HIV Stigma and CLABSI Prevention

Quantitative  Research Journal Article


As an introductory note, Katreena Collette Merill, Sharon Summer, Lorraine Linford, Carrie Taylor and Christopher Macintosh in their article, Impact of Universal Disinfectant Cap Implementation on Central line-Associated Bloodstream Infections claim that the seriousness and health implications of CLABSIs in the US are worrying.  According to them, close to half a million blood infection incidents are reported yearly in the US. The economic and social costs of these diseases, they claim, increase in patient mortality and morbidity, health care costs and length of stay. CLASBI is also associated with the failure of hemodialysis catheters. As they note, minimization of infection caused by intravenous access points is one of the central line bundle aspects. However, the problem is that a good number of the intravenous IV is made up of needleless connectors used for delivering medication and drawing blood.  This results in increased possibility of the needleless connectors being contaminated each time a nurse accesses them. This subsequently increases the chances of infection to the patients. Nevertheless, in spite of the severity of CLABSI, it is possible to prevent such infections through the use of needless disinfectant connectors which help in disinfecting the intravenous access points.

Review of the Literature

The researchers have based their finding and conclusions on the variant literature review and recommendations by the Centers for Disease Control and Prevention (CDC).  They have reviewed the relevant literature materials on the issue of CLABSI infections in hospitals, the costs and suggested solutions. Most of the research material relied upon by these authors are up to date and recent hence giving them more relevance and reliability. Their findings and conclusions are consistent with several kinds of literature on the topic that suggests that CLABSI infections have substantial economic and social costs on hospitals and the healthcare system.  These previous studies suggest that one of the best measures of preventing CLABSI following a central venous catheter insertion is to disinfect the injection ports, needleless connectors, and hubs.  This is based on the fact that the available literature shows that the main cause of CLABSI is the catheter hub or tube contaminations which arise from non-sterile access to these connectors.  However, the manner in which these authors have reviewed the literature on this topic may be criticized on the basis that it fails to include studies that have questioned the efficacy of disinfection as a way of reducing preventing CLABSI.  For instance, for comparative analysis, this article fails to demonstrate findings of other studies that might have shown different effects of disinfection as a way of reducing CLABSI.

Discussion of Methodology

The researchers carried out the study at a trauma care hospital using disinfectant caps filled with alcohol. The type of the disinfectant cap applied was the Curos Disinfecting Port Protector which is a device containing an equal percentage of isopropyl alcohol. The hospital staff was first trained on the operation of the device and then a follow-up was done.  They placed the disinfectant cap on the available IV needleless connectors and closely monitored the compliance to the disinfection on a weekly basis. The scope of CLABSI was also clearly defined. Moreover, the authors reviewed all the study hospital’s positive blood cultures to ascertain whether they fell under the CLABSI definition. They then calculate the CLABSI rate for every a thousand central line catheter days. These rates and the related costs of CLABSI were the compared for 12 months both before and after the intervention.

Data Analysis

The researchers conducted the data analysis using the IBM SPSS version 22.0. They also applied the generalized linear model for determining the variations in CLABSI rates after the disinfectant cap was implemented.

Researcher is Conclusion

From the study, the researchers concluded that despite being a severe healthcare-acquired infection, CLABSI might be prevented through the proper use of disinfection caps on the needleless connectors used by nurses to deliver treatment to the patient or to carry our blood transfusion. Their finding was that implementation of disinfectant cap leads to a reduction in patient mortality, the length of sat, CLABSI rates and costs of treating such infections. Also, based on the high compliance rates with the disinfection technique, it is possible to apply this improvement model in other infection prevention strategies. However, critically, though these researchers’ findings would support such conclusions independent of a consideration of other studies that might have made different findings. It is not possible, using the evidence available to these researchers, for them to come to sweeping generalizations and conclusion without considering findings in other similar studies that contradict theirs.


The evidence presented by these authors does not entirely support their conclusions for various reasons. Firstly, apart from the use of disinfectants, there are also other more effective techniques and devices for preventing hospital-acquired infections. For instance, they have failed to consider strategies like maintenance practices.  Further, they did not mention outcomes and effects of hospital-acquired infections such as increased costs and length of stay. Nevertheless, these researchers’ work is important for informing the future exploration of CLABSI prevention strategies.

