Write 3000 words an essay according to BCU Harvard referencing

guidelines by using 2015- 2024 referancing articles, You are required to

produce a critical appraisal of Central Line-Associated Bloodstream
Infections (CLABSI) Prevention in a Cardiac ICU

It should be of clinical relevance and to help you with this remit, it is

advisable that you consult with your local Trust (or equivalent
organisation) Infection Prevention and Control team or specialist in your
hospital,They will be able to advise you regarding relevant
Trust/organisational policies and procedure in qatar

The written justification should highlight why you have chosen the topic
and its importance to the reduction of healthcare associated infection,
adherence to legislation and national directives in qatarThere is a need to
demonstrate critical analysis of the clinical practice identified, and support
this with relevant evidence-based literature/research to validate your
discussion.

Introduction

• Give a brief overview of of Central Line-Associated Bloodstream

Infections (CLABSI) incardiac intensive care unit (specialism) and a brief
overview of how and why the practice area was chosen for discussion.

• What are the relevant issues about this practice that you wish to
discuss?

Main body

• In-depth discussion indicating how you have identified or become

aware of the issue you are reviewing.

• Incorporate any evidence-based literature/research/legislation and

national guidance or best practice examples that supports your argument.
Where possible, you should also discuss any deficits in available evidence
or literature and how this may impact or influence practice.

• Having investigated this issue, and taking into consideration the

evidence you have found, are there any recommendations that you can
make to facilitate improvements or solutions to rectify the problem. To
make this aspect explicit, you can include established systems such as
surveillance, clinical audits, risk

assessment/management; external monitoring by government agencies:

Care Quality Commission. This also should include any education or
training needs that have been identified to promote or maintain good
practice?

Conclusion
Summarise your key findings and include any recommendations or how do
you plan to monitor the issue, noting any progress?

