Evidence Based Nursing Research on Central Line Associated Blood Stream Infections

This paper reviews three different genre of research studies, a quantitative study, a qualitative study, and a systematic review study to review the findings and critically appraise the information provided by the research article on central line associated blood stream infections.

Running head: EVIDENCE BASED NURSING RESEARCH
Evidence based nursing research
Name of the student:
Name of the university:
Author note:

2
EVIDENCE BASED NURSING RESEARCH
Table of Contents
Introduction and statement of the issue:.....................................................................................3
Summary table:..........................................................................................................................4
Critique of the evidence using CASP:.......................................................................................7
Data findings:.............................................................................................................................9
References:...............................................................................................................................10

3
EVIDENCE BASED NURSING RESEARCH
Introduction and statement of the issue:
One of the greatest challenges to safe hospice stay and optimal care services provided
to the patients during their stay in the health care facility is health care associated infections
(Cruz et al. 2018). On a more elaborative note, the central line associated blood stream
infections or CLABSI have been identified as the most frequently reported conditions
affecting the patient populations. As mentioned by Patel et al. (2018), central line associated
blood stream infection is the primary contributor to thousands of deaths all across the globe.
Similarly, these infections also enhances the number of hospice stays in a day and also leads
to considerable challenges associated with the health care complications that the patient had
been suffering from. Undoubtedly this one of the most important and consequential issue that
impacts not just the patients, but also the acre providers that are associated with the care
program.
The central line is the central venous catheter, which is generally placed by the doctor
in a large vein near the neck, chest, or groin, in order to give the medication to the patients. It
has to be mentioned in this context that this invasive catheterization enhances the chance of
the pathogenic microbes inhabiting the health care environment to access the bloodstream of
the patient directly (Carpenter, McTigue and Roberts 2016). Hence, the central line
associated blood stream infections are very serious infections that can is facilitated by the
pathogen that blocks the catheter opening enter the blood stream of the patient and is spread
throughout the body immediately causing severe and even possible fatal consequences for the
patient. Even though the health care providers maintain a thorough infection control protocol,
the prevalence of the CLABSI in the health care sector is alarming (Dees et al. 2017). Hence,
I have chosen this grave issue for the this paper where I have chosen three different genre of
research studies, a quantitative study, a qualitative study, and a systematic review study to
review the findings and critically appraise the information provided by the research article.

4
EVIDENCE BASED NURSING RESEARCH
The primary aim to acquire and explore knowledge and idea regarding the CLABSI and how
it impacts the health care scenario with respect to available literature evidence. This paper
will use these three articles to construct a tabular summary of the three chosen articles,
criticism of the article using a critical appraisal tool, and illustration of the key findings
provided by the chosen literature evidences on the selected issue.
Summary table:
Author/s (year)
Country
Aims
or
Purpose
Sample/ setting
or
Key stake-
holders and
their roles
Design/
methods
or
Type of paper
Main findings
or
Primary
argument
Strengths and
limitations of
the paper
Article 1 Rosenthal, V.
D., Udwadia, F.
E., Kumar, S.,
Poojary, A.,
Sankar, R.,
Orellano, P. W.,
... & Patil, P.
2015
The primary
aim of this
randomized
clinical trial is
to compare the
rates of central
line associated
bloodstream
infection
between the
patients that
used the split
spectrum with
single use
prefilled
flushing device
and the
patients that
used a three
way stopcock
device
Sample
Participants for
this study
included 1096
patients with
547 patients and
3619 central line
(CL)-days for the
SS + SUF group,
and 549 patients
and 4061 CL-
days for the
3WSC group.
Setting for the
research study
had been 5 adult
intensive care
units.
Design for this
research study
had been a
Quantitative
randomized
control clinical
trial.
The collected
data had been
analysed with
respect to three
parameters,
clinical analysis,
microbiological
analysis and
cost
effectiveness
analysis.
The main data
findings of the
research article
indicated that
during the trial
period the use
of single slit
along with
single use
peripheral
devices was
associated with
significantly
lower rate of
Central Line
associated
bloodstream
infection then
that of the
patients using
three way
stopcock
devices. Along
with that the
patient with
split septums
with single use
the strengths
and limitations
of this resource
study are not
clearly
identified and
illustrated in the
article by the
authors.
However with
respect to our
review, the
strength of the
article include
the sufficient
sampling,
thorough and
rigorous data
analysis and
interpretation of
the data, along
with
continuation
with the
previous
research
findings.

