Essay Grade

Running head: LITERATURE REVIEW ON CLABSI
Literature Review on Central Line-Associated Bloodstream Infection (CLABSI)
Laura Kilmer
Grand Canyon University- NRS 490
January 27, 2019
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LITERATURE REVIEW ON CLABSI
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Literature Review on Central Line-Associated Bloodstream Infection (CLABSI)
Introduction
Central Line-Associated Bloodstream Infection (CLABSI) has become a significant
problem in healthcare facilities. Indeed, the centers for Disease Control and Prevention
(CDC) established that the cases of CLABSI are more than 80,000 annually within the
Intensive Care Units (ICU) alone. The cases rise to 250,000 yearly if all the hospital data is
considered. Various researchers have made attempts to find how the issue can be controlled
and prevented. For instance, Atilla et al. (2016) showed that CLABSI cases are the most
costly leading to the use of $46,000 per case. Also, Guenezan, Drugeon, Marjanovic, and
Mimoz (2018) showed that the risks of CLABSI are common in the use of Central Venous
Catheters (CVC) for the treatment of patients who are critically sick. It has also been shown
that the risks in CVCs are associated with the development of multi-resistant pathogens that
cause infections to children.
Additionally, Miliaraki et al. (2017) reported that CLABSI always causes prolonged
hospitalization among children. Consequently, Perin, Erdmann, Higashi, and Sasso (2016)
investigated the possible ways by which CLABSI can be prevented and showed that the use
of care bundles in conjunction to commitment and education can be used to reduce the rates
of the infections. Together, these researchers have made a significant contribution to the
understanding and management of CLABSI. This essay presents a literature review that
compares the research questions, sample populations, limitations, and recommendations for
further research.
Comparison of Research Questions
Different researchers have developed their own research questions towards the
investigation of the CLABSI and the ways in which it can be managed. Mostly, these
research questions are developed following the PICOT criteria. The research question for
LITERATURE REVIEW ON CLABSI
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Atilla et al. (2016), for example, addressed the importance of the care bundle in the
management of CLBSI in the ICUs. Similarly, Guenezan et al. (2018) developed a research
question on the effective ways for the treatment of CLABSI. Still, Perin et al. (2016)
developed research questions that investigated the evidence-based care that can be used in the
management of adult patients who are admitted in the ICUs.
On the other hand, the research questions of Venturini et al. (2016) assisted in
determining the prevalence of CLABSI among the admitted children. Also, Miliaraki et al.
(2017) addressed the risk factors for CLABSI among children who are admitted in the ICUs.
From the research questions developed by the various researchers, it is clear that all of the
researchers are interested in finding the possible ways by which CLABSI can be managed
among the patients who are admitted in the ICU and other departments in the hospital. It can
also be deduced from the research questions that the researchers are determined to find the
intervention and treatment strategies for CLABSI.
A Comparison of Sample Populations
Similarities and differences have also been flagged in the available literature on
CLABSI. The commonest sample population has been patients with CVCs in ICUs. For
example, the sample population used by Atilla et al. (2016) included 114 patients who had
CVCs in medical ICUs. Similarly, Venturini et al. (2016) used a sample population of
children below the age of 18 in Mayer Children’s hospital who had ever experienced
CLABSI cases between Mid-October 2014 and Mid-October 2015. On the other hand,
Guenezan et al. (2018) considered patient under 15 days of antibiotics treatment for CLABSI.
As opposed to other researchers, Perin et al. (2016) conducted their study using a systematic
review of the previous literature in Brazil to determine the preventive measure of CLABSI.
Moreover, the sample population used by Miliaraki et al. (2017) included pediatric patients
below the age of 16 with CVCs as they were receiving their care. It is apparent from the
LITERATURE REVIEW ON CLABSI
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sample population used by these researchers that CVCs and ICUs are common. This shows
that CLABSI is common to patients who are critically ill.
