Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)

Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)

Submitted by

Kerry Sean Murphy

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

Prevention of Central Line-Associated Bloodstream Infections (CLABSIs) 1

June 26, 2019

Appendix A

Ten Strategic Points Comments or Feedback
Broad Topic Area 1. Broad Topic Area:The topic is the Prevention of Central Line-Associated Bloodstream Infections (CLABSIs).
Literature Review 2. Literature Review:Summary Comment by Kathryn Flynn: summarya. Background of the problem/gap:· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs (Yaseen, et al., 2016).· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections (Dick et al., 2015).· The nurses need to have significant knowledge associated with evidence-based practices for the prevention of central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter in adult Intensive Care (ICU) units with (CVC) patients (Kadium, 2015). Comment by Kathryn Flynn: prevention of Comment by Kathryn Flynn: make this another clear sentence.· Research has shown the existence of variations in the practice of nursing regarding the prevention of CLABSI, thus stressing the need for monitoring and education/training (Elbilgahy et al., 2015).· There is a need for implementation of educational interventions to deal with the practice and knowledge gaps about CLABSIs prevention as well as ensuring that nurses apply prevention interventions which are evidence-based (Esposito et al., 2017).· The Quality Health Outcomes Model (QHOM) Investigating Prophylactic measures to eradicate the incidence of Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich et al., 2014) Comment by Kathryn Flynn: Use primary sources (as many as you have) and not one author who synthesized the synthesis.b. Carrying out a review of literature topics with a key theme for each one.c. Prevention of Central Line Associated Blood Stream Infection (CLABSI) (Masse, Edmond, & Diekema, 2018).· The Quality Health Outcomes Model (QHOM) is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. This model/framework has been used by various researchers to test the effectiveness of infection prevention measures (Gilmartin & Sousa 2016). Comment by Kathryn Flynn: &Setting· Adult ICU (Elbilgahy, et al., 2015).· The incidence of Catheter-Related Infections (CRIs) in cancer patients at the hospital (Hentrich et al., 2014).Summary· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention through nursing education (Dombecki, Vercher, Valyko, Mills, & Washer, 2017).· Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting. There seems to be a problem regarding the training and education regarding the procedures which should be followed when carrying out catheter-related procedures. The objective of this study is to address this issue (Dombecki, Vercher, Valyko, Mills, & Washer, 2017). Comment by Kathryn Flynn: The authors probably didn’t refer to your study. Clarify..· Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site are necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia (Yaseen, et al., 2016)2.a. Background of the problem/gap:Even though earlier CVCs were associated with mechanical complications such as leaks, air embolisms, and hub separation, CLABSIs quickly became a serious problem when it came to the use of catheters. Studies indicate that elementary infection control steps may reduce incidences of CLABSIs significantly(Owings et al. 2017). Comment by Kathryn Flynn: cite with all the studies that indicate it, authors separated by ;a. Theoretical Foundations (models and theories to be the foundation for the project). Specifically, the model proposed is the Quality Health Outcomes Model (QHOM), which is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. (Gilmartin & Sousa, 2016).The theoretical model is associated with the strategies deployed and operational processes linked to the prevention of Central Line Association Bloodstream Infection. A meta-analysis review of randomized control and quasi-experimental studies (Moody, 2019). Comment by Kathryn Flynn: make this a full sentence.b. Review of literature topicRapid Dissemination of Universal Decolonization in Adult Intensive Care Units (ICUs) reduces healthcare-associated (HA) central line-associated bloodstream infections (CLABSI) in over 100 Community Hospitals (Hickok et al., 2015).a. Single Healthcare Systemc. Prevention of Central Line Associated Blood Stream Infection (CLABSI).
Problem Statement There are several safety measures to follow during a procedure involving the insertion of a central line catheter. Despite this, there still exist many cases of infections resulting from such insertions, especially in adult ICUs. For example, a study conducted in an ICU in northern India indicates that in spite of there being several guidelines for CLABSIs prevention, cases of such infections are still high (Mishra et al., 2016).
