Impact of Central Line Bundle Care on Reduction of Central Line Associated-Infections: A Scoping Review

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use. Methods A literature review was completed of nine critically appraised articles from the years 2010-2021. The association of the use of central line bundles and CLABSI rates was examined. These relationships were investigated to determine if the adherence to a central line bundle directly reduced the number of CLABSI rates in critically ill adult patients. A summary evaluation table was composed to determine the associations related to the implementation or current central line bundle care use. Results Of the study sample (N=9), all but one demonstrated a significant decrease in CLABSI rates when a central line bundle was in place. A trend towards reducing CLABSI was noted in the remaining article, a randomized controlled study, but the results were not significantly different. In all the other studies, a meta-analysis, randomized controlled trial, control trial, cohort or case-control studies, and quality improvement project, there was a significant improvement in CLABSI rates when utilizing a central line bundle. The extensive use of different levels of evidence provided an excellent synopsis that implementing a central line bundle care would directly affect decreasing CLABSI rates. Implications for Nursing Practice Results provided in this scoping review afforded the authors a diverse level of evidence that using a central line bundle has a direct outcome on reducing CLABSI rates. This practice can be implemented within the hospital setting as suggested by the literature review to prevent or reduce CLABSI rates. Implementing a standard central line bundle care hospital-wide helps avoid this hospital-acquired infection

Prophylactic Administration of Steroids and the Effect on Post-extubation Stridor: A Scoping Review

Purpose/Background Stridor occurs due to laryngeal edema which arises when a patient has been intubated for an extended period of time. There are several factors that affect the degree of swelling. Post-extubation stridor signals that a patient requires reintubation because the airway is no longer patent. Corticosteroids, such as dexamethasone, can be used prior to extubation to minimize complications and overall length of stay if a patient is at high risk for stridor. This scoping review will evaluate the literature and the association between the use of prophylactic steroids on mechanically ventilated adult patients and the occurrence of post-extubation stridor. Methods A literature review of eleven articles from the years 2007-2020 was conducted. The effect of prophylactic steroids on post-extubation stridor was examined. A summary of evidence table was constructed which included a total of 7,211 participants, with 3,683 being included in the intervention group and 3,428 being included in the control group. This data was used to determine whether the use of prophylactic steroids decreased the occurrence of reintubation due to laryngeal edema. Results Out of the total 7,211 participants, with 50% receiving steroids (intervention group) and 50% receiving a placebo or nothing (control group), there was a 9.8% increase in laryngeal edema, stridor, and reintubation in the control groups versus the intervention groups. This suggests that the administration of prophylactic steroids decreases the occurrence of post-extubation stridor. Implications for Nursing Practice The prophylactic administration of steroids can help decrease the incidence of reintubation due to post-extubation stridor. While the use of steroids remains a topic of controversy among healthcare professionals, the evidence supports the implementation of prophylactic steroids to decrease the risk of complications associated with prolonged intubation, laryngeal edema, and decrease the total length of ICU stay