Evidence-Based Practice - Nosocomial Infections - Essay Example

Evidence Based Practice Evidence Based Practice Problem Nosocomial infections are the main cause of deaths in hospitalized patients. The need is to evaluate various sources that could be the potential means of spreading the disease in a hospital setting. Conventionally bath basins have been used for patient bathing, which have been reported to contribute in the transmission of nosocomial pathogens. Therefore, alternatively chlorhexidine gluconate solution (CHG) has been used as an antiseptic for reducing the infections’ risk in inpatients during hospital stay. The PICOT question to address the problem is: In hospitalized patients (P) does chlorhexidine gluconate (I) as compared to using a traditional bath basin (C) decrease the risk of nosocomial infection (O) during hospital stay (T)? Significance The environmental surfaces have been reported as a potential source of contamination resulting in disease spread. Considering the importance of environmental surfaces the role of bath basins as a reservoir of pathogens is very crucial. The literature review shows that the role of bath basins in the hospitals transmission of nosocomial infections has not been studied widely. Therefore, this study is of great importance. Background Nosocomial infections are the major cause of complications in the inpatients particularly in patients admitted in the ICU. According to statistics, around 1.7 million infections and 99,000 casualties have been reported in the US due to the hospital acquired infections. The most common pathogens involved in causing nosocomial infections are Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE) and gram-negative bacteria (Thomas & Skelton, 2011). Gap The gap was found when extracting the studies that have compared the spread of nosocomial infections after using CHG or standard soap. Separate research was available only. Literature Review Study 1: Comparison of traditional and disposable bed baths in critically ill patients. Introduction: 1. The purpose of the study was clearly mentioned, that is to do a comparative study of traditional bed baths with a disposable bath for evaluating the impact on time and quality of bathing, microbial count, cost effectiveness and nurses’ satisfaction. 2. The significance of the study has been discussed as it will be helpful in identifying the potential advantages of using antiseptic (chlorhexidine) and disposable bed baths. 3. The authors have clearly formulated the study by explaining the background and purpose followed by the research outcomes and the conclusion. Problem Statement 1. The problem statement was, in bedridden patients bed baths can be a source of contamination and spread of pathogens. 2. Key research questions have not been mentioned separately. However, variables of the study have been given, including the use of gloves, patient privacy, waste handling, contamination control procedures, etc. 3. The study has the potential to present a solution to the stated problem because of the validity. Literature Review 1. The literature review followed a logical sequence to compare the study outcomes with the evidences obtained from prior work. 2. The relationship of the study to previous research was not clearly mentioned. 3. Knowledge gaps were not mentioned in the study. Theoretical Framework 1. The rationale for the study was stated briefly in the background. 2. The theoretical basis for testing the problem statement was given. However, the hypothesis statement was not separately stated. 3. The hypothesis was not stated specifically. However, the research question was tested as a hypothesis in the study. Methodology 1. The relevant variables are clearly defined in the table in the study. 2. The research design that is an interview was perfect to evaluate the research question. 3. The data collection method was clearly defined. 4. Limitations of the study could be a potential threat for the external and internal validity of the study such as cost of water consumption, sewage and heating. Sample 1. Subjects (patients) and sampling method (microbial swab test) and others have been described properly. 2. The sample size (47) was sufficient for the variables and study design. 3. No legitimate data was available indicating that rights of human subjects were protected. Instrument 1. The instrument used for data collection was a questionnaire that was appropriate for the study design. 2. The questionnaire and interview method were adequately reliable and valid. Data Analysis 1. The statistical tests used for data analysis were Mean, Fisher exact test, Wilcoxon signed rank, variance and t-test. 2. The statistical approaches used were appropriate according to the research question. Quality indicators were analyzed via Mean and Fisher exact test. Nurses’ evaluation was done by Wilcoxon signed rank and time calculation was conducted via variance. Results 1. The results for each outcome were clearly defined and presented. 2. The figures and tables explained the obtained results. 3. The results were described in the light of theoretical ground. Conclusion 1. The conclusion was based on results and was related to the hypothesis. 2. Study limitations were clearly defined that are cost of water consumption, sewage and heating. 3. Generalizations were made based on the use of disposable bed baths with in hospital settings. 4. Implications of the findings were not discussed in the study. 5. Recommendations for further studies were not given in the study. Study 2: Effectiveness of 2 Methods of Chlorhexidine Bathing. Introduction 1. The given study purpose was to study the impact of Chlorhexidine on the spread of MRSA and VRE. 2. The significance of the study has been discussed. 3. Investigators provided the sense of research strategy clearly. Problem statement 1. The problem statement was that the hospital environment acts as an ideal source of pathogen transmission specially the resistant strains. 2. Research questions and variables were clearly mentioned. 