DPI Project Proposal Chapter 3 – Methodology
Chapter 3 of the DPI Project, entitled “Methodology,” will expand upon the content and concepts presented in the “Strategic Points Final Draft” (Appendix A) document you completed in its final iteration in Topic 2.
General Requirements: Use the following information to ensure successful completion of the assignment:
•Locate the “DPI Proposal Template” in the PI Workspace of the DC Network. •Locate the Strategic Points Final Draft assignment completed earlier in this course. •Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. •This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. •You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. Directions: Use the “DPI Proposal Template” and the “Strategic Points Final Draft” document, to develop a draft of (Chapter 3) Methodology that describes the methodology you are utilizing in your DPI Project Proposal. Sections in Chapter 3 include:
1.Introduction
2.Statement of the Problem
3.Clinical Question(s)
4.Project Methodology
5.Project Design
6.Population and Sample Selection
7.Instrumentation
8.Validity
9.Reliability
10.Data Collection Procedures
11.Data Analysis Procedures
12.Ethical Considerations 1
3.Limitations
14.Summary
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)
Submitted by
Kerry Sean Murphy
Direct Practice Improvement Project Proposal
Doctor of Nursing Practice
Grand Canyon University
Phoenix, Arizona
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs) 1
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)
June 26, 2019
Appendix A
| Ten Strategic Points | Comments or Feedback | |
| Broad Topic Area |
1. Broad Topic Area: The topic is the Prevention of Central Line-Associated Bloodstream Infections (CLABSIs). |
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| Literature Review |
2. Literature Review: a. Background of the problem/gap: · There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs (Yaseen, et al., 2016). · The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections (Dick et al., 2015). · The nurses need to have significant knowledge associated with evidence-based practices for the prevention of central line-associated bloodstream infections (CLABSIs). Their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter in adult Intensive Care (ICU) units with (CVC) patients needs to change for the better (Kadium, 2015). · Research has shown the existence of variations in the practice of nursing regarding the prevention of CLABSI, thus stressing the need for monitoring and education/training (Elbilgahy et al., 2015). · There is a need for implementation of educational interventions to deal with the practice and knowledge gaps about CLABSIs prevention as well as ensuring that nurses apply prevention interventions which are evidence-based (Esposito et al., 2017). · The Quality Health Outcomes Model (QHOM) Investigating Prophylactic measures to eradicate the incidence of central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich et al., 2014) b. Carrying out a review of literature topics with a key theme for each one. c. Prevention of Central Line-Associated Blood Stream Infection (CLABSI) (Masse, Edmond, & Diekema, 2018). · The Quality Health Outcomes Model (QHOM) is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. This model/framework has been used by various researchers to test the effectiveness of infection prevention measures (Gilmartin & Sousa, 2016). · The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed uses Standardized Infection Ratios (SIRs). Clear Lake Regional Medical Center (“NHSN | CDC,” 2018) uses SIRs, and this study will also utilize SIRs for measuring the effectiveness of preventive CLABSI maintenance bundles (“SIR Report | HAI | CDC,” 2019). Setting · Adult ICU (Elbilgahy et al., 2015). · The incidence of Catheter-Related Infections (CRIs) in cancer patients at the hospital (Hentrich et al., 2014). Summary · Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention through nursing education (Dombecki, Vercher, Valyko, Mills, & Washer, 2017). · Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting. There seems to be a problem regarding the training and education regarding the procedures which should be followed when carrying out catheter-related procedures (Dombecki, Vercher, Valyko, Mills, & Washer, 2017). The objective of this study is to address this issue. · Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site are necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia (Yaseen et al., 2016). 2. a. Background of the problem/gap: Even though earlier CVCs were associated with mechanical complications such as leaks, air embolisms, and hub separation, CLABSIs quickly became a serious problem when it came to the use of catheters. A study by Owings et al. (2017) indicates that elementary infection control steps may reduce incidences of CLABSIs significantly. a. Theoretical Foundations (models and theories to be the foundation for the project). Specifically, the model proposed is the Quality Health Outcomes Model (QHOM), which is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system (Gilmartin & Sousa, 2016). The theoretical model is associated with the strategies deployed and operational processes linked to the prevention of Central Line Association Bloodstream Infection. This is demonstrated through a meta-analysis review of randomized control and quasi-experimental studies (Moody, 2019). b. Review of literature topic Rapid Dissemination of Universal Decolonization in Adult Intensive Care Units (ICUs) reduces healthcare-associated (HA) central line-associated bloodstream infections (CLABSI) in over 100 Community Hospitals (Hickok et al., 2015). a. Single Healthcare System c. Prevention of Central Line-Associated Blood Stream Infection (CLABSI). |
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| Problem Statement |
There are several safety measures to follow during a procedure involving the insertion of a central line catheter. Despite this, there still exist many cases of infections resulting from such insertions, especially in adult ICUs. For example, a study conducted in an ICU in northern India indicates that in spite of there being several guidelines for CLABSIs prevention, cases of such infections are still high (Mishra et al., 2016).
