- Choose a vein where the catheter can be safely inserted and where the risk for infection is small.
- Clean their hands with soap and water or an alcohol-based hand rub before putting in the catheter.
- Wear a mask, cap, sterile gown, and sterile gloves when putting in the catheter to keep it sterile
- Clean the patient’s skin with an antiseptic cleanser before putting in the catheter
- Clean their hands, wear gloves and clean the catheter opening with an antiseptic solution before using it to draw blood or give medications.
- Follow company procedures of using a checklist at all times. Healthcare providers are also given the power to use their discretion if a procedure has an error.
- Decide every day whether the patient still needs to have the catheter and remove it as soon as possible.
Overview of the Safety QSEN Competency
According to QSEN, safety is defined as the minimization of risk and harm to patients and providers through both system effectiveness and individual performance. Safe, effective delivery of patient care requires understanding the complexity of care delivery, the limits of human factors, safety design principles, and characteristics of high-reliability organizations and patient safety resources. BWH neonatal intensive care units support the QSEN competency of safety by integrating a multidisciplinary team with highly and collaborative members. The medical team includes resident physicians, physician’s assistants, and nurse practitioners, fellows (pediatricians training to become specialists in newborn medicine), and attending neonatologists. At all times, there is at least one attending neonatologist working in the NICU, day or night. In addition to the medical team, there exist respiratory therapists. To ensure patient safety in the NICU, the procedures stated earlier in this paper are enforced and carried out to prevent CLASBIs.
Evidence-Based Best Practices of Central Line-Associated Infections in Neonates
Evidence-based care is the practice of making all clinical decisions based on scientific evidence from credible sources. In the clinical management of CLABSIs in the NICU, evidence-based care is widely applied when selecting which interventions to use. The prospective interventions should be evaluated in terms of efficacy and safety in line with QSEN training. The evaluated article below is based on the impact of QSEN on evidence-based care. Regular education and training of medical staff are most important as a preventive strategy for CLABSIs. The use of checklists during the installation and treatment of central catheters and bundle techniques are useful ways to minimize the occurrence of CLABSIs.
One of the most common interventions used before catheter insertion and dressing replacement in neonates is the use of chlorhexidine. Chlorhexidine, commonly used as a skin disinfectant, is not approved for infants less than two months old but is usually used in many neonatal intensive care units due to the lack of alternatives (Cho, 2019). Appropriate replacement intervals for dressing and administration sets are similar to those recommended for adults. Cho suggests that umbilical catheters should not be used longer than five days for the umbilical arterial catheter and 14 days for the umbilical venous catheter. Preventative methods of CLABSIs include the selection of the PICC site, intervention bundle for CVC insertion, and maintenance and education, training, and staffing. These best practices have been used, and standardizing the central line insertion process throughout BWH has dramatically lowered central line infection rates over time.
Impact of Patient Safety and Quality of Care
The research findings can be used as evidence to improve the quality of care and patient outcomes. The first impact of evidence-based care is improving safety. For instance, avoiding the interventions that can harm a patient will contribute to safety and reduced complications, length of hospital stay, and patient suffering. From the reviewed studies above, Chlorhexidine is not safe for infants under two months old. Secondly, replacing the dressing at appropriate intervals is recommended to improve patient safety. Quality is measured in different ways. While there are no defined standards regarding which particular methods should be used, many of the factors listed below can help patients learn more about a hospital's quality of care.
To evaluate quality and safety, patients may wish to consider whether or not the hospital:
- Is rated highly in outcome measures by state or nationally recognized organizations
- Has experience with your particular condition as evidenced by procedure volumes
- Reviews and continuously improves its own quality of care
- Is highly rated by patients by viewing patient satisfaction scores
- Is one where your doctor has practicing privileges if it is important to you to have your own doctor able to treat you in the hospital
- It is accredited by The Joint Commission
BWH is dedicated to offering high-quality, healthy, and meaningful treatment to all patients who come through Brigham and Women's Hospital doors.
Conclusion
QSEN training seeks to give nurses the knowledge, skills, and attitudes needed to deliver safe and quality health care services. It can be implemented in the clinical management of central line-associated bloodstream infections (CLABSIs) in patient safety. Patient safety enables the minimization of risk and harm to patients and providers through both system effectiveness and individual performance. This increases the acceptability of care and reduces suffering. Evidence-based care means using evidence to make clinical decisions. From the evaluated articles, various safe and effective interventions such as umbilical catheters can be used to prevent CLABSIs in the NICU. Unsafe practices such as the use of chlorhexidine on neonates under two months old have been highlighted. This will help practice nurses in optimizing sepsis clinical care interventions.
References
Haddadin Y, Annamaraju P, Regunath H. (2020) Central Line-Associated Blood Stream Infections. StatPearls Publishing.
Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK430891/
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Quality and Safety Education for Nurses. (2021). QSEN competencies.
Retrieved from http://qsen.org/competencies/pre-licensure-ksas/
Eddy, D. M. (1996). Clinical decision making: From theory to practice: a collection of essays from the Journal of the American Medical Association. Boston: Jones and Bartlett Publishers.
Cho, H. J., & Cho, H. K. (2019). Central line-associated bloodstream infections in neonates. Korean journal of pediatrics, 62(3), 79–84.
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