Preventing Central Line-Associated Bloodstream Infections in the Cardiac

ICU
1. Introduction
Overview of Topic
IPC forms the very core of healthcare, most of all in such a high-
risk environment as a cardiac ICU. Cardiac ICUs house patients
with acutely life-threatening cardiovascular conditions, many of whom
require invasive monitoring and therapeutic interventions-
for example, central venous catheters. While the central venous catheter
is life-supportive for
the critical illness of the cardiac patient population, it also represents one
of the highest risks for the development of CLABSI.
CLABSI is an infection where microorganisms gain entry
into the circulatory system via a central venous
catheter. It is a big surprise that, with existing established protocols,
CLABSI still remains one of the major sources of morbidity and
mortality, especially among those targeted high-risk patient groups in
cardiac ICUs. Prevention of CLABSI in these units is vital not only
for patient safety but also
for a reduction of one of the increasing concerns of hospitals around the
world: health care-associated infections.
Justification of the Topic
CLABSI is one of the most frequent HAIs to occur in ICUs
and is of particular relevance to cardiac ICUs given their high and often
prolonged utilization of central venous
catheters. Patients in cardiac ICUs are
already seriously ill, and their immune status has been further compromi
sed by the underlying cardiac condition or intervention. Because of this,
they are at a higher risk of developing infections like CLABSI, which can
result in longer hospital stays, greater morbidity, higher healthcare costs,
and even death.
The emphasis on CLABSI in the cardiac ICU is in
line with international and local healthcare goals directed toward the
reduction of HAIs and improvement in patient
safety through a more judicious use of healthcare
resources. Prevention of CLABSI will minimize the durations of stay in the
ICUs, enhance survivability among patients,
and avert other complications that might result from such infections,
such as sepsis, usually an outcome of untreated bacteremia.
This becomes of grave significance in countries like
Qatar, which is still evolving in healthcare and where patient
safety has remained of essence.
Connection with Qatar National Directives
Infection prevention and
control features among the priority concerns in the Qatari healthcare.
The Qatar National Health Strategy 2018-2022 has identified healthcare-
associated infection, including CLABSI reduction,
as one of the mainstays in patient safety improvement and quality of
care. Furthermore, national guidelines put an emphasis on adhering
to evidence-based practices for infection prevention in high-risk
settings such as ICUs, which is in line
with international recommendations such as those by the WHO and CDC.
Qatar's health care system, and specifically hospitals like the Hamad
Medical Corporation (HMC), adheres to international norms
and standards on infection control for the prevention of
CLABSI by means of thorough protocols and education.
________________________________________
2. Literature Review
Current Practices Involving Evidence-Based Procedure
CLABSI prevention involves various practices, some of which address cat
heter insertion, while others are concerned with
the maintenance or removal of a catheter. Here are several evidence-
based practices which have been found to reduce the incidence of
CLABSI:
1. Aseptic Technique During Insertion of Catheter: According
to the CDC guideline 2017, CVC insertion should be
performed by practicing full sterile barriers in the form of gloves and
gowns, masks, and sterile drapes.
This will significantly reduce contamination during the procedure.
2. Hand
Hygiene: One of the most significant deterrents to infection is hand
hygiene. Pittet et al. explain that proper hand hygiene practices before
and after manipulating the central lines can prevent the rates
of CLABSI by as much as 50%. This involves washing hands
with either soap and water or using alcohol-based hand rubs.
3. CLABSI Central Line Bundle: The term "central line
bundle" describes the collection of most important evidence-
based practices that the CDC and other infection
control entities recommend to reduce CLABSI.
These included appropriate hand hygiene, aseptic technique during
insertion, skin antisepsis with chlorhexidine, and daily reassessment of
the need for central venous access. Maragakis et al. (2020) investigated
these practices in the ICUs and found that adhering to these bundled
practices consequently resulted in a 50% reduction in CLABSI rates in
ICUs.
4. Antibiotic Stewardship: Appropriate use of antibiotics is
also one of the critical factors in CLABSI prevention. The misuse of broad-
spectrum antibiotics can only result in resistant pathogens that are
difficult to treat. Antibiotic stewardship programs foster the judicious use
of antibiotics and are deemed part of the important strategies in
reducing infection rates in an intensive care unit (Mermel, 2019).
5. Maintenance and Dressing Changes: Anticipation of the central line
infection involves the use of practices that aim at maintaining central
lines by periodic changing of dressings and observing for signs of
infection. According to Mermel, 2019, sterile
dressings together with chlorhexidine for site antisepsis is
recommended in order to reduce the colonization of bacteria around the
catheter insertion site
Critical Literatures Analysis
The evidence to address these practices is enormous; however, there
are particular limitations and gaps in the studies.
Strengths The central line bundle has been the subject of extensive
research, and it has been shown to reduce CLABSI rates in a wide range
of settings. For example, Marschall et al. (2014) and Pittet et al.
(2016) found that strict adherence to infection control bundles reduces
CLABSI rates by as much as 50%. The importance of hand
hygiene for infection prevention is widely accepted and is an evidence-
based practice.
• Weaknesses: These practices are evidenced-
based, but their implementation may be hard in practice. For
example, in a busy and stressful cardiac ICU, the staff may be pre-
occupied, which may lead to inconsistency in adherence
to the protocols and
bundles. Furthermore, antimicrobial impregnation of catheters, though ef
fective in reducing infection rates, as identified by Mermel (2019), is not
universally effective in all ICU populations, and their overall cost-
effectiveness remains still uncertain.
Gaps in Research: Among the most essential gaps in the
literature, there are studies with respect to the long-term sustainability of
CLABSI prevention practices in resource-limited
settings. Specifically, few studies have examined the specific ways in whi
