Publication Date

Spring 2018

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Constance Hill

Second Advisor

Kinnery Patel

Third Advisor

Jennifer Delozier-Smith

Keywords

Central-line blood stream, Infection prevention in children, Health belief model, Compliance issues

Abstract

Central venous catheters (CVC) are devices necessary to medically treat pediatric patients diagnosed with conditions such as cancer. Central line associated bloodstream infection (CLABSI) is a complication associated with utilizing a central line. Nurses are responsible for maintaining and complying with strict prevention protocols. The aims of this quality improvement project are to: (a) gain an understanding of perceptions of CLABSI prevention, (b) observe adherence to the CLABSI prevention bundle, (c) measure adherence to the current CLASBI prevention bundle (post-training), (d) identify ways to improve adherence to the CLASBI bundle, and (e) ascertain potential strategies for further compliance efforts. Three sources of data included (1) medical charts, (2) online survey, and (3) observation. The survey contained questions based on the Health Belief Model including (1) Perceived Susceptibility, (2) Perceived Severity, (3) Perceived Benefits, (4) Perceived Barriers, and (5) Self-Efficacy. Charts and observational data recorded the use of CLABSI prevention bundle components. Outcomes suggested that health beliefs were strong and noncompliance was likely not a result of questionable health beliefs. Adherence to the bundle components reported though medical record review (66%) and observation (90.9%) were compared. A one sample t-test estimated that the difference in compliance reported through records versus observation were highly significant (t=11.2, p < 0.001) and suggest that lack of compliance may be due to factors other than health perceptions. Adherence between patients treated was also noted. Approximately half (48%) the respondents expressed interest in becoming a “champion”. Survey responses were compared by interest groups. These findings can be used to inform the implementation of CLABSI infection prevention efforts inclusive of supporting the use of “champions” respondent suggestions such as lowering the nurse-patient ratio and increasing family engagement.

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