NURS 6101 -week 4 Policy and Politics in Nursing and Healthcare Essay

Renal Failure can be permanent or temporary. Millions of people are diagnosed with permanent Stage 4-5 end-stage renal disease (ESRD). Although transplantation would be the intervention of choice it is a process to be a candidate and a list of thousands that are waiting for a transplant for each person diagnosed to be added to. More than half of the people in the world diagnosed with ESRD are on hemodialysis (HD). Dialysis replaces the process that a normal functioning kidney would do by removing waste and fluid from the blood. The other form of dialysis is peritoneal dialysis (PD). This type of dialysis is done more so at home. Hemodialysis is generally done in an in-center setting but can be done in a home setting. Hemodialysis in-center is less desirable related to the increase risk of infection.

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Infection, the second leading cause of hospitalization and deaths in patient with ESRD on dialysis. The leading cause of infection, blood-stream infection (BSI), is related to central venous catheters (CVC). According to Stefan, Stancu, Capusa, Ailioaie, & Mircescu, (2012), septicemia account for 75% of those infections. First time hemodialysis patients are more than likely to receive the initial treatment via CVC access for many reasons. A common reason is emergent dialysis is needed. Central Venous Catheter are normally a temporary access, to be in place for no more than 7 to 21 days. In many cases CVC, will be in place for month or years because the patient has no other option. The preferred access in hemodialysis is arteriovenous fistula (AVF) and the second preferred is arteriovenous graft (AVG). Although all access has risk for infection. Patient with CVC access has a greater risk for bloodstream infection. The purpose of this research is to identify intervention to prevent, decrease, and eliminate blood-stream infection related to CVC in patient receiving hemodialysis.NURS 6101 -week 4 Policy and Politics in Nursing and Healthcare Essay
Summary of Literature
There were multiple articles reviewed as resources for the topic selected addressing bloodstream infection caused by central venous catheters. When reviewing all sources, there were many similarities to be noted. The infection control procedures in each setting was often compromised and showed great need for focus and improvement. There was also similarity it the selected processes to use in relation to infection control. Several of the article collected clinical data retrospectively. Overall the major consensus of all the sources were that central venous catheter have a very high risk for infection.NURS 6101 -week 4 Policy and Politics in Nursing and Healthcare Essay
The authors of “Catheter-related infections in chronic hemodialysis: a clinical and economic perspective”, goal was to assess the incidence of bacteremia and how it has a clinical and economic impact. All 75 of the subject were admitted to the same physician in the same hospital with a suspicion of bacteremia over a 15 months’ period. The all had temporary CVC. The data was collected retrospectively.
Although the limitation of sample size, retrospective observational design, and cross-sectional data with no information post discharge; this study could show that 1 in 5 HD patients with CVC will suffer from complicated bacteremia. This impacts morbidity, mortality and cost. Chu, Adams, & Crawford (2013), used a practice developmental framework to conduct their study. They goal was to identify causes of the rise in bloodstream infections as well as strategies to reduce them; while engaging the staff, and monitoring the compliance. The researchers were focus on the quality improvement of the setting. They used an audit tool to observe clinical practices caring for CVC. They noted that there are many contribution to catheter related blood stream infection (CRBSI) such as environment, aseptic technique, and dressing just to address a few. The audit reveal variation to practice among staff and documentation of the medical record reveal lack of documentation; specifically, that addressed the CVC exit site. An action plan was developed as a result of the finding from the audit. Implementation of the action plan included standardized assessment of CVC and modification of treatment form to address access. It also included KDOQI guide line and top 10 tips for CVC care. The researcher focus mainly the nurses which was a limitation because in many setting the patient care technician provide more that 75% of the hands-on care. They also were only able to focus on nursing care post catheter placement not during placement. In getting there result they could compare the difference in practice pre-and post-audit. This allowed them to see a great improvement in practice which impact infection control. It is often the small things that majorly impact practice performance and outcome. This could be used in other setting to improve clinical practice which is a plus.
“Prevention and Treatment of Hemodialysis- Related Bloodstream Infection”, focuses on the increasing number of patient requiring accesses. Camins, (2013) discussed how prevention of BSI is and will always be a multidisciplinary and multifaceted approach. There was great emphasis on the placement of AVF first. It compliments previous works noted in the light of decreasing the use and placement of CVC. According to Scarritt, Paragone, O’gorman,Kyriazis, Maltese, and Rostas (2014), there should be an increase in AVG initial placement and transition to AVF oppose to central venous catheter transition to AVF. The wait for use of a AVG is a little as 24 hours and the risk of infection is much lower. Both works also addresses prevention with interventions discussed such application of antimicrobial or antiseptics on the catheter exit site, antimicrobial lock solution, hand hygiene, environment and use of luer lock connector.NURS 6101 -week 4 Policy and Politics in Nursing and Healthcare Essay  Blood culture are utilized to test for infection and treatment of BSI involving coagulase-negative Staphylococci and most gram-negative pathogen includes antibiotics. Removal of CVC is generally not necessary. The goal is not to require the CVC to be removed in any cases but CSI involving S. aureus, Pseudomonas species, Enterococcus species, and Candida species continues to require the CVC will need to be removed.
Even with a method of a prospective study and a larger population over a 7-month period infection control hygiene an issue. As all sources, have revealed a lack of compliance even with direct observation and the need for policy and procedure of infection control enforcement to impact the incidence of BSI. A difference noted among studies were; according to Sahli, Feidjel, & Laaloui, (2016) diabetes were significantly associated with the risk of CRBSI while Stefan, (2012) did not find a relationship between diabetes and bacteremia. Bacteremia being the most common strand of CRBSI.
Conclusion
Review of the collected resource were very consistent on the stance of prevention of infection is possible. The incidence of CRBSI varied for study to study with one contributing factor being the sample population. The all were based on 1000 days of the CVC being place. The incidence ranged from 6.5 to 10.8 per 1000 depending on the study. Age, sex, comorbidity, and insertion site was not always considering in each study. All of these could have some contributing factor in the likely hood of infection in the patient. The commonality that was consistent was the lack of infection control. Whether it was hand hygiene or proper us of personal protective equipment (PPE). Infection are no longer acceptable as the normal with central venous catheters because of the goal and strategies in place to eliminate Catheter related blood-stream infection.
Not all hemodialysis accesses are created equal (Landry & Braden,2014). Cath has a 15- fold increase risk of infection. Although the incidence of CRBSI over all had decrease there continues to be hundreds of patients diagnosed and dying. As previously stated the number of CVC continues to rise and many place for greater than the recommended time. Research highlighted throughout the review the need of fistulas being placed first. This will require planning and earlier detection from nephrologist.
Many patients are never referred to a nephrologist before they need dialysis. It’s often too late to place an arteriovenous fistula and in many cases an arteriovenous graft. None of the articles reviewed in detail the need for the prevention of central venous catheter of those 80% of hemodialysis patient that initiate dialysis with a catheter. The 80% speak volumes of the quality of improvement needed before the patient even need dialysis. The topic focus is to prevent, decrease, and eliminate blood-stream infection but the reality of it all is we need to start before an access is require. This decrease mortality and cost related to dialysis. NURS 6101 -week 4 Policy and Politics in Nursing and Healthcare Essay