in the medical and nursing field also increases. Thus making change inevitable as far as improvement is concerned. In this study, measures and medication that have been taken in the past to reduce or prevent CVC line infection should be substituted gradually with chlorhexidine dressing. This gradual change should take a three step approach adopted by Kurt Lewin (1951) which includes, unfreezing, moving and refreezing.
In this paper, the first step which is unfreezing will be taken because from the study results shows that chlorhexidine dressing use will reduce CVC related infection systematically and statistically hence advantageous. The second phase is moving which involves taking the direction of change. As the use of chlorhexidine has been initiated, nurses and medical personnel should follow that lead in preventing CVC line infection. The final step in the change model is refreezing. This involves making permanent changes. In this paper, chlorhexidine dressing should be used in the prevention of CVC line related infection and substitute it with other clinical infection control.
The knowledge on the prevention of CVC infection should be given to health care givers. This will ensure those involved make informed choices while preventing or reducing CVC line infection in critically ill patients.
BEEKMANN, S. E., & HENDERSON, D. K. (2010). Infections Caused by Percutaneous Intravascular Devices. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 3697-3715. doi:10.1016/b978-0-443-06839-3.00302-7
Catheter-Related Bloodstream Infection. (n.d . SpringerReference. doi:10.1007/springerreference_225127
Fishman, N., & Calfee, D. P. (2012). Prevention and Control of Health Care–Associated Infections. Goldman's Cecil Medicine, 1780-1787. doi:10.1016/b978-1-4377-1604-7.00290-6
O'Grady, N. P., Alexander, M., Dellinger, E., Gerberding, J. L., Heard, S. O., Maki, D. G., … Weinstein, R. A. (2002). Guidelines for the prevention of intravascular catheter-related infections. American Journal of Infection Control, 30(8), 476-489. doi:10.1067/mic.2002.129427
Popovich, K. J., Hota, B., Hayes, R., Weinstein, R. A., & Hayden, M. K. (2009). Effectiveness of Routine Patient Cleansing with Chlorhexidine Gluconate for Infection Prevention in the Medical Intensive Care Unit. Infection Control & Hospital Epidemiology, 30(10), 959-963. doi:10.1086/605925
Raad, I., Hanna, H., & Maki, D. (2007). Intravascular catheter-related infections: advances in diagnosis, prevention, and management. The Lancet Infectious Diseases, 7(10), 645-657. doi:10.1016/s1473-3099(07)70235-9
SAFDAR, N., KLUGER, D. M., & MAKI, D. G. (2002). A Review of Risk Factors for Catheter-Related Bloodstream Infection Caused by Percutaneously Inserted, Noncuffed Central Venous Catheters. Medicine, 81(6), 466-479. doi:10.1097/00005792-200211000-00007
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