Data Analysis and Results

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Chapter 4: Data Analysis and Results

This chapter will review the collected data, evaluate methods used to analyze the data, and appraise the findings of the study. The purpose of this quantitative project was to determine the degree of relationship between the independent variale of nurse’s participation in an evidence-based CLABSI prevention using CHG bathing and the dependent variables of lowering CLABSI rates in patients with CVCs in a healthcare facility in Texas. The quantitative research methodology was selected as a means to review the collected data, evaluate and analyze the data and to appraise the findings of the quality improvement project. The purpose of the project is to explore the problem of CLABSIs and examine available measures to prevent, control, reduce incidences, and to implement a quality improvement project set forth by this investigator to decrease CLABSIs. More importantly, the project seeks to contribute to the field of evidence-based practices in nursing by showing the role of the nurse in helping to reduce HAIs, such as CLABSIs, in the adult critical care setting. In particular, the present project proposes nurse training on the CUSP toolkit and additional CLABSI maintenance, including CHG bathing as an intervention to prevent CLABSI. Central line Venous Catheters (CVCs) are commonly used for inpatients hospitalized in acute care Intensive Care Units (ICU) to administer blood products, intravenous fluids, parenteral nutrition, and other types of medications, such as antibiotics. The use of catheters is, however, linked to the risk of developing a hospital-acquired infection (HAI), known as Central-line Associated Bloodstream Infection (CLABSI) mainly caused by microorganisms found on the external surface of the patient’s skin, improper hand hygiene, or in the fluid pathway post-catheter insertion. Notably, CVCs have been cited as the most frequent and costliest causes of bloodstream infections (Haddadin & Regunath., 2019). CLABSI prevention is one of seven requirements by the Joint Commission for hospitals to accredited nursing care centers and listed as a National Patient Safety Goal (NPSG) NPSG.07.04.01 (Yokoe et al., 2018).

Evidence-based practices, including CHG bathing, adequate hand hygiene, and clear de-escalation protocols for central lines that are no longer medically necessary, were utilized. The Comprehensive Unit-based Safety Program (CUSP) is a program designed to teach and enhance patient safety awareness as well as the quality of nursing care (Basinger, 2015). The project will implement CUSP, which is comprised of five basic steps. The CUSP process starts with providing education on the CUSP Central-line maintenance bundle that includes chlorohexidine gluconate (CHG) bathing, followed by the identification of weaknesses and risks in patient safety, then the partnering of a senior executive of the critical care unit, learning from the flaws, and the execution of communication and teamwork tools (Basinger, 2015). The core CUSP toolkit (appendix B) gives clinical teams the training resources and tools to apply the CUSP CHG bathing intervention for this project to prevent CLABSIs.

The present project will consist of audit tools on awareness and compliance, like the AHRQ CUSP CLABSI Central Line Maintenance Audit Form and CUSP toolkit (appendix B) in which proper maintenance of CLABSI is ensured (Baldassarre, Finkelston, Decker, Lewis, & Niesley, 2015). A CUSP CLABSI maintenance audit tool (Appendix B) was used on the nurses providing care on those patients with CVCs were used within the adult ICU at Texas hospital, to help in determining the CLASBI maintenance bundle compliance. The results of the project were analyzed using the necessary statistical methods to help in establishing the conclusion of the results. The Texas hospital’s nursing data portal was used to gather statistical data that will determine if CHG use has helped reach the benchmark goal of SIR = 75th percentile and the Goal Process Measures or KPIs = 90% compliance compared to other hospitals in the division. Currently, in the last quarter of 2019, the benchmark of the 75th percentile has been achieving post quality improvements that include the addition of CHG bathing. CUSP CLABSI maintenance audit tool (Appendix B) (Heale & Twycross, 2015). Statistical significance was calculated at a p-value of < .05 and a 95% confidence interval. The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed and used standardized infection ratios (SIRs) to measure healthcare-associated infection (HAI) incidence (Soe, Gould, Pollock, & Edwards, 2015).

The Infection rate is calculated using the overall percentage of infection by dividing the number of new cases by the average census and multiplying by 100. For more specific rates, the number will be provided by dividing the number of new cases by the total resident days and multiply by 1000, which gives you the number of infections per 1000 resident days (Liu et al., 2016). Standardized Infection Ratio (SRI) is expressed as a ratio and is the comparison of the actual number of HAIs to the predicted number of HAIs in a healthcare organization. This value is based upon data reported to National Healthcare Safety Network (NHSN) during a specified time period. The Hospital Corporation of America’s (HCA) goal is 75th percentile. A SIR can only be calculated if there is at least one predicted infection

Goal: SIR = 75th percentile

To assist in determining if patient outcomes could be improved using simulation

activities, a rural healthcare facility in Southeast Texas, was chosen to conduct the project. The methodology used for this project was quantitative. A quantitative methodology was chosen to provide absolute value to the rate of incidence or occurrence of adverse events to support measurement of the difference between pre- and post-simulation intervention. A quasi-experimental design was used as participants were not randomly selected. This approach suited the request of the institution to include nurses working in the ED.

Using comparative analysis, the CUSP CLABSI Central Line Maintenance Audit Form (appendix B) shows > 90 percent compliance, the data met the key performance indicators (KPIs) for a decrease in CLABSI and it’s compliance with evidence based standars has brought down CLABSI infection rates. The Goal Process Measures or KPIs (key performance indicators) = 90% compliance. The bullet graph (Table 1) at the top right corner of Nursing Data Portal trending screens, outlines how to read and interpret progress on performance milestones. The purpose of this chapter is to summarize the collected data, how it was analyzed, and then to present the results.


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