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Clinical Guidelines On The Prevention Of Catheter Related Bloodstream Infections

4563 words - 18 pages

Because central venous catheters (CVCs), which are catheters inserted through a major vein with the tip resting near the heart, serve many purposes such as medication administration, parenteral nutrition, fluid therapy and central venous pressure measurement, their use has become increasingly common in the intensive care unit (ICU) (Polderman & Girbes, 2002). However, CVC use is associated with an increased risk for hospital-acquired infections (McLaws, Gold, King, Irwig, & Berry, 1988), with those in situ for more than six days contributing to increased infection rates compared to those in place for five days or less (McLaws & Taylor, 2003). Catheter-related bloodstream infection (CRBSI) is defined as a laboratory-confirmed bloodstream infection more likely caused by a CVC in place during or within 48 hours of insertion (Centers for Disease Control and Prevention, 2012). Increased expenditures associated with CRBSI episodes due to mechanical ventilation use and lengthened stay in the ICU can significantly impact the individual and unnecessarily tax an already burdened healthcare system (Blot et al., 2005).
Elderly patients, a particularly vulnerable population, may be predisposed to higher rates of CRBSI because the break in skin barrier may expose the bloodstream to the environment (Richard, 2001). Trauma sustained from injuries can also contribute to a weakened immune system, thus rendering one susceptible to infection (Richard, 2001). Nurses, as members of the interdisciplinary health team, play an essential role in preventing infection arising from CVC use. Minimising the occurrence of CRBSI can result in reduced costs, decreased length of hospitalisation, and more positive health outcomes. In this essay, the writer will discuss and provide recommendations to guide best practice in preventing CRBSI in the ICU.
Prior to CVC insertion, health professionals can benefit from increased awareness about measures to prevent CRBSI. In a survey done among ICU staff, Koutzavekiaris & colleagues (2011) discovered that being a nurse correlated with having more knowledge regarding CVC maintenance compared to insertion (Koutzavekiaris, et al., 2011). This implies the need for more tailored educational interventions to address this knowledge gap. Applicability of the findings may be limited as the survey questionnaire was not validated, and a relatively small sample was used. Similarly, a survey conducted among European nurses revealed that there was inconsistency in the nurses’ knowledge regarding CVC care (Labeau, Vandijck, Rello, & Adam, 2009). Seniority among the staff corresponded to better proficiency, whereas an increase in the number of ICU beds revealed poor performance (Labeau, et al., 2009). This study relied on its primary strength of drawing upon a large sample, but was limited by selection bias as the participants may have been more inclined or concerned about CVC infection prevention compared to those who did not choose to respond....

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