Prevention Change Proposal

Introduction

Most patients entering the healthcare industry require intravenous catheters for fluids and medication. Only intravenous administration of some medications and fluids into the central circulatory systems using central line catheters is permitted. Infusion therapy for acute and chronically unwell patients is crucially linked via central line catheters. Central line catheters are utilized as blood system entry points for the delivery of life-saving fluids and drugs. Central line catheters have risks in addition to the life advantages they offer. It has been suggested that certain risk factors increase complications like CLABSI (central line-associated bloodstream infection). CLABSIs lead to increased costs and significant morbidity. Many studies on techniques and strategies for reducing the prevalence of CLABSI have been carried out, including going beyond bundles and building multidisciplinary teams to insert and maintain central line catheters. Multidisciplinary teams are responsible for carrying out the surveillance necessary to eradicate CLABSIS, reduce incidence rates, and reduce related costs: this work aimsABSI research the wide range of issues it raises.

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Healthcare Centers for Reviews and Dissemination Guidance (HCRDG), Vascular Care Team (VCT), Neonatal Intensive Care Units (NICUs), National Healthcare Safety Network (NHSN), Medical-Surgical (MedSurg), Center for Disease Control and Prevention (CDCP), Central Line Maintenance kits (CLMKs), Central Venous Catheter (CVC), Evidence-Based Practice (EBP), Center for Disease Control (CDC), Evidence-Based Insertion (EBI), Central Line (CLABSI).

Background in Section 1

Even though CLABSIs are one of the significant HAIs (healthcare-associated infections) that raise medical expenses, mortality, and morbidity, numerous programs have been implemented to stop the infection (Berenholtz et al., 2014). There are many CLABSI prevention guidelines available. However, they all contain the same critical componentAlthoughmendations for reducing CLABSIs are clear and straightforward, Bundy et al. (2014) claim that many different elements must be coordinated to execute recommendations in clinical settings. There is global heterogeneity in performance or adherence to the suggested guidelines, and the treatments have not been effective. According to Bundy et al. (2014), it is impossible to overstate the importance of infection control in healthcare settings for patient safety and high-quality care. Still, the current pool of resources, including managerial support, the reimbursement system, and skilled staff, is insufficient to address all pressing problems in hospitals. Successful CLABSI prevention guidelines implementations require distinct criteria for various institutional or geographical circumstances.

CLABSI preventive strategies have wildly succeeded in intensive care units, claim Cho et al. (2017). Hospitals around the country have reported infection rates linked to CLABSIs. According to Cho et al. (2017), the National Healthcare Surveillance Network receives reports on infection rates. The reported rates range from 1.2 to 4.2 infections per 1000 catheter days. The CLABSI rate has decreased by 38% as a result. Despite the stated decline in CLABSI infection rates, infections are still happening in the medical-surgical units, according to Blot et al. (2018).

Further studies show that other hospital sections lack the strict surveillance that is usually carried out in the medical-surgical departments (Sacks et al., 2014). The accomplishments of the medical-surgical units and the CLABSI prevention initiatives have led regulatory authorities to call for increased measures beyond bundles. Only inpatient healthcare areas are being highlighted. A significant value for hospital settings might be introducing multidisciplinary teams to supervise all central line catheters.

Problem Statement in Section 2

A national average of 41,000 CLABSI cases are recorded each year in the healthcare sector, according to CDCP (2008). A CLABSI case typically costs $38,000 annually to treat (SHEA, 2009). However, until the Medicaid and Medicare services proclaimed there would be no reimbursement for infections contracted in hospitals, no additional players launched ns were launched beyond the fundamental care of preventing the infections of central l. On October 1st, 2008, Medicaid and Medicare services were impacted. Hospitals and all healthcare organizations must notify the National Healthcare Surveillance Network of all CLABSI incidents that occur in intensive care units, according to Furuya et al. (2016). (NHSN). IHIs and the CDC have started implementing aggressive efforts nationwide using the bundle idea while installing the central line device. Results submitted to the NHSN show encouraging advancements. The rate of CLABSI in intensive care units is starting to decline, according to Latif et al. (2015). The next stage is to expand interventions outside ICUs and throughout those, tal, employing a committed team approach for every central line device insertion and monitoring. The objective is to establish and maintain zeCLABSIs reality that can be attainePreventive intervention methods will outperform the bundle by

