Question

After discussion with your mentor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based practice project. Explain how your proposal will directly and indirectly impact each of the aspects. (My projecet is based on central line catheter infection control) Please provide reference as well. Thnk you

Answer 1

Financial aspects:

We are using catheter insertion in the hospital for many reasons including hemodynamic monitoring,renal replacement therapy,nutritional support and medication administration..But this catheter use,producing blood stream infections and become a costly complications of health care in the US from 670million to 2.68 billion dollars annually..To reduce cost the Centers for Medicaid and Medicare services(CMS) is established no more payment for hospital associated vascular catheter infection..To implement this prevention it provides a financial incentives to hospital who got those infection in the ICU unit.. priorities needed to manage and prevent those infection in the health care facilities..

Quality aspects:

. According to the CDC,upto 2,50,000 hospital _associated catheter--related blood stream infection(CR-BSI) happening in US every year..CVCs will be the most frequent cause of nosocomial BSIs..CR_BSI include positive culture with the same organism isolated from the catheter and peripheral blood..The most common cause of CVS_BSI is migration of the organism from the insertion site along the surface of the catheter and colonization of catheter due to CR_BSI..Some practices can reduce the incidence of CVS_BSI..That is anti microbial catheter,anti microbial impregnated dressing and interventions related to catheter insertion and maintenance of central line site during blood sampling and maintenance of sterile technique for dressing changes..

clinical aspect:

. Cathter cultures should be performed when a cathter is removed..when infection is suspected get swab drainage sample culture and gram staining..short term catheter tip cultures,the roll plate technique recommended for microbiological analysis..if venous access subcutaneous port suspected for CRBSI send th port to microbiology lab for qualitative culture of the port reservire contents in addition to the catheter tip..moist cotton swab can be used to do a semi quantitative culture.. obtain blood culture prior to antibiotic therapy administration but phlebotomy team must do this procedure..evidence is insufficient to recommend that blood culture be routinely obtained after discontaminationof antimicrobial therapy for CRBSI(C_III)..deter deter whether blood culture bottles are labelled regarding the anatomic site for catheter used to obtain the blood sample for culture..

Reference:

Rock ville,M D,Agency for Health care Research and Quality;2001.PP.149_61.AHRQPublication Ni.01_E058