Central Line-Associated Bloodstream
Central Line-Associated Bloodstream
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs) 2
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)
Submitted by
Kerry Sean Murphy
DPI Project Proposal Chapter 3 – Methodology
Doctor of Nursing Practice
Grand Canyon University
Phoenix, Arizona
July 20, 2019
CHAPTER THREE: Methodology
Introduction
This project will be exploring the prevention of Central Line-Associated Bloodstream Infections (CLABSIs). In this chapter, the discussion will focus on examining the variables that would help in preventing, controlling, and reducing the incidences of bloodstream infections. The methodology section will describe the objectives and describe the activities the project will entail to meet the objective of lowering infection rates. Further, the chapter will look into the methods of data collection and ways of analyzing the data as well as the ethical considerations the project will need to take into account.
Statement of the Problem
There is a need to have the CLABSI maintenance bundles due to cases of infection that have been recorded involves the adults that have been admitted to the intensive care units. According to Mishra et al., (2016), there are still several cases reported in India on such infections and in spite of the existence of guidelines for maintenance Central Line-Associated Bloodstream Infections (CLABSIs) continue to remain a problem. Clear Lake Regional Medical Center in Webster Texas reported a total of 18 hospital-acquired infections (HAI) in 2018. In 2019 in two quarters the facility has already reported 20 HAI (“SIR Report | HAI | CDC,” 2019). There is a need to develop procedures and expand education that would improve and reduce the number of HAI like CLABSI. Comment by Kathryn Flynn: Please describe what this is to the non nurse before terminology is used. Comment by Kathryn Flynn: It would be a lot more credible for the justification to be in research from US. Comment by Kathryn Flynn: Use APA format (author, year)
Clinical Questions
The clinical questions are how to develop different ways in which the CLABSI can be minimized, specifically among patients greater than 65 years of age. Objectives of the project will look to answer the following questions
(i) What is the influence of the staff training on maintenance of a higher level of hygiene after insertion and cleanliness of insertion sites? Comment by Kathryn Flynn: This is subjective. Use evidence based, etc. and nte why it’s better than existing care.
(ii) How is consistency in the application of the evidence-based practices likely to impact infections rates after insertion using improved site maintenance? Comment by Kathryn Flynn: How will this be measured? Has this question been approved? Comment by Kathryn Flynn: Subjective. State what intervention you are implementing and use the same name for the intervention at every location in your writing. This will give the reader clarity.
(iii) How CLABSI maintenance bundles (specifically the using of chlorhexidine gluconate bathing (CHG)) lower the number of HAI infections.
There is a need to have a higher level of training among the staff regarding proper CHG bathing to maintain a higher level of cleanliness that would consequently reduce the number of infections. The cleaner the sites of insertion, the better the possibility of reducing the infections related to CLABSIs (Guerin, Wagner, Rains, & Bessesen, 2010). CHG bathing is a part of the CLABSI maintenance bundle and performed adequately with other aspects of the bundle can prevent post-insertion infections. The measuring outcomes will consist of a periodical survey among the nurses that have CLABSIs patients before and after the maintenance bundle use. A consistent survey of one month is effectively going to determine if the intervention has achieved the objectives of the lowering CLABSI rates. Comment by Kathryn Flynn: Justify why Comment by Kathryn Flynn: Like what? Comment by Kathryn Flynn: What’s the validated tool? Name it here and refer to it in index. Comment by Kathryn Flynn: No, it will give you the data to apply statistical significance to, so you can see if a correlation exists.
Project Methodology
The project methodology describes the different ways in which the project is likely to be conducted. The project will combine both quantitative and qualitative analysis in collecting and analyzing the data. The combination of the different methods is to improve the accuracy of the results. The project looks to send questionnaires to the patients within the ICU Clear Lake Regional Medical Center, Webster, Texas to help in determining the influence on the training of the staff in the prevention of the CLABSIs among the patients aged above 65 years. The results of the study will be analyzed using the necessary statistical methods to help in establishing the conclusion of the results. Further, a comparative analysis with other existing studies would also be useful in improving the quality of the result (Kumar, 2019). The method used in the project would as such be valuable in the development of the project Comment by Kathryn Flynn: Rephrase, what questionnaires? Comment by Kathryn Flynn: Will you do this? Comment by Kathryn Flynn: Clarify?