Preventive intervention methods will outperform the bundle by utilizing dedicated multidisciplinary central line (CL) teams at all hospitals. Data gathering for compliance would be provided by developing recognized, specialized teams conducting strict surveillance throughout the entire institution (healthcare sector). A daily assessment of the line’s requirement, proper dressing changes, early symptoms, and warning signals of issues such as delayed catheter placement are all examples of data for maintenance compliance. Better patient outcomes can be achieved by having specialized teams installing and monitoring all central line apparatus throughout the hospital, which will be supported by the data acquired (Bundy et al., 2014). ICUs are only required for reportable CLABSIs, according to Zavotsky et al. (2015); nevertheless, it is estimated that actual CLABSI incidences in the healthcare sector are three times higher than those recorded, including rates in settings outside of ICUs. Tracking of whole central line catheters was included in the data gathered. The information above implies that the formula and criteria from the Centers for Disease Prevention and Control were incorporated into the data collection (CDCP, 2005). The team followed comparable preventative program structures in other inpatient zones and applied the same technique utilized in ICUs to achieve the same results as achieved by ICUs.

Section 3: The Goals of the Proposed Changes

According to Sacks et al. (2015), patients admitted to medical-surgical units are frequently susceptible, which increases their risk of developing CLABSIs. These individuals are more likely to develop CLABSIs because catheter lines are frequently utilized in them, especially in times of emergency. Additionally, Sacks et al. (2015) note that as these patients spend longer in the hospital, the prolonged usage of catheter lines increases their risk of developing CLABSIs. Although CLABSIs have decreased frequently across many healthcare institutions, they remain a significant issue in the hospital setting, according to Berenholtz et al. (2004). Effective CLABSI incidence reduction requires complex interventions involving various drugs and practices.

The EBI for central lines has been widely used in hospital setups, but Schwartz et al. (2016) indicate that despite this widespread use, CLABSIs have not been abolished. According to Schwartz et al. (2016), research has not yet demonstrated whether the persistence of CLABSIs is due to risk factors shared by other patients or the ineffective use of evidence-based practices. According to Berenholtz et al. (2004), all hospital settings require commitment and strict performance in resources and labour. The safe advancement of tasks intended to slow the pace and progression of CLABSI incidents is made possible by a strong commitment and strict performance in resources and labour.

According to Latif et al. (2015), CLABSI has a financial burden because it negatively affects the healthcare industry. Again, according to Latif et al. (2015), CLABSI is strongly linked to increased transience and morbidity. Patients with CLABSIs typically stay in hospitals for more than 7 to 21 days. The lengthier the hospital stay, the more expensive the patient’s treatment will be. Hospital “never events” are caused by increasing treatment expenses since Medicaid and Medicare have reimbursed additional charges. The development of a safety culture is encouraged or counselled by nurses. The incidence of CLABSI can be significantly decreased and prevented by fostering a safety culture promoting ed safe culture; nurses significantly contribute to avoiding CLABSI rates (Berenholtz et al., 2014). Hospitals are dealing with a sharp rise in CLABSI incidents due to inadequate information and unnecessary education about EBPs. Even though almost all hospitals have rules in place to prevent CLABSIs, these hospitals consistently fail to ensure that these policies are implemented, raising the chance of contracting the illness. To avoid CLABSIs, competent nurses must understand and use infection control procedures.

PICOT Statement/Project Question, Section 4

CLABSIs are among the frequently occurring hospital-acquired infections (HAIs). CLABSIs are linked to tens of thousands of fatalities annually, rising healthcare expenses, and extended hospital stays (Cho et al., 2017). The question to be answered is if having specialized teams oversee all central line insertions in hospitals (specifically ICU) reduces CLABSIs compared to having bedside nurses be responsible for the upkeep and care of the patients.

The issue is as follows in PICOT format:

P-Inpatients.

I- Establishing specialized teams to supervise all central line insertions.

C- Bedside nurses are responsible for the upkeep and treating patients with a central line: o-Fewer central line infections or problems.

T-Throughout the hospital stay (ICU).

An increased and more intense emphasis has been placed on infection control. The frontline of the increased focus is always on challenging the control and preventative strategies used. The way nurses monitor, care for and maintain patients with central lines is being called into question by nursing practices. Implementing knowledge focused on achieving positive aims and objectives—better patient outcomes—thus takes precedence. Healthcare facilities must focus on prevention through preventative action and clinical reasoning to reduce CLABSIs (Bundy et al., 2014). The creation of CLABSI preventive initiatives must proceed quickly, and this requires a research framework that ties empirical findings to practical applications.

