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.

Bakgrunn: Blodbaneinfeksjon er en av de alvorligste sykehusinfeksjonene pasienter kan utsettes for, og i intensivavdelingen rammes de mest sårbare pasientene. Målet med studien:Å finne insidensen av blodbaneinfeksjoner (BSI) i en intensivavdeling i et lokalsykehus i Norge, samt undersøke ulike risikofaktorer knyttet til Centrale Venekatetre (CVK) og generell infeksjon ved innleggelse i intensivavdelingen. Metode: Insidensregistrering av BSI i løpet av 12 mnd. der definisjoner av BSI bygger på 2001 International Sepsis Definition Conference. Data er samlet inn prospektivt etter hvert som pasientene ble lagt. Studiepopulasjonen er antallet pasienter som hadde vært innlagt i mer enn 48 timer i intensivavdelingen, og deles opp i tre åpne kohorter:Pasienter med diagnostisert BSI i løpet av oppholdet, pasienter som fikk lagt inn CVK og pasienter med infeksjon ved innleggelse. Resultater: 615 pasienter ble lagt inn i intensivavdelingen i løpet av 12 mnd, av disse ble 116 av de pasientene som hadde vært innlagt i intensivavdelingen i mer enn 48 timer inkludert i studien. Gjennomsnittlig liggetid i intensivavdelingen varierte fra 2 til 40 (median 4 dager). 73 av de 116 pasientene fikk lagt inn CVK, og av disse fikk 11 en bekreftet BSI. Tre pasienter uten CVK fikk bekreftet BSI, totalt 14. Av disse 14 var 6 nosokomiale, altså 5,2 % (6 av 116) eller 7,8 BSI/1000 pasientdøgn. Enpasient fikk diagnosen kateter-relatert BSI(CR-BSI), noe som tilsvarer 1,7 CR-BSI/1000 kateterdøgn. Det ble tatt totalt 69 blodkulturer, herav 54 fra pasienter med CVK. Pasienter med CVK har signifikant større risiko for å utvikle klinisk BSI, enn de utenCVK (OR=5,31; 95 % CI 2,32 –12,0; p&lt; 0,0001). Konklusjon: Denne studien viser en relativt lav forekomsten av BSI, NBSI og CR-BSI, men for å kunne sammenligne tall nasjonalt og internasjonalt er det behov for en consensus i fagmiljøet rundt definisjoner BSI og særlig CR-BSI. Det er signifikant sammenheng mellom CVK og utvikling av klinisk BSI, men studien viser ingen signifikant sammenheng mellom CVK og bekreftet BSI. Studien bør bidra til fokus på risikofaktorene knyttet til bruk av CVK, samt arbeid for consensus angående definisjoner og økt fokus på CR-BSI og klinisk BSI, siden dette har vist seg å ha like høy letalitet som bekreftet BSI / Background: BSIs is areof the most serious hospital infections patients are exposed to, and in the intensive care unit (ICU) it affects the most vulnerable patients. Aim: To find the incidence of BSI in an ICU in a local hospital in Norway, as well as examine the various risk factors related to Central venous catheters (CVK), as well as patients with general infection at point of admission. Method: Incidence registration of BSIs within 12 months, where the definitions of BSI is based upon the 2001 Sepsis Definition Conference. Data is collected prospectively as patients were admitted to the ICU. The study population is the number of patients who had been hospitalized for more than 48 hours in the ICU, and the study population is divided into three open cohorts.Patients with diagnosed BSI during their stay, patients with CVK during stay and patients with infection at admission. Results: 615 patients were in the ICU within 12 months, and 116 of those patients had been hospitalized for more than 48 hours in the ICU and were included in the study. Average length of stay ranged from 2 to 40 days (median 4 days). 73 of the 116 patients had CVK in place during their stay, andof these 11 had a laboratory confirmed BSI. Three patients without any central CVK in place during their stay in the ICU had a laboratory confirmed BSI, 14 in total. Of these 14, 6 weredefined nosocomial, i.e.5.2% (6 of 116) or 7.8 BSI/1,000 patient days. One patient was diagnosed with catheter-related BSI (CR-BSI), which corresponds to 1.7 CR-BSI/1, 000 catheter days. A total of 69 blood cultures were performed, of which 54 patients with CVK. Patients with CVK has a significantly higher risk of developing clinical BSI than those without CVK (OR = 5.3, 95% CI 2.32 to 12.0, p &lt; 0.0001). Conclusion: This study shows a relatively low incidence of BSI, NBSI and CR-BSI. CVK is significantly related to the development of clinical BSI, but the study shows no link between CVK and laboratory confirmed BSI. This study may encourage health care  workers to focus more on the risk factors associated with the use of CVK to critically ill patients. It should also encourage researchers to focus more on the importance of consensus regarding definitions of BSI and clinical BSI, since this have been proven to have as high lethality rates as laboratory confirmed BSI / <p>ISBN 978-91-86739-86-7</p>

