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Develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: ( SEE ATTACHED WORK)BackgroundProblem statementPurpose of the change proposalPICOTLiterature search strategy employedEvaluation of the literatureApplicable change or nursing theory utilizedProposed implementation plan with outcome measuresIdentification of potential barriers to plan implementation, and a discussion of how these could be overcomeAppendix section, if tables, graphs, surveys, educational materials, etc. are createdAPA Style required. picot__capstone.docx literature_review.docx Unformatted Attachment Preview 1 Running head: PICOT PICOT Statement 2 PICOT PICOT Statement Should multiple interventions tailored to the population or individuals be utilized to prevent Central Line-Associated Bloodstream Infections among the dialysis patients? Population/patient The population that is affected by the Central Line-Associated Bloodstream is the target population in this project. Intervention/indicator Many studies have been carried out to verify the use of Alcohol Impregnated Caps to reduce Central Line-Associated Bloodstream Infections. One research from NorthShore University mentioned that Catheter hub decontamination requires a thorough scrub and compliance varies (Wright et al., 2013). The researcher utilized sterilization caps with a less sponge soaked in isopropyl with a concentration of 70\%, which is wound on every lumen not frequently in use and stays in position up to when the lumen is opened. Once the cap is detached, its disposed of, and a new one is wound in onto the lumen as mentioned above. In general, the research entails three stages, whereby the CLABSI rate was observed. The first stage entailed the continuous use of alcohol wipe to clean the hub before gaining access to the line. In the second stage, the fumigation caps were utilized on all the clients with the central lines. The last stage needed disposal of all caps and repeating the phase one procedure. This research is valid to address the question posted regarding the utilization of Alcohol Impregnated Central Caps. 3 PICOT The size of the sample is three healthcare centers and entailed 799 participants with a central line that was big enough to establish the correlations (Wright et al., 2013). The findings reported that the rate of contamination was around 12.7 amid the initial stage, and this changed to 5.5 when the sterilization caps were utilized. The rate augmented to 12.0 \% after the discontinuation of the caps, and alcohol sponging was resumed. According to the finding from this study, the players in the hospital settings must encourage the utilization of alcohol impregnated caps on a client populace with many persons necessitating the utilization of central lines. The nursing intervention will include the prevention and treatment of the condition. In the treatment, the patient may use the prescribed antibiotics; such drugs include Systemic antibiotic prophylaxis. The prevention strategy will involve practicing hygiene when dealing with patients. The plan will likewise entail the provision of high-quality patient care that is patient-centered. The Health Care Agency entails professional caregivers who will play a central role in the management of the condition. Such an agency will play a vital role in managing the various conditions among the patients. The nursing practices, in this case, will entail nurses making some efforts to handle the problem are they make some efforts to prevent such incidents. Comparison/control For the chosen approach, a comparison can be made by evaluating the reported cases of CLABSI before and after the utilization of Alcohol Impregnated Caps. Making a comparison after the proposed plan has been implemented will be used to measure the effectiveness of the program. Outcome 4 PICOT The targeted outcome is to record the reduced cases of CLABSI in the dialysis center after the implementation of the sterile technique during various processes like route dressing, insertions among the others in order to deter the development of the condition. Time The expected outcome should be measured within six months after the implementation of the plan. Reference Wright, M., Tropp, J., Schora, D., Dillon-Grant, M., Peterson, K., Boehm, S., et al. (2013). Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. American Journal of Infection Control, 41, 33-38. Retrieved November 28, 2013, from the Elsevier database. Running head: CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS Central Line-Associated Bloodstream Infections 1 CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS 2 Central Line-Associated Bloodstream Infections Introduction Healthcare facilities have a responsibility to patients to provide the ideal environment for recovery from different health issues. However, they are just as much likely to create an environment in which the patients could develop more complications than they did coming into the hospital. The extensive range of healthcare issues and infections that the patients at the facilities have present opportunities for contracting healthcare-associated infections, thereby necessitating attention towards potential such cases. Central Line-Associated Bloodstream Infections (CLABSIs) form some of the potential healthcare issues that one could contract in healthcare facilities, which has necessitated significant research into potential intervention methods to address the problem. Notably, so, the use of alcohol impregnated caps, use of adequate antiseptics such as chlorhexidine, proper handwashing techniques, proper way to provide catheter care and dressing changes are one of the potential methods through which healthcare practitioners could help patients recover from the infection sand achieve full health status. Research Question The research herein is based on the necessity to answer the question of the potential that the impregnated alcohol caps could be an effective solution to CLABSI. Previous research into the potential implications of the use of disinfectant caps points to a significant reduction in the infection rates once the practitioners employed the intervention method (Merrill, Sumner, Linford, Taylor, & Macintosh, 2014). However, it would be important to determine the potential impact of the use of alcohol-related caps in addressing the issue. Particularly so, the research will compare the outcome of using the alcohol-related caps and cases in which no such intervention is provided to the patients. Data from the experiment would then form an