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| Clinical/PICO Questions |
3. Clinical/PICOT Questions: “In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of central line catheter maintain high levels of hygiene after its insertion, along with thorough cleaning of the insertion site, reduce the incidence of CLABSIs (Central Line-Associated Blood-stream Infections) compared to standard care over a one-month period?” Many caregivers seem to show more consistency in the application of evidence-based practices when inserting the CVC. However, this is not the case after the insertion, explaining the reason why many infections occur postinsertion. This study suggests an intervention measure targeting the post-insertion period. P: Patients > 65 years of age with a central line I: Staff training on proper CVC maintenance, reinforcement of central catheter, and hub hygiene to educate staff on the utilization of the Central Line (CL) Bundle with a target of at least 100% compliance. This intervention has been proposed by (Tomlinson, 2015) but has not been implemented effectively across centers. Successful implementation of CL Bundle can help in reducing the rates of CLABSI and achieving zero CLABSI events for one month (Yaseen et al., 2016). C: Compared to standard care. The aim is to identify any discrepancies between the skills gained by trained staff and the standard care procedure. O: Reduce the incidence of CLABSIs (Central Line-Associated Blood-stream Infections). Pre and post-intervention outcomes will be measured by counting the number of CLABSIs cases before and after the intervention. Using various questionnaire types (true/false, short answers, and fill in the blank. T: A period of one-month
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| Sample |
4. Sample (and Location): a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas b. Sample: The study seeks to sample 60 total nurses from the adult intensive care unit department. 30 nurse’s utilizing the CLABSI bundle, and 30 nurses’s not utilizing the CLABSI bundle (specifically CHG bathing). Patient sample size will be >30. |
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| Define Variables |
· Define Variables: · Independent Variables: training and education on proper CVC maintenance when carrying out a central line catheter insertion. · Dependent Variables: number of cases of infections resulting from central line catheter insertion. |
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| Methodology & Design | · Review of past research will form the core basis of collecting data for this project. Data on new infections related to the insertion of the central line catheter will be collected. measures which are in place to prevent CLABSI include ensuring procedural pause, aseptic techniques, hand hygiene, optimal site selection, use of Chlorhexidine Gluconate (CHG) to protect the skin and taking maximal sterile precautions. According to Iliopoulou, Anderson, & Day (2015), other measures include education on appropriate indications for central lines, including antibiotics indications & durations. There is a need for clear escalation protocols for hard stick IV/phlebotomy patients and clear de-escalation protocols for central lines that are no longer medically necessary. Many nurses employ consistent bi-annual education on CVC dressings/maintenance by product reps. In addition to these measures, this project proposes consistent quarterly CVC dressing/maintenance checkoffs for all nursing staff on direct patient care units. Also, nurses working in adult ICUs will be surveyed, and the total number of infections resulting from their central line catheter procedures recorded. These cases will be recorded before and after an intervention to determine the effect of the intervention. The intervention will be a short training on how to apply various guidelines after central line catheter insertion, maintenance bundle, and its application. Daily monitoring will be done via daily rounding. The likelihood of causing an infection post or pre-training will be determined by monitoring the number of infection cases recorded by each nurse before and after the training. | |
| Purpose Statement |
5. Purpose Statement: The purpose of this project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff Clear Lake Regional Medical Center in Webster, Texas for the prevention of CLABSIs. |
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| Data Collection Approach |