Human Subjects Protection and Cultural Considerations

The protection human participants when conducting such a study involving humans is a necessary aspect of research ethics. Some of the key areas of human subjects that need to be considered in such research include minimization of risks, hospital staff training, expression of conflicts of interest and privacy and confidentiality of the participants. Moreover, such functions that make up the protection of human subjects include informed consent of participants, adequate monitoring, fair subject selection criteria and reasonable benefit-risk ratio.  In the present research article, there is no much evidence of human subject protection measures put in place by the researchers. The authors only report having carried out staff training on the application of the disinfectant cap device. Additionally, the researchers provided a monitoring system for ensuring compliance with the disinfection procedure among hospital staff nurses.  However, there is no evidence of human subject protection in the form of a statement on the expression of conflict of interest in the research or its outcomes, measures to reduce the risk of infection among participants and protection of the human subjects’ privacy and confidentiality. There is also a lack of indication of the steps that were put in place by the researchers to ensure that the participant selection process was fair enough.

At the same, it is very crucial for researchers in any medical field such as nursing to take into account cultural considerations. Culture refers to the totality of values, beliefs, practices and norms that define a particular group of people or community. Therefore, when carrying out research with humans as the primary participants or subjects, it is advisable to have regard to their cultural values and principles. The methods and designs used in process of research should, therefore, be culturally sensitive and not offensive to the values of the participants or invasive of their privacy and confidentiality. For example, in the research on HIV infection or even CLABSI prevention, it may be that certain methods are offensive to the given cultural group hence its use must be  restricted. The research experiment by Merrill, Sumner, Linford, Taylor and Macintosh (2014) does not contain any evidence of cultural consideration having been taken into account.

Strengths and Weaknesses

One of the primary benefits of this the study by these researchers is that through it, they have adequately noted the costs associated with central line-associated bloodstream infections (CLABSI)  and the implications of this to the quality and cost of healthcare delivery. The other strength of the study is that it points out the severity of the problem of hospital-acquired infections in the United States and hence the need to do something about it. Furthermore, this study shows that in spite of the seriousness of the CLABSIs, it is possible to prevent them through the use of disinfection which is a much more efficient and less expensive way of reducing infections. Also, the research demonstrates precisely how the disinfection prevention method helps in reducing potential infections that patients may acquire when in the hospital facilities. The fact that the researchers have noted both the improved patient outcomes and reduced hospital operation costs as being some of the benefits of this prevention methodology also gives this study validity and reliability.

The research also has certain notable limitations. Firstly, the fact that the staff training and education on the use of the disinfectants were simultaneously executed which might have had impacts on the rates of CLABSI.  Also, the survey did not include a measurement of the likely rise in the level of central line bundle vigilance. Moreover, the researchers based their costs estimates on projections based on the previous studies. These may therefore not be reflective of the real costs as they should have been.  Additionally, it has a weakness in that it the researchers have not addressed other possible findings that may be contrary to the results of this study. Furthermore, since the experiment was restricted to patients in the trauma hospital, and excluded those in labor, surgical, ambulatory care and emergency hospital units.

Influence on Nursing Practice

The findings of this survey have several implications for healthcare and nursing practice.  To begin with, the results of this research reflect the possibility of infections occurring in the health care context and hence the need for precautions among nurses. It also influences nursing practice in that it informs the adoption of methods by hospitals that will reduce the growing number of health care-related infections.  Moreover, this experiment informs nursing practice by pointing out the potential cost reductions that may be realized when disinfectant devices are used by nurses. For, according to these researchers’ findings, central line-associated bloodstream infections and the consequential impacts like mortality and morbidity can be substantially reduced with the application of disinfectants. The research also reports nursing practice by influencing safe healthcare practices among nurses to improve the quality of healthcare. Hence, the results may be applied by policy makers and administrators in the nursing field to introduce such disinfection devices to reduce the high rates of CLABSI in our hospitals.

