Evidence-Based Practice Change

Evidence-Based Practice Change

Basically, the paper involves revising and merging the previous papers into one, and doing the conclusion part. Please check the previous papers you did attached


Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question 

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

General Requirements

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.



Evidence-Based Practice Change

Central Line-Associated Blood Stream Infection

Central Line-Associated Blood Stream Infection (CLABSI) is a bloodstream infection that causes increased mortality, morbidity, and length of stay in the Intensive Care Units (ICU), escalating health care costs. About 260,000 central line-associated bloodstream infections are reported in hospitals in the United States (Cleves et al., 2018). Also, approximately 29,000 death cases related to the central line-associated bloodstream infections are reported every year (Savage et al., 2018). Nearly 29,000 US dollars are spent on treating each patient, which creates a burden of about 2.4 billion dollars on the US healthcare system every year (Noto et al. 2015).  Multidrug-resistant organisms (MDROs) such as vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) are the most endemic pathogens that cause CLABSI and other bloodstream related infections (Cleves et al., 2018). These pathogens are endemic in most acute and long term care areas, and their resistance makes it difficult to treat because of the decreasing armamentarium of active antimicrobials. Significant efforts are put to prevent and reduce the rate of infections through health practices designed to decrease the transmission of pathogens. Such methods include care of devices, bundles for insertion, isolation of multidrug-resistant organism’s patients, and hand hygiene (Noto et al. 2015). Chlorhexidine can be used as one of the interventions in reducing bacterial burden, thus decreasing the rate of infections.

PICOT Statement

In patients in the Intensive Care Unit (ICU) (P), how does daily chlorhexidine baths (I) compare to baths with soap and water (C) in decrease the rate of central line-associated bloodstream infections (CLABSI) (O) after one year of the intervention (T)?

Evidence-Based Practice Change

The utilization of antiseptic chlorhexidine gluconate (CHG) can be used as the primary intervention to fight bacterial load both in the central lines and central venous catheters. CHG daily baths are imperative compared to regular baths using soap and water in the ICU unit. Chlorhexidine has a broad-spectrum topical antibacterial agent, which decreases the bacterial burden, thus reducing the rate of infections when used daily during baths (Noto et al. 2015). The antibacterial activity is also essential in reducing microbes and pathogens in patient’s skin thereby preventing both primary and secondary infections. Therefore, daily baths with chlorhexidine wipes in traditional bathing procedures in the Intensive Care Unit should be considered as a significant intervention in the prevention of Central Line-Associated Bloodstream Infections.

Evidence-Based Practice Change

Many studies have also shown the efficacy of CHG in intensive care patients, and support is increasing in caring for non-ICU patients. Daily baths with Chlorhexidine are associated with reduced skin colonization with organisms that have multidrug resistance, reduced clostridium difficile infections, and reduced bloodstream infection rates (Savage et al., 2018).  Therefore, nurses should consider the use of Chlorhexidine as a primary intervention in the prevention and reduction of Central Line Bloodstream Infections in hospitalized patients.

A study by Holder and Zellinger (2009) used a research design where nurses came up with a bathing procedure, which included bating frequency, technique, contraindications, required documentation, and bathing technique. The study method was controlled by advanced nurses and nursing leaders that ensured the accuracy of the findings. The results of the study on Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections showed that the Bloodstream Infections reduced from 3.6 per 1000 patients to 1 per 1000 patients after six months of chlorhexidine bath procedure implementation. The study findings indicated that the use of chlorhexidine baths reduces the rates of Central Line-Associated Bloodstream Infections and resistant organism’s acquisition rates in patients admitted in the Intensive Care Units.