3. The study has the potential to help in a clinical setting. Literature Review 1. The literature review was critical as well as logical. 2. The study relationship with prior research was clear. 3. The necessity of the research was given, however gaps were not mentioned. Theoretical Framework 1. Rationale for the theoretical framework was given. 2. Theoretical evidences for hypothesis formulation were mentioned. 3. The hypothesis could be tested. Methodology 1. Defined variables were gender and age. 2. Research design was quasi-experimental, 2-group design. 3. Data collection method was clearly defined. 4. Threats to research validity were not identified. Sample 1. The sample size was (909), and method was elaborated. 2. The size was sufficient as per study design. 3. Adequate assurance of the rights of human subjects was not mentioned. Instruments 1. Instruments for data collection were appropriate. 2. The reliability and validity of the measurement instruments were adequate. Data analysis 1. Statistics was done via Sigma Stat 3.1 software. 2. The statistical approach used was suitable for the design. Results 3. The results were clearly presented. 4. The data clearly demonstrated the results. 5. The results were presented based on the experimental data obtained from the research. Conclusions 1. Conclusion was based on results and was related to the hypothesis. 2. Study limitations were clearly defined that are six months duration of the study, limited patients’ demographic data and no linkage of patient diagnosis with the spread of pathogens. 3. The results were generalized based on the research outcomes in oncology ward. 4. Implications of findings were briefly discussed in the study. 5. Recommendations for further studies were not stated in the study. Study 3: Patient bath basins as potential sources of infection: A multicenter sampling study. Introduction 1. The purpose of the study was to analyze the bacterial count after using chlorhexidine gluconate solution in wash basins as compared to standard soap and water. 2. The significance of the study was discussed in the introduction. 3. The authors clearly formulated the study by explaining the background and purpose followed by the research outcomes and the conclusion thus they give a perfect sense and understanding to the study. Problem Statement 1. The problem statement was clear that is patient’s bath basins are the main source of bacterial contamination. 2. The key research question was to assess the presence of bacterial contamination using CHG as compare to standard soap and water in bath basins. The identified variables were patients’ demographics, device variables and basic variables. 3. The study has the potential to present a solution for the stated problem because of its credible method and data analysis approach. Literature Review 1. The literature review followed a logical sequence to compare the study outcomes with the evidences obtained from previous researches. 2. The relationship of the study to previous research was clearly mentioned. 3. The investigators have mentioned the necessity of the study as previous researches have not covered the research question. Gaps in the literature were not identified. Theoretical Framework 1. The rationale for the study was stated briefly in the background. 2. The theoretical basis for testing the problem statement was given. However, the hypothesis statement was not separately stated. 3. The hypothesis was not stated specifically. However, the research question was tested as a hypothesis in the study. Methodology 1. Relevant variables defined in the study include infection and isolation variables, basin variables and device variables. 2. The study design used was the quantitative analysis of bacterial growth in bath basins after using CHG. The design was appropriate for the research question analysis. 3. Data collection method is clearly elaborated. 4. The study did not indicate any threats to internal or external validity. Sample 1. The subjects that are patients and sampling methods were clearly described. 2. The sample size (90) was sufficient. 3. Rights of the human subject assurance were not applicable in the study. Instrument 1. The data collection tool was Microsoft Excel spreadsheet which was used appropriately for the study. 2. The reliability and validity of the measurement instruments were adequate. Data Analysis 1. The statistical tests used were Pearson X2 test, Wilcoxon rank sum test Mintab version 15 and Fisher exact test. 2. The statistics used were appropriate. Results 1. Results were clearly presented. 2. The tables clearly demonstrated the results. 3. The results were presented based on the experimental data obtained from the research. Conclusions 1. The conclusion was based on results and was related to the hypothesis. 2. Study limitations were clearly defined that are no of sample, the specific unit and lack of the control group. 3. The results were generalized based on the research outcome in the ICU. 4. Implications of the findings were not discussed in the study. 5. Recommendations for further studies were stated in the study. Study 4: Hospital bath basins are frequently contaminated with multidrug-resistant human pathogens. Introduction 1. The purpose of the study was to investigate the frequency with which bath basins are contaminated with pathogens. 2. The significance of the study was given. 3. Investigators provided complete sense to the study. Problem Statement 1. The problem statement was that the Bath basins have been recognized as the reservoir of pathogens causing nosocomial infections. 2. The key research question was given. 3. Study outcomes can be applied in clinical settings. Literature Review 1. The literature review was logical and critically analyzed prior researches. 2. The study relationship with previous studies was clear. 3. The necessity of the present study was identified. Theoretical Framework 1. The extensive theoretical framework was missing. 2. Theoretical basis of hypothesis formulation was briefly given. 