NURS FPX 8045 Assessment 4 Interpretation and Synthesis of Scholarly Sources

Name

Capella university

NURS-FPX 8045 Doctoral Writing and Professional Practice

Prof. Name

Date

Interprofessional Communication and Practice Gap

Inconsistent infection control practices, exacerbated by the ongoing nursing shortage, have contributed to an increase in Central Line-Associated Bloodstream Infections (CLABSIs), challenging patient care and healthcare quality in acute care settings. The rising incidence of these infections highlights the critical need for implementing effective and standardized infection control strategies (Badparva et al., 2022).

Project focuses on implementing evidence-based interventions, such as standardized infection control protocols, including daily Chlorhexidine Gluconate (CHG) bathing at Lima Memorial Hospital (LMH). By engaging stakeholders in the development and execution of these strategies, the project aims to foster a collaborative environment that prioritizes patient safety and enhances care quality. The initiative not only seeks to reduce CLABSI rates but also aims to strengthen team dynamics and improve infection control practices within the organization.

Identification of Practice Gap

The identified practice gap for the DNP project is the inconsistent adherence to central line care protocols, exacerbated by the ongoing nursing shortage, which increases the risk of CLABSIs. The shortage of nursing staff often leads to increased workloads and time constraints, making it difficult for nurses to consistently follow central line care protocols (Kim & Choi, 2023). Evidence shows that inadequate staffing can contribute to lapses in infection control practices, resulting in higher CLABSI rates (Karapanou et al., 2020). For instance, nurses working longer shifts can experience fatigue, reducing their ability to maintain sterile techniques (Xia et al., 2020).

Aiming to address the gap of inconsistent infection control measures, the project implements a standardized central line care protocol, incorporating strategies to optimize workflow despite staffing challenges. Regular monitoring and staff education will help ensure compliance, ultimately reducing infection rates. The scope of this DNP project is appropriate as it focuses on improving central line care processes in a specific clinical setting over 8 to 12 weeks, addressing both procedural adherence and workload factors related to the nursing shortage. However, broader issues like long-term staffing solutions and central line care practices in other facilities are beyond the scope of this project, which will concentrate on immediate, site-specific improvements at LMH.

Evidence of Problem in Project Site

Inconsistent adherence to central line care protocols, exacerbated by the ongoing nursing shortage, continues to contribute to the significant challenge of CLABSIs in acute care settings, including at LMH. In the USA, only 66% of nurses adhere to recommended central line care protocols (CDC, 2021). Nationally, CLABSIs affect approximately 41,000 patients annually, with mortality rates ranging from 10-30% and treatment costs between $25,000 to $56,000 per case (AHRQ, 2021; Johns Hopkins, 2022). The national benchmark for CLABSI rates in acute care hospitals is 0.8 infections per 1,000 central line days (CDC, 2022).

However, the nursing shortage has resulted in inconsistent adherence to these protocols, hindering infection control efforts. While states like North Dakota and Vermont have lower CLABSI rates, demonstrating the effectiveness of rigorous infection control (Joint Commission, 2024). LMH has seen a 43% reduction in CLABSI rates over five years through targeted infection control initiatives (Leapfrog, 2022). LMH Hospital has a CLABSI rate of 0.458, which is lower than the national benchmark, highlighting the need for consistent adherence to central line care protocols to maintain and further improve these outcomes (Medicare, 2024). 

This highlights the critical need for standardized protocols that can withstand the pressures of staffing shortages to maintain safety and quality care. However, challenges persist due to the ongoing nursing shortage, leading to increased workloads and inconsistent adherence to central-line care protocols. Hyte et al. (2023), indicate that the shortage of staff and the lack of consistent training and education have resulted in elevated infection rates. These statistics highlight the urgent need for further improvements and the implementation of a standardized central line care protocol, which will be the focus of the proposed DNP project aimed at reducing infection rates at LMH.

Formulating PICOT Question

In adults with central lines (P), how does the implementation of daily CHG bathing (I), compared to current central line care (C), reduce CLABSI rates (O) within twelve weeks (T)?

Inconsistent adherence to infection control protocols due to nursing shortages contributes significantly to the high rate of CLABSIs at LMH. CLABSIs not only increase patient morbidity and mortality but also lead to considerable healthcare costs, ranging from $25,000 to $56,000 per case (AHRQ, 2021). The nursing shortage exacerbates this issue, making it challenging to consistently implement necessary infection control measures. Evidence suggests that daily CHG bathing can reduce CLABSI rates and improve patient outcomes (Reynolds et al., 2021).

Implementing CHG bathing is a key action of this project to lower infection rates, which could, in turn, reduce costs and enhance patient safety. This approach aligns with the goal of reducing CLABSIs by addressing the practice gap while improving adherence to protocols despite staffing shortages. Addressing the practice gap of inconsistent protocol adherence, the project aims to improve outcomes despite the challenges posed by the ongoing nursing shortage.

Facilitating Discussions with Stakeholders

Facilitating discussions among stakeholders at LMH regarding the reduction of CLABSIs required effective communication strategies tailored to the hospital’s unique challenges. Engaging the nursing staff, who were dealing with staffing shortages, was crucial, and face-to-face meetings proved to be the most effective communication method. This approach allowed for real-time interaction, immediate feedback, and collaborative problem-solving on evidence-based interventions like daily CHG bathing (Reynolds et al., 2021). Studies indicate that direct engagement in decision-making fosters accountability and better adherence to infection control measures (Krauss et al., 2022).

