Healthcare-Associated Infections (HAIs) continue to be an epidemiological issue burdening patients and public health systems worldwide. The purpose of this study was to determine if specific healthcare facility types (Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities) were associated with particular categories of HAIs: Ventilator-Associated Pneumonias (VAPs), Central Line-Associated Bloodstream Infections (CLABSIs), and Catheter-Associated Urinary Tract Infections (CAUTIs). The theoretical framework for this study was the environmental determinants of infectious disease framework. A single research question focused on whether an association existed among the specified health care facility types and HAIs. Three independent categorical variables were used, including Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities, and 3 dependent variables were used, comprising of VAPs, CAUTIs, and CLABSIs. A quantitative design engaged the chi-square test of association, using a 2012 population-level report of archival data collected by the Centers for Disease Control and Prevention's National Healthcare Safety Network. Seven groups of HAIs and facility types were tested, and the results revealed that 6 groups had statistically significant differences. This study may contribute to positive social change by helping to identify whether healthcare facility types are associated with HAIs and to supply evidence to stakeholders to support standardization of best practices across all facility types, thus contributing to the reduction of HAIs in the United States.

Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a simulation-based staff educational program was developed and implemented by ICU staff (n=20). Following the implementation of the simulation-based program, adherence to CVC maintenance guidelines improved from 41.5% to 87.9%. A sample t-test showed that this improvement was statistically significant and the CLABSI rate declined to 1.24 per 1,000 catheter days in the 4-week period following implementation of the program. Findings show that introducing a simulation-based training program might help to reduce CLABSI rates in the ICU setting and contribute to positive social change by improving health outcomes in ICU patients with a CVC.

Central line-associated bloodstream infections continue to be some of the most deadly hospital-associated infections in the United States. Guided by Lewin's change theory which focuses on prior learning, rejection, and replacement, the purpose of this study was to improve the quality of care patients receive in an acute care facility by reducing life threatening central line infections. The research question examined whether additional education using Venous Access Nurse (VAN) customized newsletters and manager coaching of nurses in an acute care setting would improve the quality of care for patients with central lines. This was a quantitative nonexperimental descriptive retrospective study using secondary analysis of a hospital dataset. This dataset included variables relating to nurse tenure and nurse performance after reeducation and coaching on managing central lines. Variables from 450 of 1,300 nurses were analyzed in the current study at a 750 bed system in a southwestern healthcare system in Florida. The pre and post audits consisting of contributing factors were obtained from the VAN audits and post audits consisting of contributing factors were obtained from the Van audits and were calculated with descriptive statistics. There were a decrease from 19.1% of the lines audited having 1 or more deviations from the guidelines to 3.5%. Nurses with 2 to 5 years of tenure had a greater number of deviations from the guidelines' standard for managing central lines as compared to staff with a lesser or greater amount of tenure. Positive social change implications include knowledge useful for staff nurse educators and other researchers who are searching for direction in improving health care associated infection rates to provide a better quality of life, decrease costs, and increase safety.

Central-line-associated bloodstream infections (CLABSIs) occur during the insertion or change of the dressing of the central venous catheter (CVC) and are reportable healthcare-associated infections at the state and the national level. The purpose of this systematic review of the literature was to evaluate and synthesize available evidence to establish the effectiveness of using an adhesive transparent chlorohexidine gluconate (CHG) Tegaderm™ gel dressing for CVC in the prevention of CLABSIs. The logic model was used as a framework to guide the review of the literature to establish how an intervention that is not currently practiced can contribute to CVC prevention of infection. The practice question focused on gathering evidence to support the effects of CHG Tegaderm™ gel central-line dressing compared with the Biopatch® dressing. A total of 373 articles were retrieved and 16 met the inclusion for review and were graded according to the Melnyk and Fineout-Overholt hierarchy level of evidence and evidence synthesis broken down into the reduction of CLABSI, the cost-effectiveness and ease of use of the CHG Tegaderm™ gel. Findings from the systematic review supported the use of CHG gel dressing as a CLABSI preventative measure. The findings from the project support positive social change by reducing CLABSI and associated illnesses and saving the increased cost, mortality, and morbidity associated with CLABSIs.

Patients with cancer who receive bone marrow transplants (BMT) are at increased risk for central line-associated blood stream infections (CLABSI), a serious complication leading to increased costs, length of stay, and even death. Recognition of an increased CLABSI rate at one BMT unit in the southwestern United States prompted development of an evidence-based staff development education program to improve nurses’ knowledge of central line maintenance and CLABSI prevention practices. Guided by Lewin change theory, the program was developed based on a nurse-led analysis and synthesis of the evidence, and a formative evaluation of the educational program conducted by a 3-member expert panel made up of the BMT director, a BMT clinical nurse specialist and vascular access team member. The review confirmed the lack of standardized evidence-based guidelines for central venous catheter care, that any patient who has a central line is at risk for CLABSI, and BMT patients are at particular risk due to frequency of catheter manipulation. Findings reinforced the need for the recommendations to educate nurses in BMT settings on evidence-based central line practices, evaluate knowledge gained, and audit practice techniques post education. The social change implication of this DNP project will be the potential decrease in healthcare costs, length of stay, and mortality associated with central line infections when nursing staff are provided an educational program that aims to improve their knowledge and skills of evidence-based central line care and CLABSI prevention practices.

Central line-associated bloodstream infections (CLABSI) are usually attributable to suboptimal line insertion, care, or maintenance and are associated with poor patient outcomes. Nursing plays a pivotal role in preventing CLABSI, because nurses are generally responsible for the routine care and maintenance of central lines. The purpose of this project was to determine if CLABSI nursing education and demonstration-based competency could improve nurses' knowledge on a neurology unit as compared to current practice of an annual e-learning module as the sole source of nurse education. This project was informed by Lewin's planned change theory and involved changing behaviors, attitudes, and practices of nurses via a conducive approach consisting of three phases: unfreezing, movement, and refreezing. To have a foundation in evidence, expert literature supports the project. Participating nurses attended an educational session consisting of a presentation and demonstration-based competency of central line dressing change technique. A pre- and post-test were administered; the mean pretest score was 72.1% and the mean posttest score was 94.1%. Comparison of pre- and post-test scores reflect a 22% increase in test scores, therefore, this program increased knowledge. This project can contribute to positive social change by improving nursing practice through increasing nurses' knowledge of proper care and maintenance of central lines, which can translate into evidence-based practice changes and improve patient outcomes.

Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs. Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple search terms used and these included "neonate OR newborn OR infant", "CLABSI OR central line-associated bloodstream infection", "intervention OR prevention" and "bundle". The search solely focused on the outcome of infant patients. Therefore studies were excluded for the following criteria: being non-peer reviewed, being published before 2008, and being a case in which CLABSI was assessed in patients outside the NICU. See Table 4 and 5 for further information. Results: Eight articles were eligible for inclusion all of which CDC's guidelines were implemented in their strategy of intervention. The systematic review showed that adherence to care bundles decreases infection rates drastically. All eight articles reported a significant decrease in CLABSI rates following the implementation of the bundle set by CDC with two studies achieving a CLABSI rate of zero. Author's Conclusion: Implementation of care bundles showed a success in reducing CLABSI rates in the NICUs; however none of the studies endorsed a specific bundle application utilized to achieve its intended goal. Some practices adopted CDC's guidelines more than others and those showed a greater decrease in infection rate. In addition, it is evident that nurses deliver the best care when preventing an infection. Further research is needed to assess the effectiveness of a specific bundle element.

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