6. Sample (and Location): a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas b. Population: The population being sampled in the study is 60 adult ICU nurses. 7. Determining the Sample Size · A sample population is often selected based on the PICOT question the evidence-based study is being held on people who are 65 years and more. The patients are with a Central line catheter hub hygiene. · The sample population is targeted from the ICU unit at Clear Lake Regional Medical Center, Webster, Texas. · After a focused consideration of the required population, a random sample of 60 nurses from the target group will be picked. 30 nurse’s utilizing the CLABSI bundle and 30 not utilizing the CLASI bundle (specifically CHG bathing). · The selection of a sample population should not be haphazard for it will lead to biased results. Furthermore, a large sample size helps in having precise results (Nayak & Singh, 2015). · To avoid oversampling to have a minimal sample size that we are targeting are the 60 adult nurses out of the 120 (Andersomn, Kelley, & Maxwell, 2017). · The proposed intervention is training on the basic guidelines on safety measures to follow when conducting central line catheter insertions. With the confidence level of 95% calls upon the usage of 30 nurses to have an error of 5% only. This population will be equally divided between the intervention group and the control group. The particular ratios of gender are not necessary, yet the ration of re-trained and those left without that are of significance. Time will be 2-4 weeks post-insertion. · This population will be equally divided between the intervention group and the control group. The formula below will help determine the population to be sampled. The sample size is 60 nurses. 8. Inclusion/exclusion criteria of the subjects · People who are 65 or above and are from ICU Lake Regional Medical Centre, the central line catheter hub clinic section. · The nurses who are not the core staff of the ICU at Clear Lake Regional Medical Center will be excluded (Patino & Ferreira, 2018). · Those who will have signed consent will be included in the study because of having fulfilled the research ethics standards. · When the interviews and questionnaires have been conducted, the incomplete questionnaire forms will be excluded while the interview subjects who have not attended the interview will not be considered. |
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| Data Analysis Approach |
9. Data Collection Instruments · The sample of nurses operating within adult intensive care units will be subjected to training and their efficiency to insert the central line catheter without causing infections tested before and after the training. · The training will be as much comprehensive and intensive as possible. This is to make sure that the participants have undergone a process that would impact their skills regarding the insertion of the central line catheter. · To ensure validity, measures will be taken to ensure that the sample used is a true representative of the nursing population serving patients with CVCs. · Reliability will be addressed by ensuring that the instrument is consistent and collects consistent information from all the participants. · Statistical Package for the Social Sciences (SPSS) to understand research and data analysis will be utilized (Arkkelin, 2014).
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| Ethical Consideration |
· In this research study, any details that the respondent will not want it disclosed will be removed and deleted from any written or oral records, while others are candidly presented. · Before the recruitment process, the participants will be contacted and be informed of the research and its significance (Castillo-Montoya, 2016). · They will then be asked to declare their readiness to partake in the study and the free times they have for the interview process or questionnaire filling process. · The form will have the clinical question, the usability of results, assurance of anonymity and confidentiality in which the researcher will indicate how the results will be exposed, to whom they will be exposed and how the subjects will be prevented from harm. · To avoid mentioning of names, the participants will be allocated unique numbers (codes), and the analysis will be based on these. This will ensure that no participant is victimized or embarrassed by negative results. This will effectively help avoid labeling the nurses as unhygienic, hygienic, effective or ineffective, and mentioning their particular names. · It is necessary that Clear Lake Regional Medical Center be informed of the study. Before the study, the researcher will seek the participants’ permission through formal e-mails, which will be sent to the administration for approval. |
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