Supporting Literature, Section 5

This section’s primary goal is to present a literature review that supports the need for specialized vascular access teams. CLABSI illustrates a healthcare system and patient-costly hospital-associated infection that considerably raises death and morbidity rates. Medical-surgical units are considered to have a lower capability for oversight and control, which raises the risk for CLABSIs. The good news is that using EBPs in patient care significantly reduces the number of CLABSIs. We’ll review suggestions for insertion, keeping central lines, and prevention methods. To prevent CLABSI, search methods, research, and quality evaluations were offered. Based on the relevancy of the capstone project, literature was excluded and included.

Search Technique

The following databases were consulted for the articles: CNHAL, Medline, PubMed, Walden Library, Up to Date, and Science Direct. The English-language research literature, which covered 2000 to 2017, was written. The returned papers included CLABSIs, HAIs, PICC teams, dedicated IV teams, quality improvement, avoiding CL infections, and central bundle, among other search terms. Forty-eight publications’ abstracts and titles were found, but only 14 were used to support this capstone project data gathered. Data was gathered based on CDC guidelines for central line infections that must be reported to NH. The ICU patient population contributed to most of the project’s publications.

The research’s strengths, weaknesses, and validity are summarized.

The same approaches were used in all research studies to avoid CLABSI by putting IHI and CDC EBP recommendations into practice. Each of the eight papers acknowledged the necessity of having the central line implanted by someone with experience placing central line catheterZavotsky et al. (201 conducted a peer-to-peer review in oncology facilities conducted a peer-to-peer review in oncology facilities5) conducted peer-to-peer review in oncology facilities. The study’s qualitative goal was to describe the strategies used in oncology and medical units to lower the incidence of CLABSI. Once more, descriptive research by Furuya et al. (2016) sought to determine the association between bundle compliance and compliance rates in the adult US ICU. Both scientists came to the same conclusion. According to Zavotsky et al. (2015), using a team approach and bundle prevention significantly lowers CLABSIs.

On the other hand, according to Furuya et al. (2016), hospital sectors’ adherence to National Healthcare guidelines addressing CLABSIs lowered its occurrence by roughly 46%. The fact that those researchers employed first-hand information is a strength, however. However, data from a single si cannot accurately represent the total population. Because the research lacked control experiments, the investigations were examined for internal validity.

Latif et al. (2015) also researched the implementation of multiple interventions for CLABSIs in Abu Dhabi Hospital. Bundy et al. (2014) evaluated the viability of the multicenter efforts in standardizing CLABSIs tracking and CL care in oncology/hematology inpatient units, and Schwartz et al. (2016) evaluated the functional abilities of teams to adapt changing, coordinate, and evaluate changing dynamics of minimizing CLABSIs rates using evidence-based techniques in Michigan hospital. Although the findings were related, both researchers used qualitative methods. For example, the intervention by Latif et al. (2015) resulted in an overall reduced rate of 18% of CLABSIs, representing a considerable decrease in CLABSI morbidity and death. According to Schwartz et al. (2016), CLABSIs decreased by 10.6% when medical professionals raised problems and addressed ambiguity.

Last, Bundy et al. (2014) found that CLABSIs significantly reduced the number of pediatric oncology/hematology inpatientOne. Of that, this study offers valuable information, behavioural patterns, and age requirements. This study’s weakness is that specific points were used to obtain the data. Therefore, there is not enough data to represent the total population. Because the investigations were carried out in various ways, the researchers’ findings have differing degrees of validity.

Additionally, Sacks et al. (2014) could help lower the incidence of CLABSIs in surgical ICUs. Cho et al. (2017) did a study to ascertain the impact of focused interventions on the trends of CLABSIs in tertiary hospitals in Korea. Scheck et al. (2015) carried out research to find factors explaining differences in programs that prevent rates of CLABSI in hospitals. Both researchers used qualitative management techniques. According to Sacks et al. (2014), effectively implemented IHL lowers CLABSI rates in surgical ICUs by 68%. According to Scheck et al. (2015), employing effective management techniques and leadership abilities reduces the frequency of CLABSIs. According to Cho et al. (2017), managed targeted therapies cause a noticeable decline in the trend rates of CLABSIs. A lot of recommendations can be made using these findings. Despite the promising findings, the researchers faced some obstacles related to patients’ reluctance to contribute money and information.

