Assignment: Evidence Based Project, Part 3: Critical Appraisal of Research
Full APA formatted citation of selected article.Evidence Based Project,
Part 3: Critical Appraisal of Research Article #1 Article #2 Article #3 Article #4
Afonso, E., Blot, K., & Blot, S. (2016). Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: A systematic review and meta-analysis of randomised crossover trials. Eurosurveillance, 21(46). https://doi.org/10.2807/1560-7917.es.2016.21.46.30400
Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M., Schüpbach, R., Falk, C., Sax, H., Kuster, S., & Schreiber, P. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007 Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (Changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4 Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. https://doi.org/10.1371/journal.pone.0180473
Evidence Level *
(I, II, or III) III I I II
Conceptual Framework
Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**
The conceptual framework not indicated
No conceptual or theoretical framework indicated. No theoretical framework defined No theoretical framework defined.
Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).
The study involved a systematic review and meta-analysis conducted in conformity to the PRISMA and MOOSE guidelines. Sources from the various databases including MEDLINE, CINAHL, EMBASE, Scopus and Cochrane were involved. Only studies that involved randomized trials, and quasi experiment on the effect of CHG bathing versus non-CHG bathing in preventing CLABSI among the adult populations were included. The study involved a non-randomized clinical trial. The study focused on the patients admitted in the ICU in the University Hospital Zurich. The study involved a wedged cluster-randomized design conducted in four sequences. The study involved cross-sectional survey.
Sample/Setting
The number and characteristics of patients, attrition rate, etc.
Data were obtained from reputable journal sources and covered studies conducted in clinical setting.Evidence Based Project, Part 3: Critical Appraisal of Research
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The study was conducted in an ICU setting. The study was conducted in the university hospital setting. The study was conducted in healthcare setting
Major Variables Studied
List and define dependent and independent variables
The dependent variable was CHG baths while the independent variable was the risk of CLABSI.
The predictor variable included the daily chlorhexidine bathing in ICU and while the outcome variable was risk of CLABSI. The dependent variable was CHG bathing while the independent variable was CLABSI rates. The dependent variable was knowledge, attitude and practice among nurses while the outcome variable was CLABSI rates.
Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done).
The DerSimonian average intervention was used in estimating the average intervention effect. The logistic regression model was used in estimating the relationship between the dependent (predictor) and the outcome variable. The statistics conducted included multivariable regression analysis, odd ratio, and descriptive statistics. The primary statistics used included descriptive statistics and linear regression model. Chis-square and t-test were used.
Data Analysis Statistical or
Qualitative findings
(You need to enter the actual numbers determined by the statistical tests or qualitative data).
The data analysis was quantitative based. The risk for CLABSI infections reduced the incidence of CLABSI by about 40%. The effect of the CHG bath was significant (0.67, 95% CI: 0.53–0.85).
Evidence Based Project, Part 3: Critical Appraisal of Research The study was quantitative based. Multivariate analysis indicated that the intervention was significant (OR 0.47, 95% CI 0.26e0.84, P¼0.011). The study findings indicated that the number of healthcare providers correctly identifying facts about CHG bathing increased, from 31.11 to 50.0% (χ2 = 9.32, p = .002). Majority of nurses, with frequencies ranging from 70.7% to 90.1% were aware of the CLABSI prevention guidelines. Nursing workshops and courses (67.3%) was the main source of information CLABSIs prevention, followed by guidelines (42.7%), and internet (30.7%).
Findings and Recommendations
General findings and recommendations of the research
CHG bathing can help in reducing the risks of CLABSI among the patients admitted in hospitals. CHG bathing can help reduce the risk of CLABSI in the ICU unit. Educating the healthcare providers on the CHG bathing improves its implementation and reduce the risk for CLABSI. Improved knowledge on CLABSI prevention helps in enhancing adherence to infection prevention protocols.
Appraisal and Study Quality
Describe the general worth of this research to practice.
What are the strengths and limitations of study?
What are the risks associated with implementation of the suggested practices or processes detailed in the research?
What is the feasibility of use in your practice?