In contrast, email-based communication was less effective, often resulting in delays and miscommunication, which hindered progress (Lord et al., 2020). By organizing more in-person discussions and workshops, we ensured that stakeholders, especially nursing staff, felt heard and involved in the solution process. This tailored communication strategy helped mitigate the challenges of the nursing shortage and strengthened the team’s dedication to reducing CLABSI rates. Linking back and emphasizing real-time, direct communication proved key to driving our efforts in improving patient safety and infection control at LMH.

Conclusion

In addressing the issue of inconsistent adherence to central line care protocols leading to CLABSIs at LMH, implementing evidence-based strategies proved essential for effective infection control. A standardized protocol, including daily CHG bathing and rigorous hand hygiene practices, was identified as a critical intervention to enhance patient safety. The integration of stakeholder feedback highlighted the challenges posed by the nursing shortage, which underscored the need for collective commitment to these practices. Active participation from nursing staff fostered a collaborative environment, enhancing buy-in for the proposed changes. By cultivating a culture of open communication and teamwork, the initiative not only aimed to reduce CLABSI rates but also contributed to a more cohesive healthcare environment.

References

AHRQ. (2021). Appendix 2. Central line-associated bloodstream infections fact sheet. Www.ahrq.gov. https://www.ahrq.gov/hai/clabsi-tools/appendix-2.html 

Badparva, B., Ghanbari, A., Karkhah, S., Osuji, J., Kazemnejad, E., & Jafaraghaee, F. (2022). Prevention of central line-associated bloodstream infections: ICU nurses’ knowledge and barriers. Nursing in Critical Care, 28(3), 419–426. https://doi.org/10.1111/nicc.12757 

CDC. (2021). Enhanced interventions to prevent CLABSI (pp. 1–62). Cdc.gov. https://www.cdc.gov/infection-control/media/pdfs/Strive-CLABSI202-508.pdf 

CDC. (2022, November 7). 2020 National and State Healthcare-Associated Infections Progress Report. Archive.cdc.gov. https://archive.cdc.gov/www_cdc_gov/hai/data/archive/2020-HAI-progress-report.html 

NURS FPX 8045 Assessment 4 Interpretation and Synthesis of Scholarly Sources

Hyte, M., Clark, C., Pandey, R., Redden, D., Roderick, M., & Brock, K. (2023). How COVID-19 impacted CAUTI and CLABSI rates in Alabama. American Journal of Infection Control, 52(2), 147–151. https://doi.org/10.1016/j.ajic.2023.05.014 

Johns Hopkins. (2022). Central Line-Associated Bloodstream Infections (CLABSI). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/patient-safety/infection-prevention 

Joint Commission. (2024). Variability of Surveillance Practices for Central Line-Associated Bloodstream Infections. Www.jointcommission.org. https://www.jointcommission.org/resources/patient-safety-topics/infection-prevention-and-control/central-line-associated-bloodstream-infections-toolkit-and-monograph/variability-of-surveillance-practices-for-central-lineassociated-bloodstream-infections-and-its-impl/ 

Karapanou, A., Vieru, A.-M., Sampanis, M. A., Pantazatou, A., Deliolanis, I., Daikos, G. L., & Samarkos, M. (2020). Failure of central venous catheter insertion and care bundles in a high central line–associated bloodstream infection rate, high bed occupancy hospital. American Journal of Infection Control, 48(7), 770–776. https://doi.org/10.1016/j.ajic.2019.11.018 

Kim, M. H., & Choi, J. S. (2023). Effects of organizational and individual factors on nurses’ practice of central line-associated bloodstream infection prevention. American Journal of Infection Control, 52(4), 443–449. https://doi.org/10.1016/j.ajic.2023.11.007 

Krauss, D. M., Molefe, A., Hung, L., Hayes, K., Gorman, C., Latterner, M., Henderson, S., & Miller, M. (2022). Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic. British Medical Journal Open Quality, 11(4), e001926. https://doi.org/10.1136/bmjoq-2022-001926

NURS FPX 8045 Assessment 4 Interpretation and Synthesis of Scholarly Sources

Leapfrog. (2022, March 21). New data shows infection rates still too high In U.S. hospitals. Leapfrog.org. https://www.leapfroggroup.org/news-events/new-data-shows-infection-rates-still-too-high-us-hospitals 

Lord, H., Loveday, C., Moxham, L., & Fernandez, R. (2020). Effective communication is key to intensive care nurses’ willingness to provide nursing care amidst the COVID-19 pandemic. Intensive and Critical Care Nursing, 62(1). https://doi.org/10.1016/j.iccn.2020.102946 

Medicare. (2024). Find healthcare providers: Compare care near you. Medicare.gov. https://www.medicare.gov/care-compare/details/hospital/360009/view-all?city=Lima&state=OH&zipcode=&measure=hospital-complications-and-death 

Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4 

NURS FPX 8045 Assessment 4 Interpretation and Synthesis of Scholarly Sources

Xia, W., Fu, L., Liao, H., Yang, C., Guo, H., & Bian, Z. (2020). The physical and psychological effects of personal protective equipment on health care workers in Wuhan, China: A cross-sectional survey study. Journal of Emergency Nursing, 46(6), 791–801. https://doi.org/10.1016/j.jen.2020.08.004