Most research publications focused on catheter insertion and were by the bundle advised by IHI and CDC. The necessity of expert teams for the insertion and maintenance of central line catheters was covered in a few papers. All of the researchers found that employing the suggested tactics lowers the rate of CLABSI. Increasing professional education was crucial in lowering CLABSIs. Rates of CLABSIs are reduced by teaching the staff specific strategies to use while evaluating central line catheters. I suggest the following to maintain a committed team approach: delivering encouraging results to stakeholders to garner additional support for the project; maintaining committed team approaches in the hospital to provide 100 per cent compliance with recommendations from IHI and CDC for inserting and caring for the central line apparatus; continuously assessing team competence; and discouraging femoral venous access.

Nursing Model in Section 6

The complexity of CLABSIs has been addressed and described in a large body of literature. Patients who spend more time in hospitals develop CLABSIs. A lengthier stay in the hospital leads to poor maintenance, insertions, and care, which raises the risk of contracting the infection. Overstaying in the hospital is a direct result of CLABSIs, and the longer the hospital stay, the more expensive the therapy will be. According to Bundy et al. (2014), CLABSIs pose more difficulties for healthcare institutions, necessitating the continuing application of preventative measures.

Theory from Novice to Expert

Healthcare industries and all relevant authorities have designated specialized teams of professionals to lower the rates of CLABSIs. The designated team’s primary obligation is to carry out EBP-compliant policies. Many hypotheses have been established to help lower the frequency of CLABSIs. For instance, the theory of Novice to Expert. This hypothesis was created by Benner in 1984 and is a nursing theory. This notion incorporates the acquisition of information and skills as well as the use of preventative measures. Nurses must complete five competence levels to increase their skills: novice (beginning), advanced beginner, competent, proficient, and expert. According to Benner, these levels use post-concrete examples to reflect on the principles of abstract motion. Benner (1984) notes that these nurses (fresh nurses) enter the nursing field as advanced novices since nursing schools teach about infection prevention.

Many nurses in clinical settings have received training to maintain and care for central lines. Nurses should abide by the rules and regulations set forth by CVC regarding the insertion and upkeep of central lines because doing so is a delicate procedure. Patients become infected when exposed to high risks of CLABSIs (Yoo & Choi, 2001). Due to significant and ongoing changes in healthcare technology, nurses working in healthcare settings must consistently implement EBP daily. Utilizing expertise is required for this. Numerous nursing approaches acknowledge the value of nursing skills. According to Tond and Gaynes (2017), recognizing one’s skill entails conconsideringl providing patients in medical-surgical facilities with higher-quality care. For nurses to acquire the necessary information and skills, their expertise process should adhere to Benner’s Novice Theory levels. The level of care given to the patient is improved as a result.

Implementing a team approach plan is necessary. According to Berenholtz et al. (2014), adopting a team approach plan will help nurses and the appropriate authorities keep up with the most recent research on the methods and tactics for avoiding the spread of CLABSIs. CLABSI rates are declining due to recent findings that the methods and tactics for halting the transmission of CLABSIs are effective. I will employ the Novice Expert Theory to inform the personnel (nursing staff) and pertinent authorities about the policies and practices that will aid in reducing infection rates. Compliance with evidence-based recommendations for line insertion, patient care, and central line back maintenance using hand washing is crucial for lowering infection rates in the healthcare industry. In light of this, nurses, in particular, should obtain in-depth training in caring for catheter-line patients. According to Furuya et al. (2016), developing complaints of infection control policies requires the employment of a team approach.

Applying the novice to expert theory is crucial for discussing CLABSI dilemmas with the committed team, particularly the education issue. According to Benner (1984), five competency levels are used to categorize healthcare professionals’ learning performance processes. The classification of performance and learning should be done at five proficiency levels, according to Benner (1984). Experts have recognized five skill levels as especially helpful to the nursing industry, especially at the novice (beginning) stage. A prospective person can comprehend the knowledge and skill levels using the five competency levels of gaining skills and knowledge. The acquired abilities ought to apply to the nursing profession. Continuous staff education is necessary. Once more, staff education shouldn’t be haltedOngoing education is. Ongoing crucial education is crucial because it will put the nursing staff in a better position to safeguard the central line. Protecting central lines entails numerous steps, including tubing maintenance, changing the dress code, maintaining central lines after blood infusions, and teaching clients (patients) how to care for central lines.

