Bloodstream Infection Paper

The presence of central line associated bloodstream infections (CLABSIs) in intensive care units is an ongoing problem in many hospitals in the country and around the world. Master’s degree prepared nurse Antoinette C. Lopez states that approximately 15 million patients experience central line infections each year in intensive care units (Lopez, 2011). It not only affects the patient, but also the healthcare team caring for the patient and the hospital. According to nurses Jessica M. Dixon and Robin L. Carver (2010), CLABSIs can affect the morbidity and mortality of the patient, number of days that they stay in the hospital, and the “cost of care” (p. 817). Nurses play an important role in the prevention and treatment of CLABSIs. Research has
Keywords used include: chlorhexidine, bathing, central venous catheters, catheter-related bloodstream infections, impact, and reduction. There were no randomized controlled trials found investigating the effect of chlorhexidine bathing on CLABSI. Three articles were chosen for review, two of which are quality improvement studies, and the third is a systematic review which looked at 8 studies testing the effectiveness of chlorhexidine bathing in reducing CLABSI incidence. The three articles reviewed were published from 2010-2012. Insertion of a central venous catheter presents an opportunity for bloodstream infection. According to the literature, use of chlorhexidine bathing, as a replacement for soap and water bathing, while patients have a central line in place may help reduce skin colonization and incidence of CLABSI. Two studies report high CLABSI incidence rates before use of chlorhexidine bathing, despite having successfully implemented the Institute for Healthcare Improvement (IHI) Central Line Bundle in their facilities with high caregiver compliance. The IHI Central Line Bundle consists of: “hand hygiene, maximal barrier precautions during insertion, skin antisepsis with chlorhexidine gluconate, optimal catheter site selection with avoidance of femoral vein for central venous access in adult patients, and daily review of line necessity” (Dixon & Carver, 2010, p. 817). Researchers reported a
(2012) was done at five hospitals, a tertiary hospital and four community hospitals. The tertiary hospital had two units, oncology and respiratory, which both take care of critically ill patients. The other four community hospitals each had their medical-surgical intensive care unit take part in the study. The researchers mention that inclusion criteria for the study was “admission to the study unit” with exclusion criteria being “pregnancy, breast feeding, chlorhexidine allergy, and severely denuded skin” (Montecalvo et al., 2012, p. 506). A sample size was determined based on the rate of the tertiary hospital for which they had “4 healthcare-associated bacteremias per 1000 patient days” (Montecalvo et al., 2012, p. 507). The researchers determined a sample size of 12,700 patient days would be used for both the pre-intervention and the active intervention (Montecalvo et al., 2012). They study does not mention how the researchers came to that result. They also do not mention if the sample size was inclusive for all hospitals that were a part of the