UPDATED FINAL PRESENTATION PPT.pptx file

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1. Improving Infection Control Practices: An Evidence-Based Practice Project to Minimize the Rate of Central Line-Associated Bloodstream Infection (CLABSI) “From data to action, our CLABSI prevention project is dedicated to protecting patients and saving lives.” Naseema Bibi Fahad Suleman Sawera Khan Kaiful Ara Saira Azhar Shanza Anwar Munaza Nasir Sameer Kumar Electives Preceptor: Kashif Saad 2 1

2. Outline the agenda and goals of the project. Define CLABSI (Central Line-Associated Bloodstream Infection) and its clinical significance. Discuss the prevalence of CLABSI both internationally and nationally. Explore nursing theories applied to the CLABSI project. Explain the methodology used in the CLABSI project. Discuss about the objectives of electives evidence-based project. Present the results and outcomes of the project. Identify gaps and challenges encountered during the project. Discuss limitations of the project and areas for improvement. Provide recommendations for CLABSI prevention. Acknowledge contributions and support for the project. OBJECTIVES 2

3. To investigate how quality assurance practices contribute to the prevention of Central Line Associated Bloodstream Infections (CLABSI). To evaluate adherence to infection control standards in central line procedures. To monitor clinical practices related to the insertion and maintenance of central lines. To assess the effectiveness of staff education and training programs in reducing CLABSI rates. To identify key strategies that minimize the risk of CLABSI in tertiary care settings. To enhance patient safety through improved infection prevention practices. AGENDA 3

4. GOALS Reduce the rate of CLABSI in ICU settings by implementing Recommended infection control practices. Enhance staff compliance with infection prevention protocols through education and training. Establish a standardized approach for central line insertion and maintenance across the ICU settings . Promote a culture of safety by involving both healthcare workers and patients in infection prevention efforts. Ensure continuous monitoring and evaluation of infection rates to assess the impact of the implemented practices . The major goals to conduct this project are: 4 2

5. A central line bloodstream infection (CLABSI) occurs when bacteria or other germs enter the patient's central line and then enter into their bloodstream. These infections are serious but can often be successfully treated. CLABSI are among the life-threatening infections, with a mortality rate of 12–25%, causing thousands of deaths and billions in healthcare costs annually. (Chen & Feliciano, 2024) INTRODUCTION 2 5 5

6. CLABSI PREVALENCE Rosenthal, V. D., Yin, R., Myatra, S. N., Memish, Z. A., Rodrigues, C., Kharbanda, M., ... & Jin, Z. (2023). Multinational prospective study of incidence and risk factors for central-line–associated bloodstream infections in 728 intensive care units of 41 Asian, African, Eastern European, Latin American, and Middle Eastern countries over 24 years. Infection Control & Hospital Epidemiology, 44(11), 1737-1747. CLABSI Rate(Per 1000 Central line\Device days ) 6

7. NURSING THEORIES APPLIED TO THE PROJECT   Environmental Theory of Florence Nightingale Florence Nightingale’s Environmental Theory emphasizes the role of cleanliness, sanitation, and environmental factors in promoting health. In the context of preventing Central Line-Associated Bloodstream Infections (CLABSI), her theory advocates for maintaining a sterile environment, using proper techniques for central line care, and disinfecting high-touch surfaces. Nightingale’s holistic approach also underscores the importance of mental, spiritual, and social support, along with thorough documentation to ensure adherence to infection control practices. (Rana, 2020) Ernestine Wiedenbach’s Helping Art of Clinical Nursing Theory emphasizes the nurse-patient relationship in healthcare. In preventing CLABSI, it encourages nurses to assess patient risk, apply evidence-based infection control practices, and continuously evaluate intervention effectiveness. The theory advocates for standardized central line care, accountability, and ongoing education on the latest prevention methods. It also highlights the importance of patient-centered care and teamwork in achieving optimal outcomes. (Hawes, 2022) Ernestine Wiedenbach's Helping Art of Clinical Nursing Theory 5 2 7

8. METHODOLOGY 01   Project Design Q uasi-experimental pre and post-test  02 Project Setting ICU department, of  Memon Medical Institute Hospital, Karachi. 03 Project Duration four weeks 02 02 02 04 05 06 Sample Size 32 Healthcare professionals   Sampling Technique    C onvenience sampling technique   Project Population   Health Care Providers (HCP) of Intensive Care Unit 2 8

9. OBJECTIVES OF THE EVIDENCE BASED PROJECT (EBP) The study aims to assess the current knowledge, practices, and attitudes of ICU nursing staff regarding central line-associated bloodstream infections (CLABSI) using a per-assessment questionnaire. Implement a training program to improve ICU nursing staff's knowledge, attitude, and practices in preventing CLABSI and reducing infection rates in intensive care settings. The study evaluates the post-assessment of ICU nursing staff's knowledge, practices, and attitudes regarding CLABSI after implementing strategies to reduce the increasing rate of infection in the ICU. Develop proficiency in practicing EBP by introducing standardized guidelines of preventing the spread of CLABSI infection in ICU setting. 9 2