Developing learning management skills is crucial for nurses in various ways, according to Benner (1984). Nurses can grasp the processes of maintaining the central lines by gaining management skills. Again, nurses apply the knowledge in line maintenance through learning management skills. Bigelow (2013) asserts that CLABSIs are caused by carelessness, inadequate abilities, and ignorance of the rules and regulations governing the upkeep and maintenance of catheter lines. On the other hand, Benner’s Novice to Expert Theory offers steps that force nursing practitioners to acquire pertinent knowledge. A good management knowledge and skill set, as well as an excellent guiding program, are offered by Benner’s Novice to Expert Theory competency level for preventing CLABSI. Benner claims experienced nurses may guide and instruct less-experienced nurses using the Novice Expert Theory. Inexperienced nurses are given the necessary information and skills of practical health professionals through mentoring and education. Once more, Novice to Expert Theory presents multidimensional programs that help with education and analysis of studies about bundles. As a result, the team approach established by nurses using the Novice to Expert Theory aids in controlling and decreasing CLABSIs in medical-surgical settings.

Plan for Implementation and Evaluation in Section 7

Strong teamwork is required if initiatives for managing and preventing hospital-acquired infections are t be carried out successfully. Patients are the primary stakeholders and assets in this CLABSI capstone project. Therefore, to obtain essential and high-quality care, patients should recognize and appreciate the contributions of necessary parties (Band & Gaynes, 2017). Bigelow, Wolkowski, Baskin, and Gorko (2013) claim the higher executive should be involved in healthcare. The chief executive’s job is to provide the project with the authorized ingenuity and potential that it needs to be implemented. The quality control office has received requests regarding the execution of this project. The quality program will be the primary sponsor of this capstone project. I will collaborate with experts in the health sector and the quality control office while I carry out this project. As the project’s innovator, my first goal will be to adhere to the project’s timetables and objectives. Plans for the project will be merged to ensure that the timetable and goal are upheld. The health team members will participate in this project to ensure its success. Nurses, doctors, hospital management officials, and nutritionists are required participants (Schwartz et al., 2016).

CVCs are typically used as treatment infusions for critically ill and chronic patients in medical-surgical departments. CVCs are typically implanted intravascularly into the big vein. The internal jugular and superior and inferior vena cava are the most prominent veins for implantation. The more prominent veins offer penetration to the body, where parental nutrients, fluids, blood intravenously, and medication are administered into the body, according to Furuya et al. (2016). Again, hemodialysis makes use of CVC.

Additionally, blood is measured in the heart, arteries, and veins. CVC is a dual-purpose device that increases the risk of HAIs and saves lives. There are great dangers because CVC offers an area where bacteria can obstruct during installation. Because of this, HAIs are often lethal and pose a threat to life.

According to Cho et al. (2017), staff members’ carelessness when the femoral and subclavian veins are applied for a prolonged period, improper device care and maintenance, and ignorance in implementing better procedures during device insertion are risk factors for CVC infections. Because treating patients involves higher costs, CLABSIs are referred to be a financial burden on hospitals and patients. The expenditures are significant because Medicaid and Medicare have paid for their services. Setting up organized monitoring and infection control procedures is crucial. Again, appropriate mechanisms for reporting CLABSIs should be in place during the implementation of the procedures. When hospitals seek to control CLABSIs, they should have vascular teams to implement their plans. The vascular team ensures that CVCs are correctly maintained, proper insertion techniques and appropriate safeguards are used. The vascular team will comprise physicians and nurses skilled in CVC placement, maintenance, and care. The group will start vascular process improvement technologies by using EBP.

Evaluation

Planning evaluation is crucial because it considers if the targeted population is appropriate. The evaluation process is designed to offer the proof needed for the plan’s continuation, delivery planning, and raising of issues. The issues identified are likely to become apparent during implantation. Assigning and establishing vascular teams, the team that will aid in reducing instances of CLABSIs in medical-surgical facilities, is the primary focus of implementing the strategy. Per the Novice to Expert Theory, committed personnel receive training to ensure the plan’s objectives are affected. An evidence-based preventative package is included in the training. The establishment of critical evaluation-related criteria is the goal of VCTs. The measuring method and result process of medical-surgical procedures at particular hospitals that also serve as competency assessment facilities are thus included in the evaluation process. The compliance of the nursing staff and the appropriate application of care bundle insertions will be critical factors in the measuring and assessment procedure. Once more, use the right kind of catheter.