Johnson et al. (2019) developed an observational study to determine the relationship between Chlorhexidine baths and Central Line-Associated Bloodstream infection prevention. The groin and arm skin bacterial growth were observed in non exposed patients, and 40 Chlorhexidine exposed patients in the Neonatal Intensive Care Unit. The exposed patients were given 2 % Chlorhexidine baths for Central Line-Associated Bloodstream infection prevention. The study showed that the bacterial burden reduced after the patients took the first bath. However, the bacterial load returned to baseline after 72 hours. The concentration of residual CHG on the skin reduced with time as the bacterial burden increased. The bathing with Chlorhexidine decreases the bacterial burden on the skin. Nurses should be aware that CHG bathing twice a week may reduce the risk of CLABSI associated with using central lines and central nervous catheters. Thus, the study has shown the efficacy of chlorhexidine gluconate in intensive care patients, and support is increasing in caring for non-ICU patients.

Evidence-Based Practice Change

The study by Savage et al. (2018) applied a retrospective time series to examine the effectiveness of various prevention bundles that were developed by nurses in infection control in neonatal and pediatric intensive care units in 2006-2014. The research was subdivided in to post, peri, pre, and second peri-intervention periods depending on each bundle’s implementation status. The study showed there was a significant reduction in unit Central Line-Associated Bloodstream Infection rates where all units were less than the corresponding National Healthcare Safety Network Central Line-Associated Bloodstream Infection rates after the study. Prevention bundle for centralized Central Line-Associated Bloodstream Infection can be useful in universalizing central line care, improve and control the quality of care to help maintain low CLABSI rates in the hospital. Thus, the study showed the efficacy of chlorhexidine gluconate daily baths in reducing the risk of CLABSI associated with the use of central lines and central nervous catheters in intensive care patients.

Conclusion and Recommendations

The suffering experienced by families and patients due to the central line-associated bloodstream infections acquired in the hospitals is immeasurable. Therefore, there is a need for nurses to focus on the prevention strategies for bloodstream infections in hospitals, especially in the Intensive Care Unit. Antiseptic chlorhexidine gluconate is one of the primary measures that can be used to reduce bacterial infections in the central nervous and central line catheters. Nurses should consider the use of antiseptic chlorhexidine gluconate in the ICU since it is effective in preventing bacterial infections in patients as compared to regular soap and water bathing. Therefore, chlorhexidine gluconate daily baths are imperative compared to regular baths using soap and water in the ICU unit.

It is recommended that four strategies can be used to help implement the use of CHG daily baths for patients in the surgical or medical units to reduce CLABS rates. The strategies include increased awareness and accountability, resource availability, leadership support, and staff education (Noto et al. 2015). Therefore, targeted interventions in the ICU can reduce the risk of CLABSI associated with the use of central lines and central nervous catheters. Hospitals need to commit developing strategies to minimize the cases of central line-associated bloodstream infections, which are the primary source of high costs of care by both patients and health institutions.



Cleves, D., Pino, J., Patiño, J. A., Rosso, F., Vélez, J. D., & Pérez, P. (2018). Effect of

chlorhexidine baths on central-line-associated bloodstream infections in a neonatal intensive care unit in a developing country. Journal of Hospital Infection100(3), e196-e199.Doi: 10.1016/j.jhin.2018.03.022

Holder, C., &Zellinger, M. (2009). Daily Bathing with Chlorhexidine in the ICU to Prevent

Central Line-Associated Bloodstream Infections. JCOM16(11), 509-13. Retrieved from https://pdfs.semanticscholar.org/ace2/d11dfa4fab260bb5639c782b9baa0a1addad.pdf

Johnson, J., Suwantarat, N., Colantuoni, E., Ross, T. L., Aucott, S. W., Carroll, K. C.,

&Milstone, A. M. (2019). The impact of chlorhexidine gluconate bathing on skin bacterial burden of neonates admitted to the Neonatal Intensive Care Unit. Journal of Perinatology39(1), 63. Retrieved from https://www.nature.com/articles/s41372-018-0231-7

Savage, T., Hodge, D. E., Pickard, K., Myers, P., Powell, K., & Cayce, J. M. (2018). Sustained

reduction and prevention of neonatal and pediatric central line-associated bloodstream infection following a nurse-driven quality improvement initiative in a pediatric facility. Journal of the Association for Vascular Access23(1), 30-41. Doi: 10.1016/j.java.2017.11.002


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