Implementation Plan for the Prevention of Central Line-Associated Blood Stream Infections (CLABSI)

As a result of the frequency of Central Line-Associated Blood Stream Infections that are taking place nationwide, collaborative efforts must be made in order to reduce them. This means that hospitals and medical clinics must work in conjunction with each other to reduce the continual infections taking place, in NICUs. To ensure that an effective routine is established, an implementation plan must be executed that will offer hospital settings preventative measures and systematic changes that will hopefully prevent or at a minimum minimize CLABSIs. In performing research on an implementation plan, one collaborative article by the Prevention Collaborative of New Mexico aimed at decreasing the prevalence of CLABSI. Additional research was examined to form an implementation plan that would be successful in getting approved.

The initial implementation strategy that will be needed will be based on recommendations and guidelines suggested by the Centers for Disease Control and Prevention (CDC), the Society of Healthcare Epidemiologists of America (SHEA), the Infectious Disease Society of America (IDSA) and other organizations which stated that the following guidelines should be incorporated in any implementation plan for CLABSI prevention:

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This particular implementation strategy will be incorporated into an overall plan and is based on "Tools for Reducing Central Line-Associated Blood Stream Infections," (2013). Since the goal and objectives are to diminish and prevent CLABSI rates with the catheter use in newborns, there will need to be several elements included in the overall plan. The Prevention Collaborative of New Mexico acknowledged that objectives must be defined in any formal implementation plan. Therefore, the objectives and goals are outlined as follows:

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The implementation plan will be executed within a period of 10 months with the hope of getting approval from stakeholders that this is the right plan for execution within the collaborative network of hospitals and medical clinics. Additionally, a communications strategy will have to be woven into the implementation plan so that key stakeholders know how the plan will be put into place. The stakeholders will be hospital and medical clinic administration, medical staff, nursing staff, physicians and support staff. The implementation plan must have an assessment of the total expenses that it will take to institute this particular change in how hospitals and medical clinics will assess and examine CLABSI rates. Dawson and Moureau (2013) analyzed data associated with CLABSI treatment and found that it is "estimated to be $32,254 per incident" (p.1). Therefore, the stakeholders will have to be presented data associated with the treatment of CLABSI as well as the costs associated with implementation. Presently, the implementation plan will cost the collaborative network anywhere between $500,000 to $1 million to implement. Additional costs may be assessed. The collaborative network (stakeholders) must understand the importance of CLABSI prevention and this will include training and continual monitoring of prevention efforts. In addition to presenting data associated with the costs of the implementation plans, the stakeholders will have to be made aware of the rising amount of CLABSI rates. The CDC noted that "an estimated 41,000 central line-associated bloodstream infections occur in U.S. hospitals each year. These infections are usually serious infections typically causing a prolongation of hospital stay and increased cost and risk of mortality" ("Central Line-Associated Bloodstream Infection (CLABSI) Event," 2013). Data such as this will be presented to the stakeholders to stress and highlight the importance of proper hygiene in NICUs to ensure that infections are prevented as much as possible.

Current Issue In Need of Change

Furuya et al. (2011) examined the prevalence of CLABSI throughout US intensive care units and sought to establish an effective means of prevention. To do this, they conducted a cross-sectional study with regard to the policies and characteristics of bundle components and the current ways hospital settings are complying with overall policy (p.1). From their study, it seemed that much of the underlying issues related to CLABSIs in any medical setting are related to compliance issues, therefore, it will be necessary for the changes noted in the implementation plan to highlight compliance with new measures.

Communication then is the centerpiece of ensuring the implementation plan is followed. Draper et al. (2008) stated that as hospitals and medical arenas make changes to improve the role nurses and medical staff play in preventative measures, there is a responsibility that must be adopted and that is striving to follow compliance measures. Hospitals and medical settings should be accountable for successfully engaging their staff to comply with the changes to certain routines and existing protocols. Improving quality is not a new concept, it just must have a rationale behind in to avoid any form of escalating pressure on hospital staff to participate (p.1-2). Essentially, the previously mentioned implementation plan must secure votes and positive feedback to avoid confusion and/or issues once implemented. While medical staff at hospitals and clinics typically comply with changes to internal policies, explaining the changes will be needed to avoid any form of pressure.