A Comparison of the Limitations of the Studies
Every researcher encountered unique limitations in the course of their study. For
example, Atilla et al. (2016) found no superiority of chlorhexidine to povidone-iodine which
is a contradiction to other research in terms of skin antisepsis. Guenezan et al. (2018) also
encountered limitations with their study in that they were unable to compare the individual
class outcomes among the causative organism classes. Additionally, Perin et al. (2016) were
also faced with the limitations of lacking literature in Brazil that can be used in determining
the treatment strategies for CLABSI. Venturini et al. (2016) also had deficiencies with the
extrapolation of their results to the overall incidence of CLABSI with regard to the implanted
catheters. Also, Miliaraki et al. (2017) experienced sampling techniques that derailed their
ability to present reliable data. From the limitations of the study, it is evident that the
available research is still not specific to the point of presenting clear management strategies
for CLABSI.
Conclusion
This paper has been a presentation of literature review comparing the research
questions, sample populations, and study limitations. It has nee found that CLABSI is a
significant problem in healthcare facilities. Comparison of the research questions in the
literature review indicates that the researchers are determined to find the intervention and
treatment strategies for CLABSI. Also, the sample populations used in the studies indicated
that CLABSI is common to patients who are critically ill. Moreover, the study limitations
show that the available research is still not specific to the point of presenting clear
management strategies for CLABSI. Therefore, more specific research on the management of
CLABSI with respect to specific catheters is recommended.
LITERATURE REVIEW ON CLABSI
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References
Atilla, A., Doğanay, Z., Çelik, H. K., Tomak, L., Günal, Ö., & Kılıç, S. S. (2016). Central
line-associated bloodstream infections in the intensive care unit: the importance of the
care bundle. Korean Journal of Anesthesiology, 69(6), 599.
https://doi.org/10.4097/kjae.2016.69.6.599
Guenezan, J., Drugeon, B., Marjanovic, N., & Mimoz, O. (2018). Treatment of central lineassociated bloodstream infections. Critical Care, 22(1), 303.
https://doi.org/10.1186/s13054-018-2249-9
Miliaraki, M., Katzilakis, N., Chranioti, I., Stratigaki, M., Koutsaki, M., Psarrou, M., …
Stiakaki, E. (2017). Central line-associated bloodstream infection in childhood
malignancy: a Single-center experience. Pediatrics International, 59(7), 769–775.
https://doi.org/10.1111/ped.13289
Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016). Evidencebased measures to prevent central line-associated bloodstream infections: a systematic
review. Revista Latino-Americana de Enfermagem, 24. https://doi.org/10.1590/15188345.1233.2787
Venturini, E., Montagnani, C., Benni, A., Becciani, S., Biermann, K. P., De Masi, S., …
Galli, L. (2016). Central-line associated bloodstream infections in a tertiary care
children’s University hospital: a prospective study. BMC Infectious Diseases, 16(1),
725. https://doi.org/10.1186/s12879-016-2061-6
Laura
We have addressed the two spaces after the punctuation at the end of the sentence several
times throughout the class. Make sure you review how to set your Microsoft Word to show
when you do not have two spaces so you can fix this in all future assignments. Additionally,
LITERATURE REVIEW ON CLABSI
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some of your wording will need improvement for inclusion in the Week 9 final paper. The
reference list has https://doi.org/xxxx but when you use the doi, it should just be doi:xxxxxxx
Substituting the doi number for the x’s.
Thanks for submitting on time.
Professor O’Brien
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PICOT Statement
PICOT Statement
Laura Kilmer
Grand Canyon University: NRS-490
December 23, 2018
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PICOT Statement
PICOT Capstone Project
According to the Centers for Disease Control and Prevention (CDC) there are 80,000
central Line-associated Bloodstream infection (CLABSIs) every year exclusively in Intensive
Care Units (ICU). This estimate rises to 250,000 CLABSIs every year when entire hospital
values are incorporated (CDC, 2011). CLABSIs have been observed to be the second most fatal
type of hospital acquired infection. CLABSIs are a predominant and expensive issue in human
services and are a preventable contamination. The effects of Chlorhexidine Gluconate (CHG)
bathing on decreasing infection rates of central venous catheter (CVC) has heightened showing
healthcare-related infections prompt mortality and restorative expenses. In the United States
alone, each year 75,000 individuals with hospital acquired infections die (Zimlichman et al.,
2013). The purpose of this paper is to present PICOT statement related to prevention of
infection by implementation of daily CHG baths in patients with central lines.
PICOT
Does Using CHG baths prevent Central line infections performed daily during
hospitalization compared to patients that received typical bath daily?
