Effective Nursing Interventions to Prevent Central Catheter Infections in Dialysis Units

This clinical research paper evaluates effective nursing interventions that can be used to prevent central catheter-related infections in a dialysis unit. The study uses a phenomenological descriptive design to evaluate nurses' experiences and interventions they use when caring for patients with central catheters in an in-Centre dialysis unit.

CLINICAL RESEARCH PART B 1
Clinical Research Part B
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Introduction

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Literature Review Overview
Patients undergoing dialysis are at risk of contracting central catheter
infections(Marques et al., 2017). The risks of infections in the dialysis units are mainly due to
prolonged and frequent exposures to many possible contaminants in both hemodialysis units
and during the process of dialysis(Amer et al., 2015). The increased risks is precisely due to
close proximity with other patients, frequent and prolonged blood exposure during the
process of hemodialysis, reduced immunity of patients due to the disease process, constant
contact with nurses and other health care workers who often move from one patient to
another, prolonged hospitalization and poor adherence to prevention recommended
practices(Saha and Allon, 2017). Major sources of infections in a dialysis unit include
equipment, contaminated water, other infected patients, contaminated nurses and other health
care providers and environmental surfaces(Lindberg et al., 2013). Nurses should always
practice standard precaution strategies when caring for patients undergoing haemodialysis to
prevent contamination.
Research Aim
The primary aim of this research is to evaluate effective nursing interventions that can be
used to prevent the central catheter-related infections in a dialysis unit.
Research Question
This study seeks to answer the following question;
What nursing intervention prevents permcath related infection within the in-center dialysis
unit?

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Methods
To address catheter-related infections in a dialysis unit, most studies have used
observational research design using qualitative research methods(Trépanier et al., 2014). This
includes the review of medical records and analyzing how the patients have treated, which
prevention methods have been used and which have been found to be more
effective(Freshwater, 2017). Qualitative research methods involve a description of
phenomena based on personal experience or perspectives(Polit and Beck, 2013). In addition,
some studies have used phenomenological descriptive design to study nurse’s experience in
the dialysis units.
Findings
Most studies have found that hand washing is a significant nursing intervention when
it comes to the prevention of infections in in-center dialysis units (Marques et al., 2017).
Other interventions include proper spacing of patients, implementation and use of standard
precautions, reporting patients who have prolonged catheter to be changed, advocating for
fistula catheters, appropriate dressing, and cleaning of the catheter(Amer et al., 2015).
Limitations
Various limitations have been found to be associated with the study. These include the
unwillingness of nurses and other healthcare workers to participate, a poor method of storage,
little number of participants and time consuming when taking the interview and analyzing
data(Hickman, 2015).
Conclusion

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Most studies have concluded that prevention of infection in dialysis units is
crucial(Saha and Allon, 2017). Proper hand washing and observing standard precautions are
the key interventions nurses can use to prevent central catheter-related infections in the
dialysis units(Infection Prevention and Control Nova Scotia (IPCNS), 2015).
Research Hypothesis
Central catheter infections are common in patients undergoing hemodialysis. This study is
intended to provide various nurses interventions used to prevent such infections. The results
of the study will be used to provide recommendations for other nurses working in the dialysis
unit for better care.
Introduction
Various nursing interventions have been used to prevent permcath infections in an in-
center dialysis unit(Saha and Allon, 2017). However, patients in the dialysis unit die day by
day due to healthcare-associated infections(Kosa et al., 2017). Due to this fact, a gap has
been created for further research. This study seeks to provide an approach that can be used to
determine various nursing strategies that can be used to prevent central catheter infections in
a dialysis unit. The study will provide a research design, sample and recruitment process, data
collection process and data analysis.
Research Design
The research design in the study will be used in addressing the research objectives and
answering the research question(de Chesnay, 2015). In this study, a phenomenological
descriptive design will be used to evaluate nurses experiences and interventions they use
when caring for patients with central catheters in an in-Centre dialysis unit(Marques et al.,
2017). In addition, the design will be used to examine what are nurses’ perceptions or what