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.

Ethanol lock therapy is a novel technique that is being studied for its efficacy in eradicating catheter related bloodstream infections. A systematic review of interdisciplinary studies from CINAHL, Medline, Academic Search Premier, Biological Abstracts, and Web of Knowledge databases was performed. This meta-analysis examined the findings of thirty-five studies on ethanol lock therapy. Twenty-six of these studies compared ethanol to a placebo and nine studies performed a direct comparison of ethanol to other agents frequently used in antimicrobial lock technique. Ethanol lock therapy was shown to be effective as both a prophylactic therapy and as an active treatment in eradicating biofilms of organisms that frequently cause catheter-related blood stream infections, including Staphylococcus epidermis, Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, E. coli, and Candida albicans. Ethanol has been shown to have a synergistic effect with several other antimicrobial agents. The majority of studies examined in this thesis have found that ethanol has equal or greater efficacy to several antibiotic and antimicrobial agents used in practice and should therefore be considered for the treatment of catheter-related blood stream infections.

Central line-associated bloodstream infection (CLABSI) at the local healthcare setting exceeded the benchmark of 0 CLABSI. The Infection Prevention and Control (IPC) department determined that a role as CLABSI nurse champion would address the problem; however, no comprehensive education on CLABSI prevention and maintenance was available at the site. The purpose of this project was to develop a CLABSI prevention and maintenance education module using Knowles's adult learning theory and the chain of infection model. The practice-focused question asked whether a CLABSI educational module would provide the necessary information to educate nurse champions on CLABSI prevention and maintenance. The education module was presented to 9 local experts, composed of the Infection Prevention and Control (IPC) director, doctor of medicine, microbiologist, biomedical technologists, IPC nurses, and 2 staff nurses, who evaluated the CLABSI education module. An 11-question Likert-scale questionnaire that included an option for recommendations for improvement was used by the expert panel to evaluate the module. Of the 11 questions, only 3 were scored as strongly agree or agree, indicating a need to modify the module to raise the education level of the content and to include the clinical standards, objectives, and dressing-change procedures. After modifications, the education module was scored again, and 100% met the criteria and the recommendations of the expert panel. The project has the potential to promote positive social change by increasing the knowledge of the CLABSI nurse champions and by reducing the risk of CLABSI at the site.

Background: Catheter-associated bloodstream infections have been extensively studied in Intensive Care Unit Patients. However, less is known about the effect these infections have on non-ICU patients. This study attempted to elucidate the nature of the problem effecting non-ICU patients through descriptive analysis. Methods: Data were collected for all non-ICU patients with Staphylococcus aureus (S. aureus) infections at Grady Memorial Hospital in 2006. Demographic and hospitalization information was collected. The hospital epidemiologist responsible for surveillance of infection control programs determined outcomes attributable to the S. aureus infections. Data were entered into an Excel spreadsheet and then imported into EpiInfo 2007. Results: There were 91 S. aureus bloodstream infections documented, 38 infections in non-ICU patients and 52 infections in ICU patients. The descriptive information we accumulated offered potentially important different points between patients with MSSA and MRSA. We found more MRSA infection than MSSA infection in both the non-ICU and ICU patients. Additionally, in both groups those with MRSA infection had a length of stay at least twice as long as patients with MSSA, longer time from admission to positive blood culture, and longer time from positive blood culture to discharge. The most common type of morbidity found was sepsis, which was also the most common morbidity found in those who died. Conclusions: Our hypothesis that non-ICU patients would have increased morbidity and mortality directly attributable to the CA-BSI with S. aureus was proven to be false. Although still an issue, the morbidity and mortality was not as different as we thought it would be. While our hypothesis was proven false, this research provides information that would be well served through further studies.