The findings of the measurement process are said to be affected by the reporting of CLABSIs. The evaluation plan’s success depends on gathering input from nursing experts. Every month, auditing and evaluation of insertion usage and compliance will be done. CLABSI’s capstone project champions (nurses, infection control personnel, and doctors) will be required to respond to inquiries and look into program defects during the evaluation process. The group will also create plans to eliminate further downsides (Latif et al., 2015). An evaluation of education measurement will take place during the evaluation procedure. Pre- and post-assessment tests will assess nurses’ expertise in this process. The evaluation strategy will also evaluate behavioural change. A behavioural modification will be implemented with an educational assessment to ensure nurses complete the training successfully. Behavioural and educational programs ensure significant improvements during CVC installation and maintenance. The evaluated educational programs will be implemented to address skills and behaviours, attitudes and beliefs, and knowledge of CVC insertion. The team method under consideration will successfully detect, keep an eye on, manage, and stop the spread of CLABSI.

Section 8: Potential Obstacles to Implementation and Solutions.

Potential Obstacles to Implementation

Like every strategy, there are several obstacles to the CLABSI plan’s implementation—for instance, potential immunosuppression in the patient. Blot et al. (2018) claim that immunosuppressing patients in medical-surgical facilities is an option during the project to prevent CLABSIs. It was tough to release patients with CLABSIs due to their poor nutritional conditions and the continuous need for access to central lines in medical-surgical settings. Yet another instance of disregarding the rules and norms. This occurs due to the hospital administration’s failure to uphold essential policies. For instance, they advocate complex rules, deterring members from giving the necessary information.

Moreover, there is a lack of medical resources. The medical resources offered ought to be adequate for continuing the program. However, some hospitals cannot provide enough consumables, medical equipment, cleaning solutions, catheter kits, dressing supplies, and portable X-ray machines. This frequently occurs since these resources are expensive. Poor knowledge is another. The personnel frequently lacks adequate understanding of the most recent infection control procedures. My realization that medical-surgical unit staff members lack the appropriate knowledge of chlorohexidine protocols for central line care was aided by my research.

Getting Past the Obstacles

It is essential to address the implementation hurdle indicated above. They are considering the empowerment of nurses, for instance. All levels of management should pay attention, and the staff and management should work together. All of the initiatives above would contribute to providing recommended interventions with reliability. Once more, removing the obstacles requires institutional commitment. Furuya et al. (2014) claim that this criterion incorporates top management’s ongoing participation, the development of teamwork and accountability, and top management. additionally creating specialized teams. Creating a multidisciplinary, committed team entails updating the policies, training the employees, stepping up hand washing standards, and providing performance feedback. Once more, the government can provide medical resources that hospitals cannot provide.

Conclusion

Central line catheters are utilized as blood system entry points for the delivery of life-saving fluids and drugs. Central line catheters have risks in addition to the life advantages they offer. It has been suggested that certain risk factors increase complications like CLABSI (central line-associated bloodstream infection). CLABSIs lead to increased costs and significant morbidity. In intensive care units, CLABSI preventive strategies have had great success. Hospitals around the country have reported infection rates linked to CLABSIs. Due to their frequent vulnerability, patients admitted to medical-surgical units are more likely to develop CLABSIs. Preventive intervention methods will outperform the bundle by utilizing dedicated multidisciplinary central line (CL) teams at all hospitals—creating reputable, committed teams that operate rigorous hospital-wide surveillance.

References

Band, J., & Gaynes, R. (2017). Prevention of intravascular catheter-related infections. UpToDate. Retrieved from http://www.uptodate.com/contents/prevention of intravascular catheter-related infections.

Berenholtz, S., Pronovost, P., Lipsett, P., Hobson, D., Earsing, K., Farley, J., & Perl, T. (2014). Elimination of catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine, p. 32, 2014-2020.

Benner, P. A. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley

Bigelow, L., Wolkowski, C., Baskin, L., & Gorko, M. (2013). Lean six sigmas: Sustaining the gains in a hospital laboratory. Clinical Leadership & Management Review, 24(3), 1–14.

Blot, F., Schmidt, E., Nitenberg, G., Tancrede C., Leclercq, B., Laplanche, A., & Andremon A. (2018). Earlier positivity of central venous versus peripheral blood cultures is highly predictive of catheter-related sepsis. Journal of Clinical Microbiology, 36(1), 195-9.