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they think are the best interventions for infection prevention in the dialysis units. This design
fits the research as it involves the description of strategies and situations as explained by
those who practice them. The qualitative research will form the basis of the study. This is
because the qualitative research uses the description of a given scenario or
phenomenon(Hickman Director, 2015). This includes a collection of rich narratives materials
using interviews which address broadly stated questions about human experiences and
realities(Doorenbos, 2014). In this study, qualitative research will be applied by evaluating
nurses’ day to day strategies and their experiences through generating one’s clinical practices
in relation to preventive interventions in the dialysis units.
Research methods
Research methods involve the use of different techniques a researcher used to gather
and analyze the research aim and question(Shin, 2017). The research methods are considered
as the strategy of the whole research as compared with the research design that guides the
researcher in planning(Shin, 2017). The study will use qualitative research methods since it
involves a description of various strategies the nurses in the dialysis uses to prevent central
catheter-related infections. In this study, the research should be carried out in the dialysis
units where nurses take care patients with central catheters. The dialysis units should have
both male and female adults. The collection of data will be carried out in two hospitals which
have dialysis units that have functioned for more than ten years. The nurses in the dialysis
units should include those who are specialized in intensive care and those who have received
a continuous medical education and practice concerning the care of patients with central
catheter
Target population
The target population in research includes a group of participants the research
question is concerned with(Raines, 2013). In this study, the target population comprises all

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licensed nurses practicing in the in-center dialysis units. All the nurses in the units should be
having extra knowledge on critical care and an experience of more than two years in the
dialysis units.
Sample and recruitment process
A sample is selected from a small number of the population for a study whereas
sampling is the process of choosing a group of individuals to represent a given population in
a specific study(Raines, 2013). Purposive sampling will be used in the study which involves
the use of researcher judgment on which participants highly fits the study and will give the
maximum information(Pan and Bai, 2016). In this research, licensed and registered nurses
with more than two years of working experience in a dialysis unit will be recruited as they are
expected to be having more knowledge and skills on central catheter preventive strategies
since they have adequate exposure. In addition, two hospitals will be selected with a
minimum of ten year operating dialysis units since they likely to have own and different
strategies. A total number of twenty dialysis nurses (n=20) will be selected. Choosing a
bigger sample will be time-consuming, and the relevant information may not be taken. A
small sample is appropriate since this study involves the use of in-depth discussions and
comprehensive interviews about the interventions used. The researcher will request a list of
critical care nurses in the dialysis units from both hospitals and those above two years of
experience will be selected. The nurses will then be issued with letters asking them to
participate in the research. Those who will reply and be willing to participate will be
recruited.
Data collection and instruments
In this study data collection involved the gathering of information from nurses in two
in-center dialysis units that address the research question. The study will use interviews as a
method of data collection(Raines, 2013). The researcher will act as the instrument of the

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research who will use the theoretical knowledge in guiding the discussions towards the
research objectives. In addition, the interview sheets approved by the university research
department will be sued together with the audio recorders and recording tapes. Prior to the
day of data collection, the researcher should visit the dialysis unit manager and the chief
nurse with a letter asking them for permission to conduct the research. In addition, the
dialysis unit representative should be given a brief explanation of the study. All nurses should
later be issued with the informed consent forms that state they are aware of the research and
they are willing to participate. Each of the selected individuals should then be interviewed
privately after signing the consent forms. The interview sheets should have both open and
close-ended questions. Audio tapes will be used to record the interviews where they will
remain anonymous
Data Analysis Approach
Data analysis in this study will intend to pull all the gathered information together in
order to present a clear picture of the whole research. In this research, Data analysis will
involve observing the participants as they demonstrate the proper ways of prevention. The
following are the major sections that will be used in analyzing the data; re-reading all the
interview sheets and listening to audios to extract the required information, obtaining the
most relevant significant details, understanding the meaning of derived data, organizing and
formulating the meaning into clusters and themes, and validating the formulated descriptions
to make a conclusion.
Conclusion
Most of the patients undergoing hemodialysis die every year due to healthcare-related
infections. Various nursing intervention has been used, but a gap remains for further research.
This study has provided an approach that can be used to conduct an investigation on which

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nurses intervention are effective in the prevention of central catheter infections in an in-center
dialysis unit in two hospitals using a sample of twenty nurses.

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