Essay Grade

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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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