Evaluation of a Primary Qualitative Research Article


According to Anne Wagner, Kelly McShane, Trevor Hart and Margolese in their article titled A Focus Group Qualitative Study of HIV Stigma in the Canadian Healthcare System; HIV-related stigma is a perpetual public health problem both in Canada and globally. They refer to it as being a distressing, sophisticated and ubiquitous issue in the healthcare system. It has adverse and pervasive effects on the sexual, physical and mental health of those who live with the HIV.  They argue that the stigma against people infected with the virus in Canada has not received serious consideration regarding its extent, and impacts on the health care system in previous studies. These authors contend that one of the consequences of HIV stigma is that it has an adverse impact on the way HIV patients engage with healthcare and health professionals. It also undermines the quality of life of people living with the virus. They also claim that there is recent evidence that there is a perception or feeling among Canadian women suffering from AIDS that the healthcare providers are stigmatizing them when they seek pregnancy nursing care. They have also cited studies by Mill, Edwards, Jackson, MacLean and Chaw-Kant (2010) where it is claimed that stigma is not used as a means of socially controlling those living with the deadly virus. Also, the stigma in the context of the healthcare system has the potential of increasing the power dynamics that exist between healthcare providers and patients. Sexual status and orientations have also served to intensify the possibility of patients living with HIV being discriminated upon or stigmatized based on their medical condition. Their study was thus aimed at arriving at a qualitative and critical understanding the beliefs, attitudes, and perceptions those healthcare providers has about patients infected with the HIV.

Review of the Literature

The researchers have referred to several literature materials on the subject of HIV stigma against people living with HIV. This literature review includes previous studies that have examined the effects that HIV stigma has on the quality of life, and the institutional or structural policies governing prevention efforts. It has also covered studies by Brown, Trujillo, and Macintyre on how this stigma affects the effectiveness of efforts being put in place to prevent the spread of HIV among the population. Moreover, their literature review covers effects of stigma on the ability of people living with the virus to freely express their status or find social support when they are faced with ill health and distress. This study also involved the examination of the HIV-related stigma in the critical framework. Here, the researchers recognize how important it is for experiments on HIV stigma to consider issues such as social injustice and power dynamics that exist in the society and health care system. This, they note, is because the topic of HIV stigma and individual researchers are value-laden. Hence, through such a critical framework of HIV stigma, it is necessary to bring out the complexity of the issue and for stakeholders to recognize the historical and societal factors that inform various beliefs, values, stereotypes and attitudes about people living with the virus. Moreover, their research also examined literature materials on the views that health care providers have towards their HIV patients and how this affects the quality of health care they provide to them. However, critically, these researchers have not explored studies that focus on the costs associated with the stigma against people living with HIV in Canada. The study does not also examine the statistical data and information on the effects that HIV stigma has had on the quality of life, mortality rates, healthcare standards and costs in the Canadian context. This would have made their study more convincing and worth consideration by policy makers in the health care system.

Methodology Discussion

The researchers have used the critical psychology method to critically analyze the beliefs and attitudes that the Canadian healthcare providers have towards HIV patients seeking their assistance. According to them, this crucial approach to such issues as HIV stigma recognizes the fact that this is a value-based issue and that it is the only way to challenge the status quo on the problem of stigma. They argue that a researcher on such an issue cannot afford to take a value-free or neutral approach since this would be underestimating and to ignore the underlying socio-cultural factors and biases that may influence research and also affect the type of conclusions reached.

They have also employed the use of focus groups to help in determining the various elements and constructions of the HIV stigma-related issues like social prejudice, stereotyping and discrimination. The use of these focus groups, they note, is to assists in eliciting a variety of viewpoints and also essential for different comprehension of the issue under examination. To this extent, the researchers used women and men living with HIV, health care providers, and nursing and medical students as sources of information upon which the findings and conclusions of the study were based. Through these methodologies, they examined the various HIV experiences between different participants. They audio-taped the participants while asking them open-ended questions that examined their thoughts and attitudes towards people living with HIV. Some of the elements of the stigma that were considered included stereotypes, institutional factors, prejudice and discrimination of those infected with the virus.

Data Analysis

To analyze the data collected, these researchers made use of the crystallization or immersion approach which provided them a critical lens with which to test the validity of the results. From a critical point of view, while the data analysis method used by these researchers is merited, they should have also made use of a comparative method of analysis which would help indicate the disparities that exist on HIV stigma in Canada.

