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In adult patients who receive chemotherapy on an outpatient basis (P), does the use of applying a CHG tegaderm to mediports and PICC lines (I), verse a bandaid, biopatch or regular tegaderm (C), help decrease the chance of an infection (O)?Introduction and purpose of paperIn adult patients who receive chemotherapy on an outpatient basis (P), does the use of applying a CHG tegaderm to mediports and PICC lines (I), verse a bandaid, biopatch or regular tegaderm (C), help decrease the chance of an infection (O)?(Talk) The purpose of this presentation is to educate nurses on the use of CHG tegaderm dressings applied to mediports and PICC line’s while educating about the risk of infections. Catheter site related infections is a frequent thing and can be life threatening to the patient. A CHG dressing has been proven to reduce the rate of infections to patients. Reference: Impact of Tegaderm HP and CHG in Major Catheter Related Infections and Dressing Detachment. (March 31, 2015). A service of the U.S. National Institutes of Health. Retrieved on April 1, 2015, from results of a literature search based on the PICO questionSearch words that were used are CHG tegaderm use, mediport and PICC line infections through the search engine google and SmartSearch from Ferris State University. The results of the search were overwhelming. I had to really play around with the different types of wording used to find my specific criteria. The two research articles that I am referencing are: Article #1 Targeting Health Care-Associtated Infections: Evidence-Based Strategies.Kleinpell RM, Munro CL, Giuliano KK. Targeting Health Care-Associated Infections: Evidence-Based Strategies. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 42. Retrieved from #2 Preventing Central Venous Catheter Associated Primary Bloodstream Infections: Characteristics of Practices Among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control. Braun, B., Kritchevsky, S., Wong, E., Solomon, S., Steele, L., Richards, C., & Simmons, B. (2011). Preventing Central Venous Catheter Associated Primary Bloodstream Infections: Characteristics of Practices Among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study. Infection Control and Hospital Epidemiology, 24(12), 926-935.Article #3 Short-Dwell Ethanol Lock Therapy in Children Is Associated With Increased Clearance of Central Line–Associated Bloodstream InfectionsMcGrath, E., Salloum, R., Chen, X., Jiang, Y., Boldt-MacDonald, K., Becker, C., . . . Ang, J. (2011). Short-Dwell Ethanol Lock Therapy in Children Is Associated With Increased Clearance of Central Line–Associated Bloodstream Infections. Clinical Pediatrics, 50(10), 943-951.Article #4) Aziz, A. (2011). Audit of Blood Culture Technique and Documentation to Improve Practice. British Journal of Nursing, 20(8) 26-34.The research articles that I have chosen to reference and use relates to my PICO question because each article provides different statistical information from evidence-based practices. Research has been completed and supported to improve clinical practice in the most effective manner. Research on this subject is abundant. There were many journals and reports of studies that identify bloodstream related infections and interventions to reduce infection rates. All three articles I have chosen recognize the the different indications for medi-ports and PICC lines. Each article also expresses the importance of education to healthcare workers and to assess infection prevention to cleaning and dressing changes using sterile technique. “Nurses use research to provide evidence-based care that promotes quality health outcomes for individuals, families, communities and health care systems. Nurses also use research to shape health policy in direct care, within an organization, and at the local, state and federal levels. Nurses conduct research, use research in practice, and teach about research. ANA supports nursing research with a variety of resources such as the Research Toolkit.”Nursing Research (2015). American Nurses Association. Retrieved on April 11, 2015 from: the findings of 2 studies relating to the PICO question. The type of theory that was used was Qualitative research. All of my articles had used the approach of uncovering something more significant about experience rather than belief. The information obtained from the articles cannot be specified into larger study groups, but focus on a smaller, more specific group of people to obtain a certain outcome about infection prevention. The type of study: The study was observational and controlled with statistical data obtained from evidence-based practices to determine if patient’s acquired an infection from improper mediport and PICC line care. Design: The design of each study came from different centers and were observational studies in the settings of many different hospitals and their practice for preventing bloodstream infections. The process of information was obtained from observing mediport and PICC line access in an outpatient and hospital setting.Methods: The type of research method I used was literature research. The journal articles discuss the number of indications for central line access and its various uses. The journals identify different interventions and practices that may help reduce the rate of infection. Findings: The findings were that catheters coated with antimicrobials or antiseptics have been shown to decrease the risk of bloodstream infections. The use of chlorhexidine reduces the rate of colonization verse non-coated catheters. The Centers for Disease Control and Prevention recommends the use of CHG tegaderm dressings. 