ch staffing shortages or resource-
poor settings maintain staffing levels with high levels of compliance with
infection prevention protocols. There is limited
research with regard to patient-specific
factors, such as immunocompromised states of
patients, in preventing CLABSI.
• Conflicting
findings: Despite the majority of studies affirming chlorhexidine for skin
antisepsis, some conflicting
evidence may have given alternate indications using iodine-based
solutions, for instance. The inconsistency in
findings evidences that more standards may be required across diverse s
ettings.
________________________________________
3. Trust/Hamad Hospital in Qatar Policies and Procedures
Consultation with Infection Control Team
The Infection Prevention and Control team at Hamad Medical
Corporation is very much into writing and implementing infection control
policies. HMC adopts global best practices for CDC, WHO, and other
leading health organizations and adapts them to the local
context in Qatar. Some of the IPC bundle practices in Cardiac ICU include
• Aseptic Insertion Practices: There is diligent adherence to full sterile
barrier precautions for the insertion of central venous catheters.
• Hand Hygiene: Hand hygiene practices are emphasized, and alcohol-
based hand rub stations are placed near all central line sites.
• Daily Line Assessment: All central venous catheters
are inspected daily for their continued clinical necessity,
in accordance with national and international guidelines.
Comparison with Qatar National Guidelines
HMC infection control protocols are similar to national
guidelines in Qatar regarding the Qatar National Health Strategy, 2018-
2022, and Qatar National Infection Prevention and Control Standards.
Both HMC and national guidelines emphasize that the central line
bundle, periodic central venous catheter monitoring, and hand
hygiene are of utmost importance in preventing CLABSI.
There is, therefore, strong adherence to these best practices at
HMC, though the frequency of catheter dressing changes and the use of
antimicrobial-impregnated catheters present some discrepancies in
practice, as these are often viewed as too costly for resource-
poor settings. This is, however, an area of ongoing debate within the
institution, with some departments already piloting the use
of such catheters on high-risk patients.
________________________________________
4. Clinical Relevance
Impact on Patients Admitted to Cardiac Intensive Care
Prevention of CLABSI is highly important in cardiac
ICUs since the patients are already critically sick and at a heightened risk
for infections. Besides, the development
of CLABSI may result in sepsis, extended stays in the ICU,
and much higher mortalities. For example, Vincent et al.
(2019) reported that CLABSI in critically ill cardiac
patients resulted in increased mortality by 30% and a length of stay incre
ase by 50% in the ICU.
For effective prevention of infection, the rates of CLABSI will be reduced t
o a minimum, hence improving patient outcomes and reducing the risk of
sepsis to allow for quicker recovery and discharge. Preventing CLABSI
also minimizes the need for expensive treatments such as prolonged
antibiotics and intensive care, hence reducing overall health burdens.
Legislation and Qatar National Directives
Qatar National Health Strategy identifies infection prevention as a
priority for quality improvement
in healthcare from 2018 until 2022. CLABSI
prevention guideline adherence supports a decrease in HAIs. This is in
line with the national goals of improving patient safety
and decreasing healthcare
costs. International policies also support this national directive; for exam
ple, the Health and Social Care Act 2008 stresses that infection control
is of paramount importance in sensitive areas like the ICUs.
________________________________________
5. Implementation Barriers
Identification of the Barriers
The limiting factors to
the complete execution of strategies preventing CLABSI in the cardiac
ICU include but are not limited to:
• Staffing: Much higher nurse-to-
patient ratio obstructs consistent fidelity with infection prevention measu
res, including but not limited to hand hygiene and catheter maintenance.
• Resource: Availability of antimicrobial impregnated
catheters along with other training resources that may
be scanty especially in resource poor settings.
• Non-Adherence to Protocols: Sometimes protocols are not adhered to,
particularly in high-pressure and stressed areas like the cardiac ICU, due
to little time or feeling fatigue. Solutions to overcome these barriers
include: • Ongoing Education: Regular training sessions, audits, and
feedback are essential to ensuring staff adherence to infection
prevention protocols.
• Increased Staffing: The staffing in the
ICU should be ramped up to ensure that no single nurse is burdened, and
has ample time to follow protocols.
• Integration of Technology: Electronic health records and automated
reminders for line assessment can be integrated to ensure timely review
and maintenance of central venous catheters.
________________________________________
6. Recommendation for Improvement
Based on Evidence Recommendations
• Central Line Bundle: Infection prevention bundles should, by all means,
be adhered to, which includes aseptic insertion, frequent hand hygiene,
and routine line review.
• Education and Training: Further, continuing training, auditing, and
feedback loops have the potential for enhancing infection
prevention practices.
• Antimicrobial
Catheters: Antimicrobial impregnation of catheters is recommended for
selected high-risk cardiac ICU patients to further
reduce CLABSI incidence.
Evaluation of Effectiveness
Their effectiveness can be tracked through these measures:
• CLABSI Incidence Rates: Trending of the cardiac ICU CLABSI over time.
• Staff Compliance Audits: Routine audits of infection prevention
practices adherence, providing immediate feedback
to drive improvement in compliance.
• Patient Outcomes: Patient mortality, length of stay in the ICU, and need
for antibiotics.
________________________________________
7. Conclusion
The prevention of CLABSI in cardiac ICUs is a core patient
safety initiative and an important strategy for the improvement
of clinical outcomes. Evidence-based practices include following the
central line bundle, appropriate routine hand hygiene, and daily line
assessments that can reduce the
risk for CLABSI. Although multiple barriers
to performing these practices exist, education, adequate staffing,
and technology can facilitate compliance. It is wise to note that
strict adherence to national and international policies on infection
control will help decrease the rates of HAIs in cardiac ICUs in Qatar.
________________________________________