Clinical/PICO Questions 3. Clinical/PICOT Questions:“In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of central line catheter observe hygiene after its insertion, along with the apt cleansing of the insertion site, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) compared to standard care over a one-month period?” In thiscase, standard care refers to the typical procedures which should be followed during a central line catheter insertion procedure. These include regularly monitor and assess the central line insertion site, looking for signs like redness, swelling, pain, and discharge (Painter & Painter Law Firm, 2018). While central lines are convenient for doctors and nurses, and more comfortable for patients, they increase the risk of infection. Any time a foreign body is present inside the human body, it provides a place for bacteria to grow (Painter & Painter Law Firm, 2018). Comment by Kathryn Flynn: Word Doesn’t seem to flow Comment by Kathryn Flynn: Think of more specific word. Comment by Kathryn Flynn: You should mention that there is a gap between how they are doing it now and best practice Comment by Kathryn Flynn: Find primary source, original studies. There should be many.P: Patients > 65 years of age with a central lineI: Staff training and reinforcement of central catheter, hub hygiene. Along with teamwork and communication strategies such as structured multidisciplinary rounds and daily goal settings that educate staff on the utilization of The Central Line (CL) Bundle with a target of at least 100% compliance Successful implementation of CL Bundle can help in reducing the rates of CLABSI and achieving zero CLABSI events for a period of one month (Yaseen et al.). Comment by Kathryn Flynn: , along… find another way to break this sentence up. Comment by Kathryn Flynn: Is this the best way to get your point across to staff? This process will have to be justified by the literature that it improves outcomes. Comment by Kathryn Flynn: This last sentence should be broken into two.C: Compared to standard care. The aim is to identify any discrepancies between the skills gained by trained staff and the standard care procedure. Comment by Kathryn Flynn: This should be part of your lit review to answer why is the project necessary.O:  Reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections). Pre and post intervention outcomes will be measured by counting the number of CLABSIs cases before and after the intervention. Using various questionnaire types (true/false, short answers, and fill in the blank. Comment by Kathryn Flynn: There should be two questions in this, one measurement should be increased knowledge, second is less infections. Consider both in questionsairre.T: A period of one-month
Sample 4. Sample (and Location):a. Location: ICU Clear Lake Regional Medical Center, Webster, Texasb. Sample: The study seeks to sample 120 nurses from the adult intensive care unit department.
Define Variables · Define Variables:· Independent Variables: training and education on various safety measures when carrying out a central line catheter insertion. Comment by Kathryn Flynn: Good; have PICOT question align with both variables.· Dependent Variables: number of cases of infections resulting from central line catheter insertion.
Methodology & Design · Review of past research will form the core basis of collecting data for this project. Data on new infections related to the insertion of the central line catheter will be collected. Also, nurses working in adult ICUs will be surveyed, and the total number of infections resulting from their central line catheter procedures recorded. These cases will be recorded before and after an intervention to determine the effect of the intervention. The intervention will be a short training on how to apply various guidelines during central line catheter insertion. The likelihood of causing an infection post or pre-training will be determined by monitoring the number of infection cases recorded by each nurse before and after the training. Comment by Kathryn Flynn: What kind? In person? Slide deck? You mention up above you’ll do daily rounds. All parts should be aligned.
Purpose Statement 5. Purpose Statement:The purpose of this project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff Clear Lake Regional Medical Center in Webster, Texas for the prevention of CLABSIs.