5
EVIDENCE BASED NURSING RESEARCH
preferred
devices was also
associated with
better cost
effective
implementation
than the other
group in
comparison.
The limitations
of this research
article include
limited budget
and the
resources of the
country setting.
A thorough
illustration of
the statistical
analysis of the
quantitative data
identified for
the article is
also absent in
the research
study which can
also be
considered a
notable
limitation
Article 2 McAlearney,
A.S. and
Hefner, J.L.,
2014.
The primary
objective of
this research
study was to
determine
whether
infection
control
professionals
and frontline
staff have
different
perspectives
regarding the
facility
design
challenges of
central line
associated
bloodstream
infection
prevention
program
success.
Sampling for
key informant
Interview data
from 50
Frontline
nurses and 26
infection
control
professionals
were analysed
in order to
identify
common
themes related
to the program
facilitated and
challenges.
The research
design for this
article for
qualitative
involving data
from
interviews
which was
analysed
taking the help
of thematic
analysis.
The main
findings
indicated that
there are four
facilitators of
central line
associated
bloodstream
programs
success
including
education
leadership data
and
consistency.
There were
three common
challenges
identified as
well including
lack of
resources
competing
priorities and
This article
also lacks the
basic
discussion
regarding the
strengths and
limitations of
the research
study
conducted.
Although in
this case the
torah analysis
of the scenario
involving the
facility design
challenges and
their
consistent
illustration in
the discussion
is a
considerable
strength that is

6
EVIDENCE BASED NURSING RESEARCH
interviews
that were
carried out in
8 hospitals
participating
in the agency
for healthcare
research and
quality
central line
associated
bloodstream
infection
prevention
initiative
which is
called “on the
cusp stop
BSI.”
physician
resistance. The
article suggest
that the
infection
control
professionals
are required to
take the
perspectives of
staff nurses
into account
while they are
implementing
the
improvement
initiatives so
that the
success of the
program can
be ensured and
facilitated.
needed to be
considered
when
appraising a
qualitative
article. The
limited
sampling and
lack of explicit
details on data
collection and
analysis
procedure is a
considerable
limitation.
Article 3 Reyes, D.C.V.,
Bloomer, M.
and Morphet, J.,
2017
The primary
aim of the
article had
been to
identify and
criticize the
best available
evidence on
the
interventions
that can
prevent
central
venous line
The research
design had
been a
systematic
review
The sampling
was of 19
studies which
was
discovered
using a
systematic
search of 7
data basis
including
MEDLINE,
CINAHL plus,
EMBASE,
PubMed,
The data
findings
indicated that
central venous
line associated
bloodstream
infections can
be drastically
reduced by the
range of
interventions
that includes
closed in
fusion
The strength
of the study
includes the
consistency of
the findings
with other
literature and a
hollow
analytical
detail provided
by the authors
in the
discussion.
The limitation

7
EVIDENCE BASED NURSING RESEARCH
associated
bloodstream
infections in
the adult ICU
patients in
comparison
to other
antimicrobial
catheters.
Cochrane,
Scopus, and
Google
scholar.
systems,
aseptic
technique
during
insertion and
management
of central
venous line,
early removal
of central
venous lines
and
appropriate
site selection.
includes only
including
studies that are
published in
English and of
predominant
heterogeneity
in the
interventions
in the included
studies.
Critique of the evidence using CASP:
In order to criticize the three research evidences, the critical appraisal tool that will be
utilized is the CASP tool (Munn et al. 2014). It is one of the most abundantly used critical
appraisal tools in evidence based practice and providing a systematic framework in criticizing
the validity and authenticity of a literature evidence which is why the tool had been chosen.
The first study had been a randomized controlled trial for which the CASP tool specific for
randomized control trial has been used, which has three sections and 11 questions (Casp-
uk.net 2018). as per the tool that can be mentioned that the trial did address a clearly focused
issue, the assignment of the patients to the treatments was randomized which was accounted
for in the end of the study, although the patients and health workers were not blinded to the
treatment as it has not been a double-blind or double dummy randomized controlled clinical
trial which can be considered a imitation (Claydon 2015). On the other hand the groups were
similar and the groups were treated equally with just the exception of the experimental
intervention being different for different groups which is a valid strength of the research
article. The result was clearly mentioned in the treatment effect was also not enough
considering the sample size. As per the data findings the estimate of the treatment effect was

8
EVIDENCE BASED NURSING RESEARCH
precisely mention and the results can be applied to the local population which indicates at the
transferability and generalizability of the day tour finals. Lastly this particular randomized
control trial also two conditions of cost effectiveness of the intervention proposed all the all
the clinical outcomes when not equally considered which can be taken as a flaw of
confounders adjustment (Quigley et al. 2018).
The second article has been a qualitative review for which the qualitative checklist of
CASP has been used to criticize the literature which has three sections but 10 questions
(Casp-uk.net 2018). As per the critical tool the authors provided to clear statement of the
aims of the research and the qualitative methodology chosen has also been appropriate along
with recruitment. Although, the relationship between researcher and participants was not
adequately mentioned in the article. There is a clear illustrated statement of the findings
discussed and the article which indicates that the research findings is valuable with the only
exception of lack of enough regards given to the ethical adjustment of the study (McAlearney
and Hefner 2014).
The third study is a systematic review for which the systematic checklist of caste was
used that had 11 questions in three sections (Casp-uk.net 2018). The systematic review study
emphasized on a focused question and the selection of the people has also been correct with
the only limitation of lack of heterogeneity of interventions of the included studies. To assess
the quality of the studies the systematic review followed question effective practice and
organization of care review group recommendation which is a considerable strength of the
study design (Cavaleri, Bhole and Arora 2018). The results have been precise and can be
transferred to the local population and the possible harms and cost was also included which is
a considerable strength of a systematic review masking it inclusive and multidimensional
(Reyes, Bloomer and Morphet 2017).