Population: Patients with Central lines
Intervention: Give CHG wipe bath with proper technique daily during hospitalization
Comparison: Patients not receiving CHG baths or receiving them improperly
Outcome: Decrease in Central line infections
Timeline: 5 weeks
Evidence-Based Solution
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PICOT Statement
Evidenced-based interventions can be implemented with a specific end goal to decrease
CLABSIs, such as daily CHG baths. Musuuza (2017) noted that “Healthcare associated
infections (HAIs) lead to increased morbidity, mortality and medical costs. “In the United States
alone, about 722,000 people get a HAI every year and 75,000 people with HAIs die.” There is a
substantial need for a daily chlorhexidine bath to be established as an economic and preventative
practice to support the innovation’s permanence (Musuuza et al., 2017 p. 1). According to
(Musuuza et al., 2017) questions such as
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How does a nurse communicate that CHG baths were completed during the shift?
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What do you know about the policy for CHG bathing?
informs logical components that affect execution and maintainability of the intervention.
Nursing Intervention
Mandatory daily CHG bathing encounters many nursing practice challenges. Research
has demonstrated that chlorhexidine prevents infection, yet there is conflicting evidence on CHG
bathing preventing CVC infections better than customary bathing techniques in these articles.
Although, these studies provide considerable amounts of evidence supporting obstacles in
compliance, decreased CVC rates were also indicated. Musuuza et al., (2017) identifies factors
such as
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Nurse burn out related to patient load
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Delegation
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Communication deficiency
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Supplies
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Patient compliance
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Perception of CHG impregnated wipes
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PICOT Statement
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General hygiene of the patient
have a direct effect on whether the CHG bath is proven effective. Each of these factors proposed
its own set of dilemmas. Although the barriers where widely assessed and documented, “Daily
use of CHG in the ICU has been shown to be effective in reducing the rate of MRSA and VRE
acquisition and bloodstream infections associated with these organisms” (Lowe et al., 2017 p.
256). Chlorhexidine has been reported to have few negative consequences and showed
inconclusive evidence of decreasing CVC infections related to CHG bathing. The CLABSI rates
decreased among the neonates receiving CHG baths (Quack et al., 2014).
Patient Care
All patients with CVC will bath daily utilizing moistened CHG wipes. A few studies have shown
an extreme decline in CLABSIs from every day utilization of CHG washing. Lowe et al., (2017)
reported that, “Despite daily CHG bathing compliance of 58%, rates of hospital-associated MRSA
and VRE were significantly reduced compared with bathing with soap and water” (p. 257). Thus,
research supports the nursing care; utilization of CHG showering over soap and water.
Health Care Agency
This Capstone Project will Utilize BayCare Health System Inpatient hospital. This
facility is not for profit center that serves the community. St. Joseph’s Hospital has been a part of
the community since 1934. The research will be performed in the Pediatric population of this
hospital.
Nursing Practice
PICOT Statement
Being that the CDC creates central line infection guidelines and one of the
recommendations outlined is CHG bathing in patients with central lines I think it is safe to say
daily chlorhexidine impregnated wipes should be utilized for all patients with central venous
access that meet the guidelines of administration.
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PICOT Statement
Reference
Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of
daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining
nurses’
perspectives
and
experiences. BMC
Infectious
Diseases, 17(1).
doi:10.1186/s12879-017-2180-8
Karki, S., & Cheng, A. C. (2012). Review: Impact of non-rinse skin cleansing with chlorhexidine
gluconate on prevention of healthcare-associated infections and colonization with multiresistant organisms: a systematic review. Journal of Hospital Infection, 82, 71–
84. https://doi-org.lopes.idm.oclc.org/10.1016/j.jhin.2012.07.005
Quach, C., Milstone, A. M., Perpête, C., Bonenfant, M., Moore, D. L., & Perreault, T. (2014).
Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on
Central Line–Associated Bloodstream Infections. Infection Control & Hospital
Epidemiology,35(02), 158-163. doi:10.1086/674862
Zimlichman E, Henderson D, Tamir O, et al. Health care–associated infections: A meta-analysis
of costs and financial impact on the us health care system. JAMA Intern Med.
2013;173(22):2039–46.

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