The study involved a large sample population and the data covered were appropriate. On the other hand, the main weakness is that the study was based on adult populations alone and so cannot be inferred to children.Evidence Based Project, Part 3: Critical Appraisal of Research
However, the findings from the study can be used in reducing CLABSI among the adults.
The study’s setting was appropriate and could provide reliable answers to the research question. On the other hand, the weakness of the study was monocentric and did not monitor the intervention and this could bias the findings. However, the results from the study are feasible. The study recruited adequate sample population. On the other hand, the weakness was that the CHG bathing processes were not standardized and this could affect the outcome recorded.
The findings from the study are feasible for clinical practice.
The study covered various aspects influencing CLABSI prevention measures. The statistical tests were appropriate. On the other hand, the main weakness was lack of standard method for measuring attitude and level of knowledge.
The findings from the study are feasible and can be used for clinical practice.
Key findings
CHG bathing reduces the risk for CLABI. CHG bathing reduces the CLABSI. There is a need to educate ICU nursing on CHG bathing protocols. There is need to increase education programs on reducing CLABSI.
Outcomes
Reduced CLABSI
Evidence Based Project, Part 3: Critical Appraisal of Research
Reduced cases of CLABSI among the ICU patients. Increased awareness on CHG bathing Increased knowledge on CLABSI prevention.
General Notes/Comments Healthcare institution should implement the CHG baths among other interventions to reduce CLABSI.
The use of CHG bath can be used to reduce the risks for CLABSI among patients in ICU. Healthcare institutions should have standard guidelines for CHG bathing. Educating the nurses on CLABSI prevention measures allows them to implement to protocols accordingly.
Evidence-Based Project, Part 3: Critical Appraisal of Research
Critical Appraisal of Research
The studies reviewed explored the best practices that can be used to reduce the incidences of CLABSI among the patients in ICU. Nosocomial infections are common among the patients on catheters and those on central lines. Furthermore, the studies indicate that the risk of CLABSI increases with the prolonged hospital stay (Afonso et al., 2016). The healthcare providers have the responsibility to ensure that they engage the right interventions and only discharge the patients when they are ready. As a result, there is need to monitor and ensure safe practices and reduce the risk of the patients contracting CLABSI. The use of CHG bathing has been proven effective in reducing the risks for CLABSI (Reynolds et al., 2021). However, variations in the protocols for the CHG bathing procedure among the healthcare institutions remain a major concern. Therefore, there is need for standardizing the procedures and creating awareness so that all the nurses are aware of what they should do as they interact with the patients.Evidence-Based Project, Part 3: Critical Appraisal of Research
The study by Esposito et al. (2017) indicated a gap in the knowledge and practice of the CHG prevention measures by the nurses in the ICU units. Also, the study indicates variations in the attitudes of the nurses and this affects the level of its implementation in the healthcare settings. Therefore, there is a need to create awareness and let the nurses understand the importance and the procedures involved in the CHG bathing as part of preventing the CLABSI. Besides, there should be guidelines published and that are readily available to ensure standardized safety protocols in the ICU units. The burden of CLABSI is high and this needs that adequate and prompt interventions must be developed to curb the health menace. The guidelines should be made available to all inpatient units. Thirdly, there is a need to conduct regular trainings on the CLABSI prevention measures to ensure that all the nurses have updated information on how to respond to the CLABSI.Evidence Based Project, Part 3: Critical Appraisal of Research
Finally, there is enough evidence from the analysis that CHG bathing can reduce CLABSI. Though, future studies should be conducted to explore other alternative methods that can be used alongside the intervention especially among children. In addition, having a standard protocol for CHG bathing will means that all people will be aware of what they should do to prevent CLABSI.
Evidence Based Project, Part 3: Critical Appraisal of Research
Afonso, E., Blot, K., & Blot, S. (2016). Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: A systematic review and meta-analysis of randomised crossover trials. Eurosurveillance, 21(46). https://doi.org/10.2807/1560-7917.es.2016.21.46.30400
Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. https://doi.org/10.1371/journal.pone.0180473
Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence based nursing practices for prevention of central line associated bloodstream infections study (Changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4
Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M., Schüpbach, R., Falk, C., Sax, H., Kuster, S., & Schreiber, P. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007
Evidence Based Project, Part 3: Critical Appraisal of Research
Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.