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Describe about the Chronic Illness and Nursing Care.

Description of Central Line Associated Bloodstream Infection

One of the greatest challenges to safe hospice stay and optimal care services provided to the patients during their stay in the health care facility is health care associated infections (Cruz et al. 2018). On a more elaborative note, the central line associated blood stream infections or CLABSI have been identified as the most frequently reported conditions affecting the patient populations. As mentioned by Patel et al. (2018), central line associated blood stream infection is the primary contributor to thousands of deaths all across the globe. Similarly, these infections also enhances the number of hospice stays in a day and also leads to considerable challenges associated with the health care complications that the patient had been suffering from. Undoubtedly this one of the most important and consequential issue that impacts not just the patients, but also the acre providers that are associated with the care program.

The central line is the central venous catheter, which is generally placed by the doctor in a large vein near the neck, chest, or groin, in order to give the medication to the patients. It has to be mentioned in this context that this invasive catheterization enhances the chance of the pathogenic microbes inhabiting the health care environment to access the bloodstream of the patient directly (Carpenter, McTigue and Roberts 2016). Hence, the central line associated blood stream infections are very serious infections that can is facilitated by the pathogen that blocks the catheter opening enter the blood stream of the patient and is spread throughout the body immediately causing severe and even possible fatal consequences for the patient. Even though the health care providers maintain a thorough infection control protocol, the prevalence of the CLABSI in the health care sector is alarming (Dees et al. 2017). Hence, I have chosen this grave issue for the this paper where I have chosen three different genre of research studies, a quantitative study, a qualitative study, and a systematic review study to review the findings and critically appraise the information provided by the research article. The primary aim to acquire and explore knowledge and idea regarding the CLABSI and how it impacts the health care scenario with respect to available literature evidence. This paper will use these three articles to construct a tabular summary of the three chosen articles, criticism of the article using a critical appraisal tool, and illustration of the key findings provided by the chosen literature evidences on the selected issue.

Author/s (year)

Country

Aims

or

Purpose

Sample/ setting

or

Key stake-holders and their roles

Design/ methods

or

Type of paper

Main findings

or

Primary argument

Strengths and limitations of the paper

Article 1

Rosenthal, V. D., Udwadia, F. E., Kumar, S., Poojary, A., Sankar, R., Orellano, P. W., ... & Patil, P. 2015

The primary aim of this randomized clinical trial is to compare the rates of central line associated bloodstream infection between the patients that used the split spectrum with single use prefilled flushing device and the patients that used a three way stopcock device

Sample Participants for this study included 1096 patients with 547 patients and 3619 central line (CL)-days for the SS + SUF group, and 549 patients and 4061 CL-days for the 3WSC group.

Setting for the research study had been 5 adult intensive care units.

Design for this research study had been a Quantitative randomized control clinical trial.

The collected data had been analysed with respect to three parameters, clinical analysis, microbiological analysis and cost effectiveness analysis.

The main data findings of the research article indicated that during the trial period the use of single slit along with single use peripheral devices was associated with significantly lower rate of Central Line associated bloodstream infection then that of the patients using three way stopcock devices.  Along with that the patient with split septums with single use preferred devices was also associated with better cost effective implementation than the other group in comparison.

the strengths and limitations of this resource study are not clearly identified and illustrated in the article by the authors.  However with respect to our review, the strength of the article include the sufficient sampling, thorough and rigorous data analysis and interpretation of the data, along with continuation with the previous research findings.

 The limitations of this research article include limited budget and the resources of the country setting.  A thorough illustration of the statistical analysis of the quantitative data identified for the article is also absent in the research study which can also be considered a  notable limitation

Article 2

McAlearney, A.S. and Hefner, J.L., 2014.

The primary objective of this research study was to determine whether infection control professionals and frontline staff have different perspectives regarding the facility design challenges of central line associated bloodstream infection prevention program success.

Sampling for key informant interviews that were carried out in 8 hospitals participating in the agency for healthcare research and quality central line associated bloodstream infection prevention initiative which is called “on the cusp stop BSI.”

Interview data from 50 Frontline nurses and 26 infection control professionals were analysed in order to identify common themes related to the program facilitated and challenges.  

The research design for this article for qualitative involving data from interviews which was analysed taking the help of thematic analysis.