9
EVIDENCE BASED NURSING RESEARCH
Data findings:
Considering the data findings the first article by Rosenthal et al. (2015), suggested
that the use of combined devices of split septum and single use prefilled flushing device is
much more efficient and cost effective in reducing the rate of CLABSI than the usually used
three-way stopcock device. This study provided a very innovative insight that can improve
and reduce the rate of infections all the while being cost effective for implementation into
larger hospital settings as well. The qualitative study by McAlearney and Hefner (2014), on
the other hand provider completed different administrative point of view regarding the
facilitators and challenges present in improvement initiatives reducing the central line
bloodstream infections. Only technological improvements is not enough for reducing the
impact of disinfection there is need for administrative and management oriented changes and
improvements as well so that the technological innovations can be implemented without any
failure (McAlearney et al. 2017). This article provided insight which can be used in
addressing the administrative requirements in reducing the rate of this healthcare associated
infection. The systematic review by Reyes, Bloomer and Morphet (2017), stated 4 different
practice protocol which if implemented can also reduce the rate of central venous Line
bloodstream infection. On a concluding note all three studies provided three different
insights on reducing the infection rate, implementing the gist of the three studies can actually
improve the infection rates in different healthcare units in a cost effective and efficient
manner.

10
EVIDENCE BASED NURSING RESEARCH
References:
Carpenter, A.D., McTigue, S. and 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), p.S11.
Casp-uk.net 2018. CASP Checklists - CASP - Critical Appraisal Skills Programme. [online]
Available at: https://casp-uk.net/casp-tools-checklists/ [Accessed 22 Oct. 2018].
Cavaleri, R., Bhole, S. and Arora, A., 2018. Critical Appraisal of Quantitative
Research. Handbook of Research Methods in Health Social Sciences, pp.1-23.
Claydon, L.S., 2015. Rigour in quantitative research. Nursing Standard (2014+), 29(47),
p.43.
Cruz, M.A., Masalunga, C.D., Rodriguez, M.L.C., Gervasio, C., Thornburg, D., Hannah, K.
and Dalere, M.F., 2018. Central Line Associated Blood Stream Infection (Clabsi): A Cqi
Project.
Dees, J., Schrier, L., Meyer, M., Pettrey, P., Rouillier, T., Marthenze, A., Munkel, M.,
Nelson, P. and Thomas, J., 2017. Changing Perspectives: Clabsi Reduction in a High Risk
Patient Population. Biology of Blood and Marrow Transplantation, 23(3), pp.S480-S481.
McAlearney, A.S. and 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 control, 42(10), pp.S216-
S222.

11
EVIDENCE BASED NURSING RESEARCH
McAlearney, A.S., Hefner, J.L., Sieck, C.J., Walker, D.M., Aldrich, A.M., Sova, L.N.,
Gaughan, A.A., Slevin, C.M., Hebert, C., Hade, E. and Buck, J., 2017. Searching for
management approaches to reduce HAI transmission (SMART): a study
protocol. Implementation Science, 12(1), p.82.
Munn, Z., Moola, S., Riitano, D. and Lisy, K., 2014. The development of a critical appraisal
tool for use in systematic reviews addressing questions of prevalence. International journal
of health policy and management, 3(3), p.123.
Patel, P.K., Gupta, A., Vaughn, V.M., Mann, J.D., Ameling, J.M. and 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), pp.105-116.
Quigley, J.M., Thompson, J.C., Halfpenny, N.J. and Scott, D.A., 2018. Critical appraisal of
nonrandomized studies—A review of recommended and commonly used tools. Journal of
evaluation in clinical practice.
Reyes, D.C.V., Bloomer, M. and Morphet, J., 2017. Prevention of central venous line
associated bloodstream infections in adult intensive care units: A systematic review. Intensive
and Critical Care Nursing, 43, pp.12-22.
Rosenthal, V.D., Udwadia, F.E., Kumar, S., Poojary, A., Sankar, R., Orellano, P.W., Durgad,
S., Thulasiraman, M., Bahirune, S., Kumbhar, S. and Patil, P., 2015. Clinical impact and cost-
effectiveness of split-septum and single-use prefilled flushing device vs 3-way stopcock on
central line–associated bloodstream infection rates in India: a randomized clinical trial
conducted by the International Nosocomial Infection Control Consortium (INICC). American
journal of infection control, 43(10), pp.1040-1045.

12
EVIDENCE BASED NURSING RESEARCH
Zeng, X., Zhang, Y., Kwong, J.S., Zhang, C., Li, S., Sun, F., Niu, Y. and Du, L., 2015. The
methodological quality assessment tools for preclinical and clinical studies, systematic
review and meta‐analysis, and clinical practice guideline: a systematic review. Journal of
evidence-based medicine, 8(1), pp.2-10.