ABSTRACT
OVERVIEW: In 2012, acute care hospitals in the United States reported 30,100 central line-associated bloodstream infections (CLABSIs) to the National Healthcare Safety Network of the Centers for Disease Control and Prevention. Known to substantially increase morbidity, length of stay, and cost of care, CLABSIs are associated with a mortality rate of 12% to 25% and an additional cost of $22,885 to $29,330 per incident. Following five months with a sustained CLABSI rate of zero per 1,000 catheter days, the acuity adaptable critical care unit at Geisinger Medical Center in Danville, Pennsylvania, saw the CLABSI rate spike to 3.97 per 1,000 catheter days in March 2011, prompting a quality improvement project and, ultimately, the implementation within the unit of a champion team program to guide central line care.
Subject(s)
Catheter-Related Infections/prevention & control , Catheterization, Central Venous/nursing , Infection Control/standards , Nurse's Role , Patient Care Team/organization & administration , Quality Assurance, Health Care , Catheter-Related Infections/epidemiology , Catheterization, Central Venous/adverse effects , Evidence-Based Nursing , Humans , Inservice Training , Organizational Policy , Patient Education as Topic , United States/epidemiologyABSTRACT
The primary purpose of this pilot study was to test the feasibility of an intervention designed to reduce care-resistant behaviors (CRBs) in persons with moderate-to-severe dementia during oral hygiene activities. The intervention, Managing Oral Hygiene Using Threat Reduction (MOUTh), combined best oral hygiene practices with CRB reduction techniques. Oral health was operationalized as the total score obtained from the Oral Health Assessment Tool (OHAT). CRB was measured using a refinement of the Resistiveness to Care Scale. Seven nursing home residents with dementia received twice daily mouth care for 14 days. The baseline OHAT mean score of 7.29 (SD = 1.25) improved to 1.00 (SD = 1.26, p < .001); CRB improved from 2.43 CRBs/minute (SD = 4.26) to 1.09 CRBs/minute (SD = 1.56, t = 1.97, df 41, p= .06). The findings from this pilot study suggest that the MOUTh intervention is feasible and reduced CRBs, thus allowing more effective oral care.