(Thesis: M.S.P.H.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / INTRODUCTION: Although serious complications of invasive bedside procedures are rare they can be life threatening. Interest in identifying and preventing complications of bedside procedures has been heightened recently in light of such complications increasingly being linked to hospital reimbursement. In part I of this thesis we present the validation of ICD-9-CM codes for identification of the two most common complications associated with central venous catheterization. In part II we determine the impact of the development of a medical procedure service (MPS) on patient safety surrounding bedside procedures and resident education. METHODS: Part I: Cases of iatrogenic pneumothorax and central line associated blood stream infections (CLABSI) identified by ICD-9-CM codes in discharge data provided by Boston University Medical Center to the University HealthSystem Consortium were compared with those revealed by medical record abstraction of central venous catheters placed between 7/10-12/11. Part II: Retrospective cohort analysis of consecutive adults admitted to the internal medicine service who underwent a bedside medical procedure between 7/10-12/11 comparing characteristics and outcomes of procedures performed by the MPS versus primary services. RESULTS: Part I: The ICD-9-CM code for iatrogenic pneumothorax (512.1) had a sensitivity of 66.7%, specificity of 100%, positive predictive value of 100% and negative predictive value of 99.5%. The ICD-9-CM codes for CLABSI (999.31 and 999.32) had a sensitivity of 41.7%, specificity of 98.0%, positive predictive value of 20.0% and negative predictive value of 99.3%. Part II: We evaluated 1707 bedside procedures (548 by MPS, 1159 by primary services). While the MPS was more likely to successfully complete procedures (95.8% vs. 92.8%, p=0.02) and to use best practice safety process measures (95.4% vs. 51.0%, p<0.0001), the composite rate of major complications was similar (1.6% vs. 1.9%, p=0.71). CONCLUSIONS: Complications associated with invasive beside procedures are rare. The low sensitivity and variable positive predictive value of ICD-9-CM codes for detection of complications of central venous catheterization limits their use for internal quality improvement purposes. While use of a medical procedure service was associated with increased use of evidence based process measures, it did not significant affect the rate of major complications associated with bedside procedures. / 2031-01-01

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.

No description available.

VitalSmarts® Crucial Conversations™ general program theory might be a possible countermeasure addressing organizational culture and communication factors affecting quality and safety. This practice inquiry reports: a VitalSmarts® Crucial Conversations™ general program logic model, a major medical center's Crucial Conversations™ historical implementation program logic model, a clinical exemplar central line associated blood stream infection program logic model; and, findings that describe the fidelity of the major medical center's Crucial Conversations™ historical implementation and clinical exemplar central line associated blood stream infection program logic model to the VitalSmarts® Crucial Conversations™ general program logic model. The results demonstrated there was no fidelity between the major medical center's Crucial Conversations™ program logic model and the VitalSmarts® Crucial Conversations™ general program logic model. The clinical exemplar CLABSI program logic model and VitalSmarts® Crucial Conversations™ general program logic model fidelity differed in intended outcomes. The results might suggest that program adaptability along with program fidelity are factors that influence program strength, and these factors must be uniquely balanced within organizational dynamics to realize intended outcomes. The formative evaluation and program logic model might be a feasible methodology and applicable tool for exploring quality and safety within complex adaptive systems, such as organizational culture, where constraints possibly could exclude more rigorous scientific methodologies until factors are more understood.