Data Collection Approach 6. Sample (and Location):a. Location: ICU Clear Lake Regional Medical Center, Webster, Texasb. Population: The population being sampled in the study is 120 adult ICU nurses.7. Determining the Sample Size· A sample population is often selected based on the PICOT question the evidence-based study is being held on people who are 65 years and more. The patients are with a Central line catheter hub hygiene.· The sample population is targeted from the ICU unit at Clear Lake Regional Medical Center, Webster, Texas.· After a focused consideration of the required population, a random sampling of nurses from the target group will be picked. Comment by Kathryn Flynn: so will there be 120? Or will they be randomly sampled from 120.· The selection of a sample population should not be haphazard for it will lead to biased results. Furthermore, a large sample size helps in having precise results (Nayak & Singh, 2015).· To avoid oversampling to have a minimal sample size that we are targeting are the 120 adult nurses out of the 300 (Andersomn, Kelley, & Maxwell, 2017).· The proposed intervention is training on the basic guidelines on safety measures to follow when conducting central line catheter insertions. With the confidence level of 95% calls upon the usage of 120 nurses to have an error of 5% only. This population will be equally divided between the treatment group and the control group. The particular ratios of gender are not necessary, yet the ration of re-trained and those left without that are of significance.· This population will be equally divided between the treatment group and the control group. Comment by Kathryn Flynn: Ok, so the question would compare the intervention group with the control group. Align this in all sections.The formula below will help determine the population to be sampled. The sample size is 120 nurses.8. Inclusion/exclusion criteria of the subjects· People who are 65 or above and are from ICU Lake Regional Medical Centre, the central line catheter hub clinic section.· The nurses who are not core staff of the ICU at Clear Lake Regional Medical Center will be excluded (Patino & Ferreira, 2018).· Those who will have signed consent will be included in the study because of having fulfilled the research ethics standards.· When the interviews and questionnaires have been conducted, the incomplete questionnaire forms will be excluded while the interview subjects who have not attended the interview will not be considered.· Questionnaires that are entirely filled and interview subjects who will turn for the interview and response will be included in the findings. Comment by Kathryn Flynn: Rephrase to clarify.
Data Analysis ApproachComment by Kathryn Flynn: Address validity and reliability 9. Data Collection Instruments· The sample of nurses operating within adult intensive care units will be subjected to a training and their efficiency to insert the central line catheter without causing infections tested before and after the training.· The training will be as much comprehensive and intensive as possible. This is to make sure that the participants have undergone a process that would impact their skills regarding the insertion of the central line catheter.
Ethical Consideration · A valid research design will be created while taking into account the methods used, the theories, and the findings on crisis management from different organizations. Comment by Kathryn Flynn: How? Move to data analysis.· Since crisis management as a subject matter is very sensitive to the organization, compliance with confidentiality agreements is paramount (Mkunga, 2017). Comment by Kathryn Flynn: Clarify why this topic is coming up now.· In this research study, any details that the respondent will not want it disclosed will be removed and deleted from any written or oral records, while others are candidly presented.· Before the recruitment process, the participants will be contacted and be informed of the research and its significance (Castillo-Montoya, 2016).· They will then beasked to declare their readiness to partake in the study and the free times they have for the interview process or questionnaire filling process.· The form will have the clinical question, the usability of results, assurance of anonymity and confidentiality in which the researcher will indicate how the results will be exposed, to whom they will be exposed and how the subjects will be prevented from harm. Comment by Kathryn Flynn: In methodology and analysis, write how you will deidentify any data collected by using assigned numbers to each participant..· The only harm could be labeling the nurses as unhygienic, hygienic, effective or ineffective, and mentioning their particular names. Comment by Kathryn Flynn: See above. You might want to analyze the cohort, and not individuals. Talk to the methodologist about this. You should pick one way and stick to it.· Since the study is checking on evidence-based care and its impact, the subjects will not be mentioned, and the results will be written in a manner that they do not openly show which health care has a particular condition (Kamat, 2018). Comment by Kathryn Flynn: Which health care what?· It is necessary that health care centers be informed of the study.Before the study, the researcher will seek the participants’ permission through formal e-mails, which will be sent to the administration for approval. Comment by Kathryn Flynn: Kerry, The project is coming along; this version is very much improved. There are some minor adjustments, then you can submit for a grade. Let’s review comments over phone tomorrow in case I can clarify any. Great work.