The main findings indicated that there are four facilitators of central line associated bloodstream programs success including education leadership data and consistency.  There were three common challenges identified as well including lack of resources competing priorities and physician resistance. The article suggest that the infection control professionals are required to take the perspectives of staff nurses into account while they are implementing the improvement initiatives so that the success of the program can be ensured and facilitated.

This article also lacks the basic discussion regarding the strengths and limitations of the research study conducted.  Although in this case the torah analysis of the scenario involving the facility design challenges and their consistent illustration in the discussion is a  considerable strength that is needed to be considered when appraising a qualitative article.  The limited sampling and lack of explicit details on data collection and analysis procedure is a considerable limitation.

Article 3

Reyes, D.C.V., Bloomer, M. and Morphet, J., 2017

The primary aim of the article had been to identify and criticize the best available evidence on the interventions that can prevent central venous line associated bloodstream infections in the adult ICU patients in comparison to other antimicrobial catheters.

The research design had been a systematic review

The sampling was of 19 studies which was discovered using a systematic search of 7 data basis including MEDLINE, CINAHL plus, EMBASE, PubMed, Cochrane, Scopus, and Google scholar.

The data findings indicated that central venous line associated bloodstream infections can be drastically reduced by the range of interventions that includes closed in fusion systems, aseptic technique during insertion and management of central venous line, early removal of central venous lines and appropriate site selection.

The strength of the study includes the consistency of the findings with other literature and a hollow analytical detail provided by the authors in the discussion.  The limitation includes only including studies that are published in English and of predominant heterogeneity in the interventions in the included studies.  

In order to criticize the three research evidences, the critical appraisal tool that will be utilized is the CASP tool (Munn et al. 2014).  It is one of the most abundantly used critical appraisal tools in evidence based practice and providing a systematic framework in criticizing the validity and authenticity of a literature evidence which is why the tool had been chosen.  The first study had been a randomized controlled trial for which the CASP tool specific for randomized control trial has been used, which has three sections and 11 questions (Casp-uk.net 2018).  as per the tool that can be mentioned that the trial did address a clearly focused issue, the assignment of the patients to the treatments was randomized which was accounted for in the end of the study, although the patients and health workers were not blinded to the treatment as it has not been a double-blind or double dummy randomized controlled clinical trial which can be considered a imitation (Claydon 2015).  On the other hand the groups were similar and the groups were treated equally with just the exception of the experimental intervention being different for different groups which is a valid strength of the research article.  The result was clearly mentioned in the treatment effect was also not enough considering the sample size.  As per the data findings the estimate of the treatment effect was precisely mention and the results can be applied to the local population which indicates at the transferability and generalizability of the day tour finals.  Lastly this particular randomized control trial also two conditions of cost effectiveness of the intervention proposed all the all the clinical outcomes when not equally considered which can be taken as a flaw of confounders adjustment (Quigley et al. 2018).  

Chosen Research Studies to Critically Review CLABSI

 The second article has been a qualitative review for which the qualitative checklist of CASP has been used to criticize the literature which has three sections but 10 questions (Casp-uk.net 2018).  As per the critical tool the authors provided to clear statement of the aims of the research and the qualitative methodology chosen has also been appropriate along with recruitment.  Although, the relationship between researcher and participants was not adequately mentioned in the article.  There is a clear illustrated statement of the findings discussed and the article which indicates that the research findings is valuable with the only exception of lack of enough regards given to the ethical adjustment of the study (McAlearney and Hefner 2014)..

The third study is a systematic review for which the systematic checklist of caste was used that had 11 questions in three sections (Casp-uk.net 2018).  The systematic review study emphasized on a focused question and the selection of the people has also been correct with the only limitation of lack of heterogeneity of interventions of the included studies. To assess the quality of the studies the systematic review followed question effective practice and organization of care review group recommendation which is a considerable strength of the study design (Cavaleri, Bhole and Arora 2018).  The results have been precise and can be transferred to the local population and the possible harms and cost was also included which is a considerable strength of a systematic review masking it inclusive and multidimensional (Reyes, Bloomer and Morphet 2017).