Researcher is Conclusion

The researchers have made several important observations as their findings concerning the results of the study. Firstly, they concluded that there is a combination of factors such as stereotypes, discrimination, social prejudice and institutional factors that help in spreading the current stigma against HIV aids patients in Canada. Secondly, they conclude that there is a need for promotion of positive attitudes and attributes among healthcare providers like being open, fair and nonjudgmental about HIV patients. This, they argue, will assist in reducing some of the negative perceptions that people have about HIV victims and instead encourage positive interactions between the health care providers and patients suffering from the virus. They also concluded that following reports from the focus groups about overt historical discriminations and stigmatization because of their HIV status, the issue of stigma against HIV patients in the Canadian society is a serious one that needs urgent intervention. Though there is interplay among the factors that contribute to HIV patient stigmatization, institutional factors and the structure of the healthcare system are primarily responsible for the ongoing stigma against people living with HIV infection. Lastly, they concluded by noting the continuing existence of HIV stigma in the Canadian health care system as health care providers hold various cognitions, behaviors, beliefs and attitudes towards infected patients.


While the evidence provided by these researchers is significant in understanding the effects of HIV stigma on the Canadian health care system and the society, their study fails in many respects to supporting the conclusions. To begin with, given the small population sample and the inclusion of medical students and nurses in the study, it is not possible to safely conclude that certain beliefs and attitudes influence stigma. Moreover, though their research was carried out with the participation of the community members, the evidence may not be sufficient to support the conclusive finding that most women with HIV face stigma in hospitals during pregnancy. Nonetheless, the evidence from their study’s findings helps in appreciating the severity of stigma and its adverse impacts on HIV infection prevention efforts.

The Protection of Human Subjects and Cultural Considerations

Being a research study that involves human subject and likely to raise issues of privacy and confidentiality concerning information supplied by participants to the researchers, it is more than necessary for measures to be taken to protect human subjects. This is an important aspect of research ethics. Examples of these actions include protection against risks of participation, procedures for protecting privacy and maintaining confidence, and maximization of benefits to participants. Further, for vulnerable populations such as pregnant women, minorities, students and the elderly, there is a need for special protection to ensure that their rights to consent and privacy are upheld throughout the research process. Generally, it is important as a way of protecting human subjects in research involving humans, to inform the participants of the newly developed findings which will enable them to make a free decision on whether to continue participation or not. Moreover, they note the significance of advising the participants of the confidentiality limits and assure them that no list will be maintained against those who have expressed no interest in the study. Also, the recording of data from studies based on the medical records of participants should be minimized and also put in place procedures for disclosure of information to third parties. There is no evidence of any measures put in place by these researchers to ensure the protection of human subjects. The participants were not informed of their rights about the confidential and private information they supplied to the researchers.

Strengths and Weaknesses of Study

As noted by the authors, one of the outstanding strengths of their study was the involvement of and consultation with members of the local community where the study took place. According to them, the participation of the community in the research process-study- development and implementation of the survey- helps in addressing some of the needs and concerns raised about the topic. Also, the other strength of this work is that the design used by the researchers was based on and drew mostly from the existing literature information and concepts about HIV stigma hence making it possible to adduce enough evidence to support the findings. Furthermore, the inclusion of unique focus groups in the study made it possible for the researchers to look at the issue of HIV stigma from a variety of perspectives and also conceptualize it using different points of view of those who took part in the study.

However, some of the shortcomings of this study are that they used the study population sample or the number of participants was so small that it restricted the accurate drawing of conclusions. Moreover, the reliability of the study’s findings may have been compromised by the possibility that some of the participants shared not their experiences about HIV stigma but rather their expectations. Additionally, the use of healthcare providers as participants was inappropriate since it was possible for them to give inaccurate responses so as not to reveal their prejudices against people living with HIV.

How the Evidence Informs Nursing Practice

The evidence from this study is important in informing nursing practice in that it helps us appreciate the range of beliefs, stereotypes, and attitudes that health care providers have towards people living with HIV. This revelation is a necessary starting point in coming up with measures and policies that will help create and promote a culture and environment of acceptance, tolerance, and respect for the status of patients by nurses in healthcare facilities. Further to this, the findings of this study affirm the urgent need for nurses to change their attitudes towards these people so as to contribute to the HIV stigma prevention efforts. They need to be beacons of hope, not despair, to patients living with this virus.


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