EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

Introduction

  • This presentation will discuss:
  • A clinical issue of interest- CLABSI
  • Developing my PICOT question
  • Research Databases used
  • Peer-reviewed articles
  • Strengths of Systematic Reviews

The following presentation will discuss a clinical issue of interest that I have identified. I will describe how I developed my PICOT question. In addition, I will state the databases I used to conduct my search for the peer-reviewed articles and list the articles used.  Besides, I will describe the level of evidence for each article and explain the strengths of using systematic reviews for clinical research.

 

Clinical Issue of Interest

 

  • Clinical issue- Central line bloodstream infection
  • A lab-confirmed bloodstream infection
  • It affects patients with central line catheters
  • CDC estimate about 41,000 CLABSI annually
  • Contributes to: prolonged hospital stays
  • High patient care costs & mortality
  • Prevention: Aseptic techniques, surveillance, & management

 

Central line bloodstream infection (CLABSI) is my chosen clinical issue of interest. It is a laboratory-confirmed bloodstream infection not associated with an infection at another site, which occurs within 48 hours of a central line placement (Bell & O’Grady, 2017). CLABSI affects hospitalized patients with central line catheters. It occurs when microorganisms enter a patient’s central line and then into their bloodstream.

CLASI is an issue of interest since the CDC estimates that about 41,000 bloodstream infections are caused by contaminated central lines in U.S. hospitals annually (Bell & O’Grady, 2017). Besides, it contributed to prolonged hospital stays and increased patient care costs and mortality. Nevertheless, most CLABSI cases can be prevented through appropriate aseptic techniques, surveillance, and management interventions (Bell & O’Grady, 2017). The CDC and Infectious Diseases Society of America (IDSA) have developed CLABSI prevention guidelines during central line insertion and maintenance.

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PICO

In hospitalized patients with central lines, does daily chlorhexidine baths compared with daily bath with regular soap and water decrease the incidence of CLABSI infections during the hospital stay?

 

Developing the PICO Question

  • Identified population of interest- patients with central line
  • Researched for an EBI from peer-reviewed articles
  • Intervention- use of daily chlorhexidine baths
  • Comparison intervention- bath with regular soap and water
  • Indentified outcome- decreasing CLABSI infections

 

Research Databases

I used several research databases to search peer-reviewed articles on interventions effective in addressing CLABSI among hospitalized patients. The databases include:

PubMed, MEDLINE, Cochrane Library, and CINAHL Plus.

Peer-Reviewed Articles

Musuuza, J. S., Guru, P. K., O’Horo, J. C., Bongiorno, C. M., Korobkin, M. A., Gangnon, R. E., & Safdar, N. (2019). The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC infectious diseases19(1), 1-10. https://doi.org/10.1186/s12879-019-4002-7

Reyes, D. C. V., Bloomer, M., & Morphet, J. (2017). Prevention of central venous line-associated bloodstream infections in adult intensive care units: a systematic review. Intensive and Critical Care Nursing43, 12-22. https://doi.org/10.1016/j.iccn.2017.05.006

Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., … & 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), 1-16.  https://doi.org/10.1186/s13012-021-01112-4

Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M. R., Schüpbach, R., Falk, C., … & Schreiber, P. W. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007

Levels of Evidence

  • Musuuza et al. (2019)- Level I evidence
  • Reyes et al. (2017)- Level I evidence
  • Reynolds et al. (2021)- Level II evidence
  • Scheier et al. (2021)- Level III evidence

 

Musuuza et al. (2019) is a level I evidence article. It employs a systematic review and meta-analysis of randomized controlled trials, cluster-randomized trials, and quasi-experimental studies.

Reyes et al. (2017) is a level I evidence. It conducted a systematic review of Randomized controlled trials and observational studies.

Reynolds et al. (2021) is a level II evidence article since it uses evidence from a stepped wedge cluster randomized trial.

Scheier et al. (2021) is a level III evidence article since it uses evidence obtained from well-designed controlled trials but without randomization.

 

Strengths of Using Systematic Reviews for Clinical Research

  • Minimizes bias- reliable & accurate conclusions
  • Information is easier for the reader to understand
  • Produce reliable estimates on interventions’ impact
  • Disclose where knowledge is lacking
  • Save time for research discoveries & implementation
  • Increase generalizability & consistency of outcomes

Systematic reviews concentrate on a specific clinical question and carry out an extensive literature search to discover studies with sound methodology (Møller et al., 2018).

Advantages of using systematic reviews in clinical research include:

  1. The method employed to find and select the studies minimizes bias and thus highly likely to lead to reliable and accurate conclusions (Møller et al., 2018).
  2. Systematic reviews sum up findings from multiple studies, making the information easier for the reader to understand.
  3. They abide by a strict scientific design founded on explicit, pre-specified, and reproducible methods. Consequently, they produce reliable estimates about the impact of interventions to make defensible conclusions (Møller et al., 2018).
  4. They disclose where knowledge is lacking, which guides future clinical research.
  5. They save time used in research discoveries and implementation (Møller et al., 2018).
  6. Systematic reviews also increase the generalizability and consistency of outcomes.

References

Bell, T., & O’Grady, N. P. (2017). Prevention of Central Line-Associated Bloodstream Infections. Infectious disease clinics of North America31(3), 551–559. https://doi.org/10.1016/j.idc.2017.05.007

Møller, M. H., Ioannidis, J. P., & Darmon, M. (2018). Are systematic reviews and meta-analyses still useful research? We are not sure. Intensive Care Medicine44(4), 518-520. https://doi.org/10.1007/s00134-017-5039-y

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