Brett, J. (2002). Use of nursing practice research findings. Nursing Research, pp. 36, 344. Berenholtz SM, Lubomski LH, Weeks K, Goeschel CA, Marsteller JA, Pham JC, Sawyer MD, Thompson DA, Winters BD, Cosgrove SE, et al. (2014). Eliminating central line-associated bloodstream infections: a national patient safety imperative. Infect Control Hosp Epidemiol, 35:56–62.

Bundy, D. G., Gaur, A. H., Billett, A. L., He, B., Colantuoni, E. A., and Miller, M. R. (2014). They are preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results. Pediatrics.

Centers for Disease Control and Prevention (2005). Recommendations for preventing transmission of infections among chronic hemodialysis patients. Morbidity and Mortality Weekly Review, 50(5).

Centres for Disease Control and Prevention. (2008). Central line-associated bloodstream infections: Resources for patients and healthcare providers. Retrieved from: http://www.cdc.gov/HAI/bsi?CLABSI-resources.html

Centre for Medicare & Medicaid (2008). Medicare non-payment of hospital-acquired infections: Infection rates three years post-implementation. Retrieved from: http://www.CMS.gov/mmrr/download/mmrr2009_+003_03_a08.pdf

Cho, S. Y., Chung, D. R., Ryu, J. G., Choi, J. R., Ahn, N., Kim, S. & Song, J. H. (2017). Impact on Targeted Interventions on Trends in Central Line-Associated Bloodstream Infection: A Single-Centre Experience from the Republic of Korea. Critical Care Medicine.

Furuya, E. Y., Dick, A. W., Herzig, C. T., Pogorzelska-Maziarz, M., Larson, E. L and Stone, P. W. (2016). Central Line-Associated Bloodstream Infections and Bundle Compliance in ICUs: A National Study.

Latif, A., Kelly, B., Edrees, H., Kent, P.S., Weaver, S.J., Jovanovic, B., Attallah, H., de Grouchy, K. K., Al-Obaidli, A., Goeschel, C.A. & Berenholtz, M.(2015). Implementing a multifaceted intervention to decrease central line-associated bloodstream infections in SEHA (Abu Dhabi Health Services Company) intensive care units: the Abu Dhabi experience.

Sacks, G. D., Diggs, B. S., Hadjizacharia, P., Green, D., Salim, A., & Malinoski, D. J. (2014). Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement Central Line Bundle. The American Journal of Surgery.

Schwartz, S., Frankel, A., Rehder, K., Leonard, M., Frankel, T., Watson, S., and Sexton, J. (2016).

Central Line-Associated Bloodstream Infection Rates Associated with ICU Teamwork Climate. Critical Care Medicine.

Yoo S, Ha M, Choi D, Pai H. (2001). The effectiveness of surveillance of central catheter-related bloodstream infection in an ICU in Korea. Infect Control Hosp Epidemiol, 22:433–6.

Zavotsky, K. E., Malast, T., Festus, O. and Riskie, V. (2015). We are reducing Central Line-Associated Bloodstream Infections in Oncology—units using peer review.

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Question

Propose a change to one aspect of your local or regional healthcare system or program that would improve outcomes. Then, conduct a comparative analysis of other non-U.S. healthcare systems, focusing on the proposed change. Summarize the proposed change and your comparative analysis in a 4-5 page report.
Prevention Change Proposal

RUBRIC
Competency 1: Identify the challenges and opportunities facing health care.
- Identify an aspect of a local or regional healthcare system or program that should be a focus for change.
Competency 2: Compare the effects of different healthcare finance models and policy frameworks on resources and patient outcomes.
- Define desirable outcomes, including who will pay for care and factors limiting achieving those outcomes.
- Analyze two non-U.S. healthcare systems or programs that offer insight into a proposed change for a healthcare system or program in the United States.
Competency 3: Evaluate leaders’ positive and negative influences on healthcare processes and outcomes.
- Determine the financial and health implications of making—and not making—proposed changes to a healthcare system or program.
Competency 4: Develop proactive strategies to change the organization’s culture by incorporating evidence-based practices.
- Explain why specific changes will lead to improved outcomes.
Competency 5: Communicate effectively with diverse audiences in an appropriate form and style consistent with applicable organizational, professional, and scholarly standards.
- Write clearly and concisely in a logically coherent and appropriate form and style.
- Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.

Prevention Change Proposal