University Report: Chlorhexidine Dressing vs. Standardised Dressings

This report delves into the effectiveness of chlorhexidine dressings in reducing central venous catheter (CVC) infection rates compared to standardized dressings in hospitalized adults. It explores the application of evidence-based practice (EBP) within a healthcare setting, specifically focusing on the MSN, FNP specialty track. The report presents a case study utilizing a PICO tool to formulate a clinical question and conducts a systematic review and meta-analysis, which supports the use of chlorhexidine dressings for reducing CVCIs. The analysis considers the implications for clinical practice, including cost-effectiveness, and concludes that chlorhexidine dressings offer a simple, yet effective method for reducing the incidence of CVC infections. The report also acknowledges the importance of a collaborative model and the need for peer review in EBP processes.

Running head: CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 1
Chlorhexidine Dressing Vs Standardised Dressings
Student’s Name
University Affiliation

CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 2
Overview
Evidence based practice (EBP) helps integrate clinical care with the aim of improving
clients (patients) outcome (Parienti et al., 2012). As nurses continue to master the practice, they
are faced with the problem of searching for the best evidence to support both assessments and
interventions, refine strategies and develop new policies as well. Although determining
substantial evidence from simpler one is a complicated process, a qualitative research method
helps provide valuable knowledge for the nurses in their practice. Marinho and da Cruz (2013)
assert that qualitative research provides its results through participant’s words that can be easily
applied to the nursing care practice. However, nurses are attracted to this research since its
methods plus findings conform to the nursing practice where understanding and knowing the
patient wholly matters the most. Ultimately, the primary role of EBP is to provide the patient
with clinical services at a personal level. Apart from being continuous, EBP also provides
dynamic integration of clinical expertise as well as external evidence in daily practices (O’grady
et al., 2011).
This essay discusses the question on whether the use of Chlorhexidine dressing
decreases central venous catheter infection rates (CVCIs) compared to standardized dressing in
adults hospitalized in high complex settings. Its rationale is that although a majority of vascular
catheter –related infections occurs in people with highly complex settings, Chlorhexidine
dressing can help reduce the infection rates.

CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 3
Impact of Nursing Issues on the Student MSN, FNP Specialty Track
Master of Science nursing abbreviated as MSN is a program that deals with the
preparation of graduates for advanced nursing practice as well as doctoral study, while family
nurse practitioner (FNP) is a speciality track that helps learners expand their nursing practice
(Parienti et al., 2012). The track prepares nursing students to manage healthcare needs of the
patients, focus on promotion of health and prevention of diseases, diagnosis and management of
chronic and acute illness. In the nursing school, Parienti et al., (2012) hold that the practitioners
do acquire both skills and knowledge needed to perform nursing assessments as well as apply
sequence of steps when conducting procedures. The MSN, FNP speciality track will therefore
provide an FNP with the necessary skills to understand the use of chlorhexidine (an antiseptic
agent for skin disinfection) and know whether it has any effect on the central venous
catherization (CVC) such as the impact on infections.
Less than usual, results such as skin breakdown and infections would occur when a nurse
skips steps in their procedures or have not fully mastered the skills (Loveday et al., 2016). Most
of the times, they draw knowledge from past educational instructions when making decisions
regarding performance in their practices. According to Loveday et al., (2016), the track also help
nurses to synthesize knowledge from humanities, sciences as well as nursing theories to uphold
advanced nursing practice and develop practical approaches of EBP including nursing research.
Most importantly, the FNP track would help a learner understand that vascular and CVC cause
severe morbidities and mortality in elderly patients. Also, they would be able to examine the
chlorhexidine (antiseptic agent) dressing effects on the risks of epidural as well as catheter
bacterial infections and colonization (Chan et al., 2012).

CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 4
Evidence Based Measures Regarding the Use of Chlorhexidine to Reduce Central Venous
Catheter Infections
Methods
The essay describes the steps involved in implementing an EBP model for decision
making at service levels using a case report. The essay also demonstrates findings of systematic
reviews evaluating the effects of continued use of the Chlorhexidine in lowering CVCIs. The
dressings are fit at the entry sites of the central venous access device (CVAD) and covered to
protect them.
Theoretical Model
The EBP model helps in guiding the implementation of research into nursing practice
using necessary procedures to improve the client’s outcome (Garland et al., 2001). The model is
used to guide the current case report.
Case Report
CVCIs are linked with mortality rates of over 12%. As Kim et al., (2011) asserts, the
accepted methods of reducing catheter related infections include use of appropriate solutions for
the skin antisepsis and access of line, immediate removal of unnecessary catheters and
preferential subclavian catherization. Although dressings become detached in patients in the
intensive care unit, decreasing skin colonization by bacteria at the site of insertion by using
antiseptic dressings can reduce the risks of CVCI (Kim et al., 2011). It has been shown that the
use of chlorhexidine can decrease a majority of catheter infections including catheter related
blood infections (CRBI).

CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 5
A PICO tool was used to ask the following question: “Does the use of antiseptic
chlorhexidine dressing decrease central venous catherization infection rates when compared to
other standardized dressing in adults hospitalized in high complex settings?”
Element
Problem/
population
In adults hospitalized in high complex setting
Intervention Does antiseptic chlorhexidine
Comparison Compared with standardized dressing
Outcome Effective in decreasing central venous catherization infection rates
Conducting a Systematic Review
After identifying the clinical question, a literature search was conducted locating a
systematic review. Use of systematic reviews has been recognized in healthcare settings for
informing clinical questions. A metal analysis conducted showed that use of chlorhexidine
dressings favoured reduction of CVI rates in adults than standardized dressings. The purpose of
reviewing was to compare the number of CVIs occurring in adults where chlorhexidine was used
against the number of infections in people who used non-chlorhexidine dressing in determining
the effectiveness of chlorhexidine to reduce the catheter colonization and infection rates (Chan et
al., 2012).
A standard Cochrane collaboration methodology was used and search done for relevant
articles using different databases such as Medline, CINAHL and EMBASE. Each paper was
reviewed independently and control trials which the impact of chlorhexidine dressings was
compared to a group that received standardized dressings. Meta analyses were conducted using
outcome of the studies. Fortunately, the results favoured use of chlorhexidine dressing on the
entry sites of catheter to reduce CVI rates.

CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 6
The forest plots evaluated use non-chlorhexidine against use of dressings and
compared/contrasted prevalence’s of CRBI and catheter colonization between the groups
(O’grady et al., 2011). Irrespective of the methodological disparities between the studies,
heterogeneity of the Meta analysis using CRBI as the main result was zero. Since hetegonitiy
was far much high for catheter colonization, it would be considered less significant. According to
Parienti et al., (20012), this insignificance showed that pooling of data in the trials was
necessary. However, the number needed for treating analysis to reduce CRBI was 62. Hence,
these dressings can be used to prevent catheter colonization’s in every ten persons.
Implications to the Clinical Practice
Nurse unit manager and nurse researcher discussed outcome of the review as well as subsequent
effects for clinical practice (Marinho and da Cruz, analysis in this 2013). The review favoured
the use of chlorhexidine on reducing CVCI. Apart from the consideration of the evidence, cost
analysis was conducted where each dressing costs $6.00 and needed to be changed twenty-four
hours following catheter insertion. As per the local database, the average length of time that the
central venous access device was in situ in adults hospitalized in ICU was 29 days and would
requires six dressing during the period, hence cost of preventing one episode of CRBI was very
high. To summarize, this review concluded that chlorhexidine dressing provides simple yet cost
effective method of reducing the incidences of CRBI occurring in adult patients.
Discussion
A systematic review of this report showed chlorhexidine dressings as cost effective yet
simple clinical intervention of reducing CVCIs incidences in adult patients. Also, the case report
showed that the problems encountered by the Clinicals were in making decisions based evidence.

CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 7
Despite the fact that there are frameworks available to facilitate EBP, the case report showed a
possible operationalization of a collaborative model. However, the model was a key to the
success of clinical cases among the nurse administrators, clinical nurse plus the researchers. As
Kim et al., (2011) asserts it is also important to acknowledge that there were randomized control
trials available for analysis.
In instances where enough evidence cannot be found, it is wise to wait for evidence from
primary research before the practice change. However, the scope of the essay is confined to a
report of EBP process but failed to find the practice change effects regarding the clinical
outcome. Hence, this report presents the steps for EBP and provides rational and analysis of cost-
effectiveness estimation for proofing the practice change. Also, it’s noted that in an ideal
scenario, the reviewing conducted in the EBP needs to be peer reviewed.
Conclusion
A research utilization collaborative method in healthcare is appropriate to inform the
dressings practice as well as ensure its effectiveness is delivered with the aim of improving
healthcare’s outcome. A friendly environment and infrastructure for enquiries in clinical as well
as research are known to enable implementation of the EBP. Therefore, it has been evident from
the analysis that the use of antiseptic chlorhexidine dressing reduces central venous catherization
infection rates when compared to standardized dressings in adults hospitalized in high complex
settings.
.

CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 8
REFERENCES
Chan, R., Northfield, S., Alexander, A., & Rickard, C. (2012). Using the collaborative evidence
based practice model: a systematic review and uptake of chlorhexidine-impregnated
sponge dressings on central venous access devices in a tertiary cancer centre. Australian
Journal of Cancer Nursing, 13(2), 10-15.
Frasca, D., Dahyot-Fizelier, C., & Mimoz, O. (2010). Prevention of central venous catheter-
related infection in the intensive care unit. Critical care, 14(2), 212.
Garland, J. S., Alex, C. P., Mueller, C. D., Otten, D., Shivpuri, C., Harris, M. C., ... & Goldmann,
D. A. (2001). A randomized trial comparing povidone-iodine to a chlorhexidine
gluconate-impregnated dressing for prevention of central venous catheter infections in
neonates. Pediatrics, 107(6), 1431-1436.
Kim, J. S., Holtom, P., & Vigen, C. (2011). Reduction of catheter-related bloodstream infections
through the use of a central venous line bundle: epidemiologic and economic
consequences. American journal of infection control, 39(8), 640-646.
Loveday, H. P., Wilson, J. A., Prieto, J., & Wilcox, M. H. (2016). epic3: revised
recommendation for intravenous catheter and catheter site care. Journal of Hospital
Infection, 92(4), 346-348.
Marinho, J. S., & da Cruz, I. C. (2013). Reduction of infection associated with central venous
catheterization by antiseptics-Sistematic Literature Review. Journal of Specialized
Nursing Care, 6(1).

CHLORHEXIDINE DRESSING VS STANDARDISED DRESSINGS 9
O'grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., ... &
Raad, I. I. (2011). Guidelines for the prevention of intravascular catheter-related
infections. Clinical infectious diseases, 52(9), e162-e193.
Parienti, J. J., du Cheyron, D., Timsit, J. F., Traoré, O., Kalfon, P., Mimoz, O., & Mermel, L. A.
(2012). Meta-analysis of subclavian insertion and nontunneled central venous catheter-
associated infection risk reduction in critically ill adults. Critical care medicine, 40(5),
1627-1634.