10. ELIGIBILITY CRITERIA Inclusion Criteria HCPs working in ICU department. Having a minimum one year of experience. Upholding degree/diploma of their field of work. Are willing to participate in the study. Exclusion criteria HCPs with less than one year of experience Not having a degree/diploma in their field of work Nurses with temporary rotation to ICU department. HCPS on leave during study duration. DATA COLLECTION PROCEDURE Data collection procedure Healthcare professionals completed a baseline questionnaire to assess their initial knowledge and practices. Educational Intervention Training sessions were conducted for all participants to provide them with relevant education. Post-test Assessment Participants completed the same questionnaire used in the pre-test to evaluate improvements in their knowledge and practices after the intervention. 2 10

11. Engaging Visual Aids Interactive Sessions Video Demonstrations Role-playing Activities STRATEGIES FOR HEALTHCARE PROFESSIONALS TRAINING 2 11

12. Survey checklist OBSERVATIONAL CHECKLIST A KNOWLEDGE YES NO N\A COMMENTS 1. Staff can identify the proper indications for CVP line insertion. 2. Staff are aware of CLABSI risk factors related to CVP lines. 3. Staff are trained in aseptic technique for CVP insertion. 4. CVP insertion is done following institutional or CDC guidelines. 5. Appropriate PPE is worn during CVP insertion and care. B ATTITUDE 1 Staff demonstrate vigilance in maintaining a sterile field during CVP procedures. 2 Staff encourage compliance with hand hygiene before and after CVP handling. 3 Staff are cooperative with infection control audits and feedback. C PRACTICE 1 Hand hygiene is performed before and after CVP line handling. 2 Maximal sterile barrier precautions are used during CVP insertion (mask, cap, sterile gloves, gown, and full body drape). 3 CVP insertion site is cleaned with appropriate antiseptic (e.g., chlorhexidine). 4 CVP dressing is changed per protocol (every 5–7 days or sooner if soiled/loose). 5 CVP lines are reviewed daily for necessity and removed promptly when no longer needed. 6 CVP ports are scrubbed with alcohol/chlorhexidine before access. 7 Sterile technique is maintained during CVP medication/fluid administration. 8 Documentation of CVP care and site condition is complete and up-to-date 2 12

13. 70% 62% 20% 10% 95% 20% Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13 Observation for topic Meeting with faculty and preceptor Discussed with HOD and got topic approved Assessed knowledge ,attitude and practice Conducted sessions and did evaluation Exchang ideas with group members 2 13

14. 2 Ratio of physicians and nursing staff 14

15. RESULTS 12 The mean analysis shows decrease in the average mean score from the Pre-Knowledge phase (1.848067) to the Post-Knowledge phase (1.66987). This suggests that the learning intervention was effective, as participants showed improvement in their understanding or performance after the session. Evaluation of Knowledge Pre Knowledge Mean Post Knowledge Mean Pre knowledge evaluation Post knowledge evaluation 15

16. The mean analysis shows a decrease in the average mean score from the Pre-attitude phase (3.445313) to the Post-Knowledge phase (3.414063). This suggests that the learning intervention was effective, as participants showed improvement in their understanding or performance after the session. Evaluation of Attitude Pre Attitude Mean Pre Attitude Post Attitude Mean Post Attitude 2 16

17. The mean analysis shows an decrease in the average mean score from the Pre-attitude phase (1.84375) to the Post-Knowledge phase (1.65437). This suggests that the learning intervention was effective, as participants showed improvement in their understanding or performance after the session. Physician's pre and post evaluation of behavior and practices Pre physician practice Mean Post physician practice Mean Physicians' pre-evaluation of behavior and practice Physicians post evaluation of behavior and practice 2 17

18. The mean analysis shows an decrease in the average mean score from the Pre-attitude phase (1.6) to the Post-Knowledge phase (1.475). This suggests that the learning intervention was effective, as participants showed improvement in their understanding or performance after the session. HCPs pre and post evaluation of behaviour and practices Pre HCPS practice Mean Post HCPS practice Mean HCPS pre-evaluation of behavior and practices HCPS post evaluation of behavior and practices 2 18

19. The analysis shows a very slight decrease in the average score from the Pre-Source of Information phase (1.135417) to the Post-Source of Information phase (1.13212). This minimal change suggests that there was little to no significant shift in the source of information participants relied on after the intervention or learning process. Evaluation for source of information Pre source of information mean Post source of information mean Pre evaluation for source of information Post evaluation for source of information 2 19

20. 2 Number of patient with CVP Alive (64%) Expiry (36.3%) Days of CVP 1-5 days (46%) 6-10 days (23%) 10 or above (15%) Site Juglar (0%) Subclavicle (0%) Femoral (100%) Blood culture test Before CVP insertion (27%) During CVP insertion (0) After CVP removal (0) 20 DATA COLLECTED FROM HIMS

21. Inadequate awareness of CLABSI GAPS IDENTIFIED THROUGH OUR ELECTIVES EBP Policy stagnation Inadequate documentation practices Professional negligence 21 2