Advani, S. D., Lee, R. A., Long, M., Schmitz, M., & Camins, B. C. (2018). The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center. Infection Control & Hospital Epidemiology, 39(07), 878-880. doi:10.1017/ice.2018.78

Anderson, S.F., Kelley, K., & Maxwell, S.E. (2017). Sample-size planning for more accurate statistical power: A method adjusting sample effect sizes for publication bias and uncertainty. Psychological Science, 28(11), 1547-1562. doi: 10.1177/095679761772372428(11)

Arkkelin, D. (2014). Using SPSS to understand research and data analysis. Psychology Curricular Materials, 1-100. Retrieved from Comment by Kathryn Flynn: If you’ll use SPSS, write in data analysis section

Beverly, A. L., Hill, M. M., Camins, B. C., & Lee, R. A. (2018). Decreasing CLABSI Incidence Associated with Decreasing MRSA Bacteremia LabID Incidence. American Journal of Infection Control, 46(6), S82. doi:10.1016/j.ajic.2018.04.160

Carpenter, A. D., McTigue, S., & 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), S11. doi:10.1016/j.ajic.2016.04.183

Castillo-Montoya, M. (2016). Preparing for Interview Research: The Interview Protocol Refinement Framework. The Qualitative Report, 21(5), 811-831. Retrieved from

Dick, A. W., Perencevich, E. N., Pogorzelska-Maziarz, M., Zwanziger, J., Larson, E. L., & Stone, P. W. (2015). A decade of investment in infection prevention: A cost-effectiveness analysis. American Journal of Infection Control, 43(1), 4-9. doi:10.1016/j.ajic.2014.07.014

Dombecki, C., Vercher, J., Valyko, A., Mills, J., & Washer, L. (2017). Implementation of a Central Line-associated Bloodstream Infection (CLABSI) Prevention Bundle for Adult Hematologic Malignancy and Bone Marrow Transplant Patients. American Journal of Infection Control, 45(6), S103. doi:10.1016/j.ajic.2017.04.166

Elbilgahy, A. A., Davidson, P. M., Sharps Mohamed, P. W., & Elassmy, M. (2015). Nursing Practice for Prevention of Central Line Associated Blood Stream Infection (CLABSI) in A Pediatric Intensive Care Unit. IOSR Journal of Nursing and Health Science (IOSR-JNHS)5(6), 150-154. Retrieved from

Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6),e0180473. doi:10.1371/journal.pone.0180473

Fakih, M. G., Groves, C., Bufalino, A., Sturm, L. K., & Hendrich, A. L. (2017). Definitional Change in NHSN CAUTI Was Associated with an Increase in CLABSI Events: Evaluation of a Large Health System. Infection Control & Hospital Epidemiology, 38(06), 685-689. doi:10.1017/ice.2017.41

Gilmartin, H. M., & Sousa, K. H. (2016). Testing the Quality Health Outcomes Model Applied to Infection Prevention in Hospitals. Quality Management in Health Care, 25(3), 149-161. doi:10.1097/qmh.0000000000000102

Hentrich, M., Schalk, E., Schmidt-Hieber, M., Chaberny, I., Mousset, S., Buchheidt, D., Karthaus, M. (2014). Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management and prevention by the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Annals of Oncology, 25(5), 936-947. doi:10.1093/annonc/mdt545

Hickok, J., Moody, J., Kleinman, K., Avery, T., Huang, S. S., Bienvenu, S., Septimus, E. (2015). 1288 Rapid Dissemination of Universal Decolonization in Adult Intensive Care Units (ICUs) Reduces Healthcare-Associated (HA) Central Line-Associated Bloodstream Infections (CLABSI) in over 100 Community Hospitals in a Single Healthcare System. Open Forum Infectious Diseases1(suppl_1), S48-S48. doi:10.1093/ofid/ofu051.128

Kadium, M. J. (2015). Improving Nurses’ Knowledge to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Unit.Minneapolis, Minnesota: Walden University.

Kamat, P. (2018). Research ethics. 1-49. Retrieved from

Malone, H. E., Nicholl, H., & Coyne, I. (2016). Fundamentals of estimating sample size. Nurse Researcher, 23(5), 21-25. doi:10.7748/nr.23.5.21.s5

Masse, V., Edmond, M. B., & Diekema, D. J. (2018). Infection prevention strategies for procedures performed outside operating rooms: A conceptual integrated model. American Journal of Infection Control, 46(1), 94-96. doi:10.1016/j.ajic.2017.07.030

McAlearney, A. S., & 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 Control42(10), S216-S222. doi:10.1016/j.ajic.2014.04.006

Mishra, S., Misra, R., Azim, A., Baronia, A., Prasad, K., Dhole, T., Poddar, B. (2016). Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. International Journal for Quality in Health Care1, 63-67. doi:10.1093/intqhc/mzw144

Moody, J. (2019). Implementation Program to Improve CHG Bathing Compliance. Case Medical Research. doi:10.31525/ct1-nct03898115

Mukungu, K. (2017). “How Can You Write About a Person Who Does Not Exist?” Rethinking Pseudonymity and Informed Consent in Life History Research. Social Sciences, 6(3), 86. doi: 10.3390/socsci6030086

Owings, A., Gilliam, C., Glover, B., Gipson, M., Wright, D., Morgan, S., & Hakim, H. (2017). What to Do? What to Do? About Those Ambulatory CLABSIs? American Journal of Infection Control45(6), S40.