integral basis of analysis into the CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS 3 potential impact of the intervention measure, thereby aiding in answering the research question as is. Sample Population One of the most effective methods of comparing the research outcomes in such cases is the use of run charts to compare cases prior to and after the intervention. Particularly, following the identification of the health facility to be used for the research, the research team will collect information related to the rates of infection among the patients. Ultimately, the team will collect the same data following the intervention process to de3termine the implications if using the alcohol impregnated caps as a form of intervention to reduce CLABSI. Most importantly, the results ought to indicate a significant change in the recorded cases based on the nursing practice intervention. The method is especially appropriate as it does not put anyone’s health in peril as would be the case had the team used a different group of respondents with CLABSI, but to whom no form of intervention is offered. Limitations of the Study In as much as the research herein could be as straightforward, limitations such as the chances of confounding factors influencing the research results are likely. There are limited chances that the nursing teams involved in the research will be perfectly effective in adapting to the practices necessary in the implementation of the intervention. Ultimately, such a factor could influence the outcome based on the observed cases but would not be appropriately analyzed in analyzing the results from data collection. Such confounding factors could influence the study but receive limited credibility in analyzing the results, which would affect their generalization. Another limitation with a potential impact on generalization would be the population sample size used in the research, in which case an extensive sample, drawn from different cultural CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS 4 environments would be most effective for the study’s external validity. However, resource constraints make it hard to draw such a large sample and effectively affect the research study. Particularly, it would be important to conduct the research based on samples from different healthcare organizations scattered across the country to guarantee that the results therein appeal to the general healthcare environment. However, such research calls for extensive investment in training the practitioners to adopt the intervention measure, which would increase the number of resources necessary to complete the project. The absence of such resources creates limitations for the research to the extent of affecting its application in policy development efforts. Recommendations and Conclusion Irrespective of the challenges, the research outcomes create a basis for adaptation of the intervention methods in addressing CLABSIs. Notably so, one of the primary factors used in confirming the validity of research has always been the potential relationship between the study and previous research conducted in the field of interest. In this case, research already points to the potential for a positive outcome following interventions that include the use of disinfectant caps in solving CLABSIs. Hence, it would be appropriate if healthcare facilities considered adopting the intervention measure as a means of addressing the rates of healthcare-associated infections. In conclusion, the research herein offers significant insight into addressing an issue that has affected the quality of outcomes in healthcare interventions in the past. Consequently, an explicit effort by healthcare management teams to adopt measures such as those recommended herein, which are based on evidence and research, could be consequential to improving patient experiences and quality of services at the said facilities. CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS 5 References Merrill, K. C., Sumner, S., Linford, L., Taylor, C., & Macintosh, C. (2014). Impact of universal disinfectant cap implementation on central line–associated bloodstream infections. American journal of infection control, 42(12), 1274-1277. Flynn, E. R. (2016). Were Not in ICU Anymore: Long-term Care and Dialysis Units Collaborate on Process Improvement to Reduce Central Line-Associated Bloodstream Infections. American Journal of Infection Control, 44(6), S47-S48. Krishnan, A., Irani, K., Swaminathan, R., & Boan, P. (2019). A retrospective study of tunnelled haemodialysis central line-associated bloodstream infections. Journal of Chemotherapy, 1-5. Ling, M. L., Apisarnthanarak, A., Jaggi, N., Harrington, G., Morikane, K., Ching, P., ... & Lee, C. M. (2016). APSIC guide for prevention of central line associated bloodstream infections (CLABSI). Antimicrobial Resistance & Infection Control, 5(1), 16. Neu, A. M., Richardson, T., Lawlor, J., Stuart, J., Newland, J., McAfee, N., ... & Foster, D. (2016). Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney international, 89(6), 1346-1354. Nguyen, D. B., Shugart, A., Lines, C., Shah, A. B., Edwards, J., Pollock, D., ... & Patel, P. R. (2017). National Healthcare Safety Network (NHSN) dialysis event surveillance report for 2014. Clinical Journal of the American Society of Nephrology, 12(7), 1139-1146. Patel, P. R., Sarah, H. Y., Booth, S., Bren, V., Downham, G., Hess, S., ... & Jernigan, J. A. (2013). Bloodstream infection rates in outpatient hemodialysis facilities participating in a CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS 6 collaborative prevention effort: a quality improvement report. American Journal of Kidney Diseases, 62(2), 322-330. Rhee, Y., Heung, M., Chen, B., & Chenoweth, C. E. (2015). Central line-associated bloodstream infections in non-ICU inpatient wards: a 2-year analysis. infection control & hospital epidemiology, 36(4), 424-430. Sarah, H. Y., Kallen, A. J., Hess, S., Bren, V. R., Lincoln, M. E., Downham, G., ... & Lines, C. (2016). Sustained infection reduction in outpatient hemodialysis centers participating in a collaborative bloodstream infection prevention effort. infection control & hospital epidemiology, 37(7), 863-866. Saran, R., Robinson, B., Abbott, K. C., Agodoa, L. Y., Bhave, N., Bragg-Gresham, J., ... & Gaipov, A. (2018). US renal data system 2017 annual data report: epidemiology of kidney disease in the United States. American journal of kidney diseases: the official journal of the National Kidney Foundation, 71(3 Suppl 1), A7. ... Purchase answer to see full attachment