Current Practice and Why Change Is Needed

Han, Liang, and Marschall (2010) documented that the current practice of central venous catheters is an invaluable tool, but prevention and management issues come into play because of their complex uses. Much of their findings added to existing research regarding CLABSI rates in that it did not reveal any potential mechanism for hospitals and medical settings to stop the use of those types of catheters. The authors reason that it is not so much a catheter issue, but more or less an educational measure or measures must be taken or instituted to ensure competency among health care professionals in lowering rates of CLABSI. In their assessment of a program/implementation plan that was done in several tertiary teaching hospitals, the rates associated with CLABSIs dropped notably from 11.2 to 8.9 infections over a period of 1000 catheter days (p.147-148), indicating that educational programs are effective or rather can be in ensuring hospital staff complies with prevention measures and new policies/guidelines.

Han, Liang, and Marschall (2010) also stressed the importance of sterile environments as being a crucial component of any hospital strategy (p.148). The previously mentioned implementation plan includes sterility and hygiene as core components needed in the prevention efforts of CLABSI. To ensure that healthcare professionals are complying with the identified preventative measures, monitoring with a checklist as well as set aside funding will be created. This will ensure that kits and carts comply with guidelines instituted by the collaborative network implementation plan. Moreover, this will be presented to the staff associated with the network so there is no miscommunication as to the expectations associated with the prevention of CLABSI in NICUs. Additionally, monitoring may take place in the actual insertion process of the catheter to ensure there are no issues. While isolated incidents can occur, the purposes of the implementation plan will be to make sure that problems associated with lack of cleanliness or improper insertion are lessened and/or negated by the new guidelines.

Finally, the hospital staff will have to be educated on the expansion of prevention activities which includes different ways to treat CLABSI should problems continue to persist. There are several types of treatments. Preventive measures have shown to have a notable effect on the rates of CLABSI and will undoubtedly be the standard that the collaborative network will take on in terms of proper understanding. The field of CLABSI prevention, however, is ever-evolving, so while the implementation plan will be a necessity for stakeholders to adapt and to resolve the issues pertaining to CLABSI, there will need to be continual studies and data uncovered about CLABSI infections. While the collaborative network will understand that this implementation plan will prove to be effective in minimizing and/or preventing CLABSI, which will not necessarily resolve future issues regarding the infection. Hospital management will have to continue to assess and evaluate the field of prevention further and any new methods that arise with regard to infections. With this measure in place, the hospital staff will have to be educated on the new treatments. Also, there may be new ways of prevention that come as a result of the changing field. If this should occur, an updated implementation plan will have to be created that incorporates the changes efficiently. The hospitals and medical clinics associated with the network will then have to be educated properly to ensure that compliance measures are met sufficiently. Additionally, there will have to be additional costs put into the educational process. By doing this, the implementation plan will hopefully continue to be effective in ensuring that CLABSI rates in NICUs are prevented and/or minimized to the best of the abilities of the medical staff within the collaborative network. This is the only way to proceed in ensuring that the rising rates of Central Line-Associated Blood Stream Infections that are taking place nationwide are no longer a serious and grave problem with regard to mortality and costs associated with hospital settings due to lack of planning and improper education.

References

Central Line-Associated Bloodstream Infection (CLABSI) Event. (2013, July). Retrieved October 10, 2013, from CDC website: http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf

The Central Line - associated Bloodstream Infections (CLABSI) Prevention Collaborative of New Mexico [Guide]. (2013). Retrieved from The Central Line - associated Bloodstream Infections (CLABSI) Prevention Collaborative of New Mexico website: http://www.nmmra.org/resources/Patient_Safety/184_2035.pdf

Dawson, R. B., & Moureau, N. L. (2013, March 15). Midline Catheters: An Essential Tool in CLABSI Reduction. Retrieved October 10, 2013, from Infection Control Today website: http://www.infectioncontroltoday.com/articles/2013/03/midline- catheters-an-essential-tool-in-clabsi-reduction.aspx

Draper, D. A., Felland, L. E., Liebhaber, A., & Melichar, L. (2008, March). The Role of Nurses in Hospital Quality Improvement. Center for Studying Health System Change, (3), Retrieved from http://www.hschange.com/CONTENT/972/972.pdf

Furuya, E. Y., Dick, A., Perencevich, E. N., Pogorzelska, M., Goldmann, D., & Stone, P. W. (). Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream Infections. PLOS ONE, 6(1), doi:10.1371/journal.pone.0015452

Han, Z., Liang, S. Y., & Marschall, J. (2010). Current strategies for the prevention and management of central line-associated bloodstream infections. Journal of Infection and Drug Resistance, 3, 147-163. doi:10.2147/IDR.S10105

Tools for Reducing Central Line-Associated Blood Stream Infections [Guide]. (2013, January). Retrieved from Agency for Healthcare Research and Quality website: http://www.ahrq.gov/professionals/education/curriculum-tools/clabsitools/clabsitools.pdf