Project Design
The project has a design that is based on reviews of previous literature on the ways of minimizing CLABSI in acute care hospitals. According to Marshall et al., (2014) various methods can be used in the prevention of the CLABSIs including the sterilization of equipment, proper site selection, and training the staff on the role of hygiene in the prevention of further infections, and the use of CLABSI maintenance bundles (Specifically CHG bathing). The challenge, however, has been in the improper or the limited training of staff on the critical part of the hygiene on the prevention of the infections. The following project will develop ways in which the nursing staff can undergo the training that will help in improving consistency with patients care. Comment by Kathryn Flynn: Kerry , I mentioned a n education intervention is not enough, per AQR. You’ll need to add additional evidence based doctoral level nursing interventions. List what they will be in all appropriate sections.
The project will further look into the number of the infections that are resulting from nurses not performed benchmarked central line catheter maintenance. The project will make a record of the use of the CLABSI bundle, specifically CHG bathing. While carrying out the intervention, the nurses should be keen to adhere to the guidelines and the procedures related to the central line catheter maintenance. The nurses that have undergone maintenance bundle training will be compared to those nurses who have not undergone training, and statistical comparison of the infections performed. It is through the comparison that the understanding of the need to have training and education would be determined to be a way of reducing the infections from CLABSI. Comment by Kathryn Flynn: unclear Comment by Kathryn Flynn: clarify. Comment by Kathryn Flynn: Mention the guidelines and procedures here. What has been used up until now, and what will you change them to?
Population and Sample Selection
The research will be conducted at the Intensive Care Unit (ICU) of the Clear Lake Regional Medical Center in Webster, Texas. The hospital has a total of 60 nurses, all of who can give the results out of the taking care of the patient in the hospital. However, due to the limitations in the time and the resources when carrying out the research, there is need to pick a sample that would represent the rest of the nurses for the project (Chow et al., 2017). Additionally, the use of the samples equally helps in creating a focus on improving the accuracy of the results. All of the patients that are participating in the research are equally part of the research population in the study.
The choice of the sample will be done through the purposive sampling method to help in choosing the type of patients (those with central lines) that would help in attaining the aims of the project. Using the PICOT question method, the patients of 65 years and above with the central line catheter hub hygiene are picked for the project to improve the level of the accuracy (Rios, Ye, & Thabane, 2010). The 60 nurses will be divided into two equal groups of 30 nurses. One of the groups shall have undergone the training for the hygiene process of CLABIs while the other 30 will not have undergone for the sake of being used as a control group. Comment by Kathryn Flynn: Good; Add this into your 10 strategic points to update and align with all chapters. Comment by Kathryn Flynn: Explain second population first
The process of the selection of the sample should be a careful process to improve the accuracy of the project. The process of the sample selection will be done through the purposive method since the results are drawn from a particular group of the patients that have central line catheters. The study has a target of 60 nurses out of the total number of nurses within the hospital. Comment by Kathryn Flynn: Explain how you picked 60.
Instrumentation
To establish infections rates, the project will make use of a questionnaire as the instrument in surveying the condition of the patients after undergoing care by the nurses (Corchon et al., 2010). The questionnaire will be designed such that the patients can provide only yes or no answers. On the other hand, there will be questionnaires that will equally be directed to the nurses on the training process and with the compliance to the maintenance procedures as prescribed in the training process. The use of the questionnaire is an effective and economical way of carrying out the research. Comment by Kathryn Flynn: Did he use the q? it’s not clear what the citation is referring to. Comment by Kathryn Flynn: Tool cannot be made up, per AQR. Comment by Kathryn Flynn: Now is the time to expose what the questionnaires are.
The Validity of the Research Comment by Kathryn Flynn: Needs work. Include validity of tool
Research is only useful and meaningful to the extent to which the standards of the results of the study are valid. The validity of the research determines the quality of the research and the ability of the research recommendation to be used. The research is valid to the extent when the results of the study are close to that which was to be measured (Taherdoost, 2016). This project will be valid when it establishes the significance of the training on the prevention of CLABSI patients. The project will make use of a reasonable number of nurses and patients to participate. While project is keeping the number of the participants manageable, the number must be kept to the level that they can represent the full number of the population.