3B) Ethical principles guide public health research are built on a foundation of medical ethics, developed in the first instance to regulate the conduct of clinical research (Fritz, 2008). Ethical considerations to consider from each article are to take into consideration the privacy of the patient’s, making patients aware of the benefits and risks imposed as to being a part of the study and maintaining privacy and congeniality. None of the patients involved were mentioned by name and were acknowledged as a number or statistic. The research of this study was more beneficial and did not put any patients at risk or do harm. Article 1: There is strong credibility with this article. This study makes a contribution to EBP because the research was taken from evidence-based strategies. I feel that the strength of this article is great because it takes from evidence based practice implications and reviews the results of different studies. Kleinpell, R.: Ph. D., R.N., F.A.A.N., and a professor at Rush University College of NursingMunro, C.: R.N., A.N.P., Ph. D., F.A.A.N., and a professor at Virginia Commonwealth University School of Nursing.Giuliano, K.: R.N., Ph. D., F.A.A.N., Clinical Nurse SpecialistArticle 2: This article has strong strength due to the credibility of the authors and where they attained their research information from. They have many different affiliations including the University of Tennessee Health Sciences Center, Joint Commission on Accreditation of Healthcare Organizations, McGuire Veterans Administration Medical Center and Medical College of Virginia, Hospital Infections Program, Centers for Disease Control and Prevention and Methodist Health System. I think this article contributes to EBP because it affiliates with the CDC and uses relevant criteria from their website. Article 3 and 4: I used each of these articles for a small reference to some information I was looking for. I felt that these articles were credible because they were peer reviewed but did not provide any contribution to EBP. 3D) Describe how or if the findings are relevant to practice The findings are very relevant to practice because it is evidence based. The CDC recommends that central venous catheters follow a strict guideline recommended by the Oncology Nursing Society to decrease the risk of infection. The best evidence comes from empirical evidence from randomized control trials; evidence from scientific methods and qualitative research. How would they be communicated? (Include at what level, individual level, policy, standard of care level, professional level) This would be communicated through multiple strategies at every level. From an organizations perspective, the use of CHG tegaderms must be written through a guide of policy and procedures with evidence based information presented to a group of employees such as unit managers, coordinators and charge nurses. These employees are in charge of educating staff members on the proper policy, proper mediport/PICC line access, dressing changes, use of sterile technique and follow up. By having a group of team members skilled in this policy and respected by peers, they can implement the practice to their co-workers and make it a standard of care. There is a chain of command that must be included when trying to communicate practice changes at every level, which includes: the healthcare system wanting to make a change, executing the delivery of practice and care from all nursing units, and the experience the patient has during their visit. 2) What are the implications for practice change related to quality and safety of care (do they have the potential to change practice? If so how would it relate to quality and safety and would it be at the level of individual practice or at generalizability and how that is determined by strength and quality)Every hospital wants to do their best to provide the safest and best care to their patients possible, and every hospital has an opportunity to change their practice for the better. Hospitals changing to use CHG tegaderm dressings on mediports and PICC lines help reduce the risk of infection. The CHG dressing is an antimicrobial dressing that cannot be applied improperly, reduces skin flora (which is a leading cause of bloodstream infections), helps improve facility compliance, and is available in different sizes to fit the type of central line you are working with. This practice would be generalized to every nursing unit and practiced on an individual basis. This is determined by strength and quality because nurses are receiving more education and decreasing patients risk for infection. Implications to change the practice:The Tegaderm CHG dressing demonstrated broadspectrum antimicrobial activity against 37 strains of microorganism – 21 gram positive and 14 gram negative bacteria and 2 yeasts – that mostly commonly caused catheter-related bloodstream infections (CR-BSIs).The CHG dressing gel pad produced a clear region on agar that shows the absence of microbial growth. The dressing’s antimicrobial agent (CHG) exceeded the concentrations needed to inhibit each of the microorganisms tested. Aged CHG tegaderm dressing retain their antimicrobial properties as well and unaged dressings. Skin organisms remain and will regrow even after prepping with a CHG prep.CHG dressings had significantly lower skin organism regrowth than a standard transparent adhesive dressing. At 7 days CHG dressings had significantly lower skin organism regrowth than biopatch.Implications for practice change would create a safer environment for the patients by developing and implementing a program based on evidence-based practices. This is achieved by protocols, procedures, support systems, education, and building effective teamwork while working on communication. This must be initiated through the hospital and carried out at the individual level of the nurses because they are the ones who are doing the dressing changes. Barriers hospitals can overcome would be educating staff members about the new application process and educating staff on the proper use of the tegaderm CHG dressings. CHG dressings are actually cheaper than biopatch and regular tegaderm dressings. 68% of biopatch applications were reported as incorrect in clinical practice so by switching to the new dressing would decrease local infections, decrease CR-BSI and downstream costs of reimbursement and public disclosure. Fritz, K. (2008). Ethical Issues in Qualitative Research. John Hopkins School of Public Health, Department of International Health. Retrieved on April 13, 2015 from: ................
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