Painter, R., & Painter Law Firm. (2018). Which Houston-area hospitals have abnormally-high infection rates? Retrieved from

Parveen, H. &. Showkat, H. (2017). Research ethics. 1-12

Patel, P. K., Gupta, A., Vaughn, V. M., Mann, J. D., Ameling, J. M., & 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), 106-116. doi:10.12788/jhm.2856

Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies: definitions and why they matter. Jornal Brasileiro de Pneumologia, 44(2), 84-84. doi: 10.1590/s1806-37562018000000088

Rodrigues, A. Kozak, M. & Correia, A. (2016). Exploring the benefits of using mixed methods approach in destination image studies. 4(5), 159-181.

White, L., Brent, K., Eherenman, H., & Vance, C. (2016). Infection Prevention and Quality Coordinators Collaborating to Decrease Central Line Associated Blood Stream Infections (CLABSI) by Monitoring Central Line Catheter Maintenance. American Journal of Infection Control, 44(6), S94-S95. doi:10.1016/j.ajic.2016.04.120

Yaseen, M., Al-Hameed, F., Osman, K., Al-Janadi, M., Al-Shamrani, M., Al-Saedi, A., & Al-Thaqafi, A. (2016). A project to reduce the rate of central line-associated bloodstream infection in ICU patients to a target of zero. BMJ Journals. Volume 5, Issue 1, 1-4.

I, Kerry Murphy, verify that I have completed (30) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.


Get 20% Discount on This Paper
Pages (550 words)
Approximate price: -

Try it now!

Get 20% Discount on This Paper

We'll send you the first draft for approval by at
Total price:

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Our Services

Ace Writing Center has stood as the world’s leading custom essay writing services providers. Once you enter all the details in the order form under the place order button, the rest is up to us.


Essay Writing Services

At Ace Writing Center, Nowadays, students normally have extremely busy schedules. You will note that some of them have to take on some evening or weekend jobs in order to get some income that can help them to sustain in college or in the university. This can deny them a chance to write all the essays given. Others usually get bombarded with a lot of work by their lecturers. This can still delay such students from working on all their essays. However, some of them usually try to work on all these essays but end up delivering their work late. This can prevent them from graduating since most lecturers are strict on deadlines. If you want to write a business essay, the wise way is to hire an outstanding essay writing service like us, so that you can get the best results. If you are keen, you will note that many companies usually overcharge their customers. Some of them are there only to make money. And in reality, they really don’t care to build a long term commitment with students. You should not choose such companies. You should take your time and choose a reliable company to work with. Ace Writing Center is the ultimate solution for you. We have been offering our writing service for more than 7 years. This is a clear indication that you will get quality essay writing service. We have a wide range of writers who can work on any business essay that you might have. We believe in doing extensive research so that we can provide quality work to all our clients. .


Admission and Business Papers

Have you ever had to write an admission essay for college? The majority of students face the same issues when applying to a university or college and many in such situations decide they need professional help to cope with this matter. They get in a situation when the deadline keeps coming closer but lack motivation to start because they are just not sure if their writing skills are strong enough. We have a solution for you! Ace Writing Center is the best admission essay writing service with a large professional team and years of experience in providing high-quality papers to students of all levels and faculties. The mission of our team is to help students make their dreams of entering a good college come true and that’s what we offer!.


Editing and Proofreading

Sometimes all the words for your paper just flow out of your mind and into your fingers. You type quickly at your keyboard and there they are, your beautiful words right there on the screen. But you have no idea how to polish it up. You may be wishing there was a paper writing service that offered this type of writing service. Look no more! Here at Ace Writing Center, we offer you an editing and proofreading option that you can't find anywhere else..


College Essay Writing

In case you are familiar Ace Writing Center, you know the way to distinguish a better company from a cheap one exactly. First of all, poor service website does not have a sufficient support. We think support team is an essential part of success; it has to answer all clients’ questions and be a connecting link between clients and their writers. On our web-service you will get answers about anything you need and your writer will receive all your instructions, assignments and requirements exactly and swiftly. A writing service that we run has got a flexible pricing system that will save you from senseless wastes and many bonus systems that let you sparing money for something important for you.

Open chat
Hello. Can we help you?