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Evidence-Based practice project proposal: Identification of nursing practice problem
Evidence-Based practice project proposal: Identification of nursing practice problem
PICOT question
In hospitalized pediatric oncology patients receiving parenteral drugs and fluids through central intravenous lines, how does antimicrobial baths done once daily using chlorhexidine compare to the results of long-term use of ordinary soap and water baths in reducing the rate of hospital acquired central line infections at the time in which the patients are hospitalized and being undergoing active chemotherapy treatment.
Define each element of the question:
P (Patient, problem, or population)
Patients in the pediatric department who are receiving oncology care and receiving parenteral drugs and fluids through centrally placed catheters. Patients tend to be more at risk of infection at the central line site and generally in their bodies since they are immunosuppressed. The drugs administered are potential cytotoxic agents, and therefore, they weaken the immunity of the patients. The patients are also not of old age and may not have well-developed immune systems.
I (Intervention)
Performing antimicrobial baths using chlorhexidine to the entire body or to the site of the central line and the surrounding areas. Antimicrobial agents reduce the risk of hospital-acquired infections to the skin and the central line-entry site. Chlorhexidine is a broad-spectrum antibiotic agent that, if used in performing patient bed baths, will significantly reduce the risk of central line infection in pediatric oncology patients (Bell & O’Grady, 2017). Other skin infections and bacterial contaminations will also be managed through antimicrobial baths.
C (Comparison)
Ordinary water and soap baths done to the general body in patients with central lines. Ordinary water baths are potential carriers of bacterial and fungal agents that cause diseases. Central line sites are opening through which these agents can access and develop into disease processes to these patients. In patients whose central lines are indicated to stay in situ for a longer time, soap and water baths have been indicated to cause substantial cell irritation and spark different bacterial infections on the site.
O (Desired Outcome)
Reduce the risk of infection and the rate at which patients with central lines acquired infections at the site of insertion. The population of patients considered in this case has factors that reduce their immune levels and, therefore, need to be protected from the occurrence of additional infections to optimize management. The use of topical and parenteral antibiotics evidences reducing the occurrence of infections in patients doing a long period of admission in hospital. This intervention will result in significant changes in the management of patients in the department with the potential to increase the quality of care delivered to the clients.
T (Time Frame)
The time which patients are admitted in hospital and receiving chemotherapy drugs with central lines for parenteral administration and rehydration. The probability and the timing of most occurrences of infections in patients will be studied to determine the differential results of the two practices within the time of stay. It is anticipated that the time of hospital stay will be reduced through the implementation since fewer patients may develop bacterial infection complications.
Practice issue or problem, scope of the issue, or need for change
Nurses are the professionals that encounter the most time with these patients. So, any complications occurring during the time of management would mean that it creates additional work for the nurses. Pediatric oncology care patients require specialized approaches in their management since many of them, especially very young children, may not have fully developed immune systems. Further, their immune responses are limited by the use of chemotherapy drugs, increasing the susceptibility to infections on the site of central lines.
A study considering the differential performance in the management of central lines in hospitalized patients identified that those patients using antimicrobial baths had a 67% less chance of developing infections and any complications on the central line site (Jusino-Leon, G. N. et al., 2019). The remaining percentage in which infections occurred was associated with common practices allowed by nurses or deliberately done by patients that resulted in infections. Other practices were, however, out of control of the patients and nurses. For example, caregivers are sometimes involved in the cleaning; patients may have aggressive behavior and fail to coordinate with the nurses, or rare occasions where the patient has other infections spreading to the central line site.
EBP solution
Regulation of the nursing practices that predispose patients to these infections and strict implementation of measures to check the occurrence of the infections is undoubtedly a way to resolve the burden of double infection and the potential of poor prognosis in these patients. The viability of this proposal is based on the effectiveness of the use of antimicrobial agents in the management and prevention of infection occurrence (Bell & O’Grady, 2017). This proposal is also supported by the fact that children are easy to handle and may therefore be easy to instruct and adhere to the plan. With the rising incidence of central line infection in patients with extended hospital stays in the pediatric department, it is essential that this implementation is put into considerations to moderate the management of these patients.
Search terms to narrow the search
Pediatrics, Oncology, Chlorhexidine, Patient care, Central line, nursing care
References
Bell, T., & O’Grady, N. P. (2017). Prevention of Central Line–Associated Bloodstream Infections. Infectious Disease Clinics of North America, 31(3), 551–559. https://doi.org/10.1016/j.idc.2017.05.007
Jusino-Leon, G. N., amp; Forsythe, L., & Matheson, L. (2019). Chlorhexidine Gluconate Baths: Supporting Daily Use to Reduce Central Line–Associated Bloodstream Infections Affecting Immunocompromised Patients. Clinical Journal of Oncology Nursing. https://doi.org/10.1188/19.cjon.e32-e38
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