Introduction, Analysis of Existing Evidence, and Quality Improvement Process
Hemodialysis patients are at high risks of infection due to their impaired immune defenses and repetitive access of the bloodstream via vascular access types. The treatment process of hemodialysis involves using different processes and equipment that sometimes worsen the patients’ conditions. For example, frequent antibiotics administration to these patients generates antimicrobial resistance and multidrug-resistant organisms. Central venous catheters (CVCs) are among the most commonly used vascular access types. While the use of CVCs is geared toward enhancing the health and wellbeing of hemodialysis patients, they enhance the risk of hospital-acquired infections. This paper provides a brief overview of the practice problem, analyzes existing evidence on this issue, and describes the quality improvement process and the Quality model that will be used to address this practice problem.

Practice Problem

The lifeline for patients suffering from long-term hemodialysis is a well-functioning vascular access. This is primarily because hemodialysis patients are at significantly high risk of developing vascular access-related blood stream infections (VRBSI) that could generate severe complications. According to Thompson et al. (2017), infection is regarded as the second leading cause of death among hemodialysis patients and the leading cause of hospitalization. Similarly, Nguyen et al. (2017) states that infections in hemodialysis patients increase hospitalization, mortality, need for antimicrobials, and healthcare costs. Nguyen et al. (2017) further states that hemodialysis patients are at high risks of infections due to their impaired immune defenses and repetitive access of the bloodstream using vascular access sites and types like central venous catheters (CVCs). Over the past 25 years, numerous efforts have been undertaken to lessen the number of bloodstream infections cause by the use of CVCs in hemodialysis and end-stage renal disease patients. These efforts have proven relatively ineffective since the use of CVCs for hemodialysis patients continues to be a major contributor of high bloodstream infection rates, increased healthcare costs, mortality, and morbidity (Hymes et al., 2017). Even though CVCs remain unavoidable for hemodialysis patients in need of immediate dialysis access, they continue to have undesirable side effects with regards to increasing infections. The undesirable side effects of CVCs contributes to a major practice problem in hemodialysis care settings.

Analysis of Existing Evidence

CVC infections have attracted considerable attention in existing literature since they are undesirable side effects of using central venous catheters in providing care to hemodialysis patients. Existing literature have examined various aspects...…effective in lessening CVC infections among hemodialysis patients in comparison to adhesive dry gauge dressing. Therefore, existing evidence-based practice suggests that CVC infections among hemodialysis patients can be significantly reduced through the use of chlorhexidine-impregnated transparent dressings as part of CVC maintenance.

Quality Improvement Process and the Quality Model

The proposed quality improvement process for this project is promoting CVC maintenance care through chlorhexidine-impregnated transparent dressings (CHG-transparent dressing). In this regard, CHG-transparent dressing will be introduced in the hemodialysis unit as part of clinical practice on the use of CVCs for hemodialysis patients. This process will entail conducting clinician education and training on CHG-transparent dressing for CVC maintenance. The training will help enhance clinicians’ knowledge on this change in practice in order to enhance hemodialysis patient experiences and general wellbeing. To help in effective implementation of this quality improvement plan, the quality model that will be utilized is Plan-Do-Study-Act Cycle. The model will be utilized since it will allow for testing of the proposed change in clinical practice prior to full implementation. Once the change has been developed, a plan for testing it will be developed and carried out before its consequences are observed and modifications made prior to full implementation.…