The Reliability of the Research
The reliability of the research is the measure of the extent to which the instruments used in collecting and analysis the data are useful and have a high level of accuracy. The project looks to make the research reliable by picking all of the participants in the same environment while carrying out the improvement project. Further, there is a division of the participant’s, the number of the patients taken care of by the nurses that have undergone the maintenance bundle training and another group among the patients that have not undergone the training as a control group. The analysis of the data will be done through the statistical package for social sciences (SPSS) upon which the data can be subjected to establish the Cronbach’s alpha (Heale & Twycross, 2015). The greater the value of the Cronbach’s alpha, the more the reliable the results of the study. The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed and use standardized infection ratios (SIRs) to measure healthcare-associated infection (HAI) incidence. SIR is what Clear Lake Regional Medical Center using for data collection and will also be utilized in this project.
Data Collection Procedures
The researcher will work on getting the data among the respondents that will help in answering the research questions. The nurses identified to participate in the research will make a confirmation of their participation as a way of complying to the ethical standards. The sampled nurses will be divided into two groups, half of which would be taken through the comprehensive training on the CLABSI maintenance bundle. The time taken for the training would be in a month so that all of the aspects of the training are taken into consideration and that the nurses can get the skills needed for proper maintenance. Upon the training, the project will look at the possible patients that the trained nurses will take care of against the patients that are going to be taken care of by the nurses that have not undergone the process of training. The results of the studies can be collected through the administration of the questionnaires. The project will collect the results on the aspects of the infection of the patients.
Data Analysis Procedures Comment by Kathryn Flynn: How will you analyze? What data will you place in SPSS?
The collected data can be subjected to the analysis process so that the data can create meaning out of the available information. The information filled in the questionnaire will be collected and coded to help in carrying out an unbiased analysis. The coded data will be analyzed using the SPSS software to assist in getting the quantitative aspects of the data (Mihas, 2019). Equally, the research will work on the descriptive aspect of the data to assist in making meaning out of the complex scientific elements of the data. The analysis of the data will be critical clinically in achieving the objective of the project and answering the clinical questions regarding CLABSI prevention maintenance.
Ethical Considerations
The research should be carried out in a manner that would meet the expected ethical standards as well as within the laws and regulations in the areas of operation. The project will take care of the details of the respondents such that they are not accessed by third parties but only used for the sake of the project. The biodata of the respondents and any other information that reveals the identity of the participants will be deleted. All of the respondents participating in the research will be consulted and made aware of the intent to get them to participate in the project (Wester, 2011). Consequently, the respondents will confirm their consent to participate in the process. The confirmation will be done through an email to have as records. No participant should, as such, be coarsened to participating in the research.
The ethical practices in the project should be expressed by both the participates. The respondents should confirm their readiness and declare they are in the right state of mind as they participate in the research. Also, the information in the project improvement should not be used in a manner that would harm any of the parties when the project improvement is being conducted and after the project improvement (Wester et al., 2018). Further, the project will work to inform and get the permission of the Clear Lake Regional Medical Center. The adherence to the ethical consideration encourages the participants to gain the trust of the participants and give their best efforts in making the project improvement a success.
Limitations of the Research
The project improvement may come with several limitations that would see the objectives of the research not conclusively met. There is no way in which the project can control the responses from the patients. The analysis of the responses is based on the assumption that the patients are honest and adhere to the highest ethical standards. Additionally, the project is carried out within one hospital in Texas. As a result, it is a challenge that the results of the project in one region would apply to the rest of the world. There is a need to have the same research conducted in different parts of the world to determine the accuracy of the research study (Lefcourt, 2013). The limited scope and the inability to control the responses of the researcher respondents are could have an impact on the results of the project.
Summary
In this section, the projects description of the methods through which the data will be collected and analyzed to achieve the results of the study were discussed. The chapter has defined the objectives of the project and states the research questions that would be answered to meet the project’s objectives. Additionally, the research describes the population and the sample selection used in the study. The method of data collection and analysis are equally discussed in the chapter. The section also describes the ethical considerations the study would be looking to take into account to help in achieving the results of the project. The precautions the project is taking in making the study both valid and reliable are equally described. Comment by Kathryn Flynn: Kerry, Add rubric, and develop all content according to rubric and my comments, then resubmit. Thanks.
References
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Guerin, K., Wagner, J., Rains, K., & Bessesen, M. (2010). Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle. American journal of infection control, 38(6), 430-433.
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