22. LIMITATIONS Hospital has guidelines on CLABSI prevention and CVP line care, but they were not always accessible when needed. Staff had theoretical knowledge about CVP line insertion and CLABSI prevention but faced challenges in consistent implementation. We did not have access to previous years of  CLABSI audit data to compare with our current findings. 22

23. 1. Site Selection Prefer subclavian site in adults (IA) Avoid femoral site where possible (I) Use ultrasound guidance to minimize complications (IB) Select site/device based on duration, risks, operator skill (IB) 2. Hand Hygiene & Aseptic Technique Perform hand hygiene before and after insertion or manipulation (IB) Maintain full aseptic technique (IB) Wear sterile gloves for insertion (IA) and guidewire exchanges (II) Use clean or sterile gloves for dressing changes (IC) 3. Skin Antisepsis Use alcohol-based chlorhexidine (0.5–2% CHG with 70% alcohol) for site prep (IA) Let antiseptic dry completely before insertion (IB) Alternatives (if CHG contraindicated): 70% alcohol, iodine, or iodophor (IA) No recommendation for use in infants <2 months (UI) 4. Maximum Barrier Precautions Use full sterile gown, gloves, cap, mask, and full body drape (IB) Use sterile sleeve for PA catheter insertion (IB) EVIDENCE BASED RECOMMENDATIONS 2 24

24. 5. Daily Review of Line Necessity Assess daily for need; remove if no longer required (IA) Replace emergency-inserted CVCs within 48 hours (IB) Avoid routine replacement of catheters (IB) Do not remove for fever alone; evaluate clinically (II) 6. Hub Disinfection & Accessing Catheters Use minimum lumens needed (IB) Disinfect hubs/connectors with CHG-alcohol, iodophor, or 70% alcohol (IA) Access with sterile devices only (IA) Prefer split septum valves over mechanical (II) 7. Dressing Management Use transparent semipermeable dressing or sterile gauze (IA) Change dressing if soiled, damp, or loose (IB) Do not use topical antibiotics, except on dialysis catheters (IB) Avoid submerging catheter site in water; use waterproof cover during showers (IB) Change transparent dressings every 7 days (IB) Use CHG-impregnated dressings if CLABSI rates are high despite other measures (IB) 8. Tubing & IV Administration Sets Change tubing: Propofol: every 6–12 hours or when vial is changed (IA) Blood, blood products, lipids: within 24 hours (IB) Other continuous infusions: every 96 hours to 7 days (IA) No recommendation for intermittently used sets or implantable ports (UI) EVIDENCE BASED RECOMMENDATIONS 2 25

25. 2 EVIDENCE BASED RECOMMENDATIONS Watch for fever, chills, or confusion signs of infection. Check the catheter site for redness, swelling, or pain. Look for poor blood flow or trouble drawing blood from the catheter. Take blood cultures from the catheter and a regular vein if infection is suspected. Use sterile techniques when handling the catheter and changing dressings. Start antibiotics quickly and adjust based on culture results. Educate patients to report any redness, swelling, or pain around the catheter. 26 Assessment for CLABSI

26. I would like to extend my heartfelt gratitude to my esteemed teachers, the Head of Department, Sir Altaf, Assistant Principal, Sir Junaid, Clinical Preceptor, Kashif Saad, and Clinical Supervisor, Sunita Ali, for their unwavering guidance and support throughout my senior elective project. Their expertise, insightful feedback, and encouragement have been instrumental in shaping my learning journey and the successful outcomes of this project. ACKNOWLEDGEMENT 27

27. Khan, M., Ahmad, I. W., Waheed, M., Tahir, H., & Hurain, K. (2024). Knowledge, Attitude and Practice among Nurses Regarding Prevention of Central Line Associated Bloodstream Infection in Tertiary Care Hospital of Peshawar: Prevention of Central Line Associated Bloodstream Infections. Pakistan Journal of Health Sciences , 88-91. Chen, L., & FELICIANO, E. (2024). Knowledge, Attitudes, and Behaviors of Intensive Care Unit Healthcare Workers in Preventing Central Line-Associated Blood Stream Infections in Selected Hospitals of Zhejiang Province, China. International Journal of Frontiers in Medicine , 6 (5). Al-Yateem, I. S. A. (2021). Knowledge, Behavior and Attitude of Nurses Regarding Prevention of Central Line Associated Blood Stream Infections (Doctoral dissertation, Royal College of Surgeons in Ireland). Chi, X. W., He, R., Wu, X. H., Wu, L. J., Yang, Y. L., & Huang, Z. (2024). Development of best evidence-based practice protocols for central venous catheter placement and maintenance to reduce CLABSI. Medicine , 103 (27), e38652. Odada, D., Munyi, H., Gatuiku, J., Thuku, R., Nyandigisi, J., Wangui, A., ... & Adam, R. D. (2023). Reducing the rate of central line-associated bloodstream infections; a quality improvement project. BMC Infectious Diseases , 23 (1), 745. REFERENCES 2 28

28. THANK YOU 2