3. The hypothesis was not precisely given, however the research question was given in the form to be tested. Methodology 1. Study variables were not defined. 2. The study design was prospective, multicenter trial, which was appropriate for the study. 3. The design was appropriate for the research question. 4. Data collection method was not sufficiently described. 5. Threats to research validity were not identified. Sample 1. The sample size was (1103), and subjects defined were patients. 2. The sample size was sufficient according to the scope of the study. 3. Protection for the rights of the human subject agreement was not mentioned in the study. Instrument 1. The instrument used was appropriate as per study design. 2. The data collection instrument was reliable. Data Analysis 1. The statistical method used was Mean and was clearly presented in tables. 2. The method was appropriate. Results 1. The results were clearly presented. 2. The study clearly demonstrated the results. 3. The results were presented based on the comparison of the sample results obtained from the research. Conclusion 1. The conclusion was based on results and was related to the hypothesis. 2. Study limitations were not clearly defined. 3. The results were generalized. 4. Implications of the findings were not discussed in the study. 5. Recommendations for further studies were stated in the study. Study 5: Chlorhexidine Gluconate Bathing to reduce Methicillin-Resistant Staphylococcus aureus Acquisition. Introduction 1. The purpose of the study was to study the impact of bathing the protocol by using CHG on MRSA acquisition. 2. The significance of the study was discussed. 3. The investigators gave the sense of conducting research with evidences and literature support. Problem Statement 1. The problem statement was clearly mentioned that is MRSA is a virulent pathogen increasing the rate of morbidity and mortality in ICUs. 2. The key research question does CHG impact the MRSA acquisition in bath basins? Variables were not identified in the study. 3. The study was capable of solving the problem faced in clinical practice. Literature Review 1. The literature review was very comprehensive and followed a logical sequence to support the study. 2. The relationship of the study with previous researches was clear. 3. The necessity of the study was elaborated. Theoretical Framework 1. The rationale for the theoretical framework was given. 2. The theoretical ground of the hypothesis was clearly mentioned. 3. The hypothesis was not precisely given. However, the research question was given in the form to be tested. Methodology 1. Variables were not clearly defined. 2. The study design was pre/post intervention design which was appropriate for the study. 3. Data collection methods were given clearly. 4. Potential threats to research validity were not identified. Sample 1. Subjects and the sample size were described. 2. The sample size was not sufficient as per the study. 3. Assurance of human rights was not given. Instrument 1. Appropriate instruments for data collection were used. 2. The reliability and validity of the measurement instruments were adequate when compared with previous studies using the same tool. Data Analysis 1. The statistical software used for data analysis was OpenEpi30 software, and the values were reported in the study. 2. Appropriate statistics was used for data interpretation. Results 1. Results were clearly mentioned. 2. Tables and graphs clearly presented results. 3. The results were presented with the literature support. Conclusion 1. The conclusion was drawn based on the result linked with the hypothesis. 2. Study limitations included limited bathing protocol and difference in surveillance protocol. 3. Generalizations were made based within the scope of research. 4. Implications of findings in nursing practice were discussed. 5. Recommendations for future research were not given. Synthesis Table (Melnyk & Fineout-Overholt, 2011, p. 131) Study Author Year Number of Participants Sample Characteristics Study Design Interventions Major Findings (Johnson, Lineweaver, & Maze) 2009 90 Bath basins in which CHG was used. Quantitative Analysis Use of CHG in bath basins. Decrease↓ (Larson, Ciliberti, Chantler, Lazaro, Venturanza, & Pancholi) 2004 47 Microbial count Interview Use of Disposable bath basins. Dec↓ (Marchaim, et al.) 2012 1103 No of resistant pathogens multicentre trial N/A Inc ↑ (Padula, Pashnik, Ritz, & Simmons) 2012 Control= 454 Trial= 405 Cancer patients Controlled trial (Quasi-experiment) Use of CHG in controlling MRSA and VRE. Dec↓ (Petlin, et al.) 2014 Pre= 34,333 Post= 41,376 Bed ridden in ICU pre/post intervention Use of CHG on MRSA acquisition Dec↓ References Johnson, D., Lineweaver, L., & Maze, L. (2009). Patient bath basins as potential sources of infection: A multicenter sampling study. American Journal of Critical Care, 18(1), 31-38. Larson, E., Ciliberti, T., Chantler, C. A., Lazaro, E., Venturanza, M., & Pancholi, P. (2004). Comparison of traditional and disposable bed baths in critically ill patients. American Journal of Critical Care, 13(3), 235-241. Marchaim, D., Taylor, A., Hayakawa, K., Bheemreddy, S., Sunkara, B., Moshos, J., et al. (2012). Hospital bath basins are frequently contaminated with multidrug-resistant. American Journal of Infection Control, 40(1), 562-564. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. New York: Lippincott Williams & Wilkins. Padula, C., Pashnik, B., Ritz, J., & Simmons, K. (2012). Effectiveness of 2 Methods of Chlorhexidine Bathing. Journal of Nursing Care Quality, 27(2), 171-175. Petlin, A., Schallom, M., Prentice, D., Sona, C., Mantia, P., McMullen, K., et al. (2014). Chlorhexidine Gluconate Bathing to reduce Methicillin-Resistant Staphylococcus aureus Acquisition. Critical Care Nurse, 34(5), 17-25. Thomas, K., & Skelton, L. (2011). Environmental Testing of Patient Bath Basins Drive Quality Improvement Efforts for Preventing Bacterial Cross Contamination. American Journal of Infection Control, 39(5), 112-113. Read More