Effect of CLABSI Bundle on Reducing Central Line Infection Compared with Standard Care for Central Line

TABLE OF CONTENT

INTRODUCTION1

Need for the study2

Importance of the study2

Previous studies3

Cost and benefits4

Direct Medical Cost Associated with CLABSI and standard care for central line infection5

STATEMENT OF CLINICAL QUESTION7

Variables and design7

THEORETICAL FRAMEWORK9

Economic Study Type and Cost Variables9

Kristen Swanson's Theory of Caring10

Importance and use for the topic11

THEORETICAL AND OPERTIONAL DEFINITIONS13

Theoretical definition13

Operational definition13

Defining variables13

REVIEW OF LITERATURE15

Search strategy15

Keywords15

Databases15

Strategy for Extracting the Data16

Review of studies16

Critique19

DETERMINATION OF THE EVIDENCE-BASE FOR YOUR CLINICAL QUESTION22

Determining the best evidence23

CONCLUDING PARAGRAPH25

References26

INTRODUCTION

The CL Bundle has been widely promoted across the United States and even included as a basis of a checklist by the National Patient Safety Goals (NPSG) and the Joint Commission in 2010 (Needham 2011). Two independent studies that implemented the CL Bundle across hundreds of ICUs, however, had different outcomes. The study that showed effectiveness was conducted by Pronovost and associates in 2006. It was a collaborative cohort study, acquiring data from 103 ICUs in Michigan focusing on the CL Bundle intervention. Pronovost et al. found that after 6-12 months of implementing the CL Bundle of aseptic techniques, the mean rate of CLABSI decreased from a baseline rate of 7.7 cases per 1000 catheter days to 1.4 cases per 1000 catheter days. The study's limitations were its study design, potential measurement bias, and lack in ability to generalize findings, among other limitations mentioned (Schumock 2010).

An independent cross-sectional study, surveying 312 ICUs in 250 hospitals revealed when implementing the CL Bundle on a much grander scale, effectiveness in reducing rate of CLABSI depended heavily on compliance. Authors of this study found of the total ICUs that monitored compliance, only 38% reported very high compliance with the CL Bundle (Furuya et al., 2011). Authors further concluded that “only when an ICU had a bundle policy, monitored compliance with it, and had 95% or greater compliance did CLABSI rates decrease” (Furuya et al., 2011). This alludes to the fact that bundled policies alone cannot guarantee reliable implementation throughout a health care system. More importantly, even through decreases in CLABSI were reported (Perl 2010).

Need for the study

This research was needed because healthcare executives and physicians who practice medicine need reliable information central line and CLABSI rates. This information assist clinicians in better clinical management strategies, improved selection of antibiotics, improved aseptic technique, and even better selection criteria for procedures being performed on the patient. The healthcare executive may find opportunities for improved diagnostic coding techniques, improved utilization of personnel, or improved negotiations with insurance companies. The research identified a causal relationship between care techniques for those with CLABSI and care for central line infection in comparison with standard care for central line infection (Walker 2008).

This study bridges the gap in knowledge between these hospital environments and provides substantive data that offers clinical and managerial information that directs physicians and executives to better clinical and operational management paradigms. Clinical research developed the scientific foundation for medical practice, and the effect of research on medical practice is observed now ...