Considering the data findings the first article by Rosenthal et al. (2015), suggested that the use of combined devices of split septum and single use prefilled flushing device is much more efficient and cost effective in reducing the rate of CLABSI than the usually used three-way stopcock device. This study provided a very innovative insight that can improve and reduce the rate of infections all the while being cost effective for implementation into larger hospital settings as well.  The qualitative study by McAlearney and Hefner (2014), on the other hand provider completed different administrative point of view regarding the facilitators and challenges present in improvement initiatives reducing the central line bloodstream infections. Only technological improvements is not enough for reducing the impact of disinfection there is need for administrative and management oriented changes and improvements as well so that the technological innovations can be implemented without any failure (McAlearney et al. 2017).  This article provided insight which can be used in addressing the administrative requirements in reducing the rate of this healthcare associated infection.  The systematic review by Reyes, Bloomer and Morphet (2017), stated 4 different practice protocol which if implemented can also reduce the rate of central venous Line bloodstream infection.  On a concluding note all three studies provided three different insights on reducing the infection rate, implementing the gist of the three studies can actually improve the infection rates in different healthcare units in a cost effective and efficient manner.

References:

Carpenter, A.D., McTigue, S. and Roberts, G.K., 2016. Suspected Origins of Bacteremia in Center for Disease Control (CDC) National Healthcare Safety Network (NHSN) Defined Central Line Associated Bloodstream Infections (CLABSI) at a Tertiary Care Academic Medical Center. American Journal of Infection Control, 44(6), p.S11.

Casp-uk.net 2018. CASP Checklists - CASP - Critical Appraisal Skills Programme. [online] Available at: https://casp-uk.net/casp-tools-checklists/ [Accessed 22 Oct. 2018].

Cavaleri, R., Bhole, S. and Arora, A., 2018. Critical Appraisal of Quantitative Research. Handbook of Research Methods in Health Social Sciences, pp.1-23.

Claydon, L.S., 2015. Rigour in quantitative research. Nursing Standard (2014+), 29(47), p.43.

Cruz, M.A., Masalunga, C.D., Rodriguez, M.L.C., Gervasio, C., Thornburg, D., Hannah, K. and Dalere, M.F., 2018. Central Line Associated Blood Stream Infection (Clabsi): A Cqi Project.

Dees, J., Schrier, L., Meyer, M., Pettrey, P., Rouillier, T., Marthenze, A., Munkel, M., Nelson, P. and Thomas, J., 2017. Changing Perspectives: Clabsi Reduction in a High Risk Patient Population. Biology of Blood and Marrow Transplantation, 23(3), pp.S480-S481.

McAlearney, A.S. and Hefner, J.L., 2014. Facilitating central line–associated bloodstream infection prevention: a qualitative study comparing perspectives of infection control professionals and frontline staff. American journal of infection control, 42(10), pp.S216-S222.

McAlearney, A.S., Hefner, J.L., Sieck, C.J., Walker, D.M., Aldrich, A.M., Sova, L.N., Gaughan, A.A., Slevin, C.M., Hebert, C., Hade, E. and Buck, J., 2017. Searching for management approaches to reduce HAI transmission (SMART): a study protocol. Implementation Science, 12(1), p.82.

Munn, Z., Moola, S., Riitano, D. and Lisy, K., 2014. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. International journal of health policy and management, 3(3), p.123.

Patel, P.K., Gupta, A., Vaughn, V.M., Mann, J.D., Ameling, J.M. and Meddings, J., 2018. Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. Journal of hospital medicine, 13(2), pp.105-116.

Quigley, J.M., Thompson, J.C., Halfpenny, N.J. and Scott, D.A., 2018. Critical appraisal of nonrandomized studies—A review of recommended and commonly used tools. Journal of evaluation in clinical practice.

Reyes, D.C.V., Bloomer, M. and Morphet, J., 2017. Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive and Critical Care Nursing, 43, pp.12-22.

Rosenthal, V.D., Udwadia, F.E., Kumar, S., Poojary, A., Sankar, R., Orellano, P.W., Durgad, S., Thulasiraman, M., Bahirune, S., Kumbhar, S. and Patil, P., 2015. Clinical impact and cost-effectiveness of split-septum and single-use prefilled flushing device vs 3-way stopcock on central line–associated bloodstream infection rates in India: a randomized clinical trial conducted by the International Nosocomial Infection Control Consortium (INICC). American journal of infection control, 43(10), pp.1040-1045.

Zeng, X., Zhang, Y., Kwong, J.S., Zhang, C., Li, S., Sun, F., Niu, Y. and Du, L., 2015. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta?analysis, and clinical practice guideline: a systematic review. Journal of evidence-based medicine, 8(1), pp.2-10.

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