Evidence-Based Clinical Question Search Assignment

Instructions: Enter total points possible in cell C12, under the rubric. Next enter scores (between 0 and 4) into yellow cells only in column Evidence-Based Clinical Question Sear Unsatisfacotry Satisfactory 1 2 Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Length Less than 7 pages 8 pages Format/Style Did not follow APA format Major errors with APA formatting Identify your refined PICOT question. Using PubMed and the Cochrane collaboration database, do a systematic review of your clinical question. Describe your systematic review and include an errors analysis. Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial. Summarize the case study selected. Describe the study approach, sample size, and population studied. Apply the evidence from this review to your practice specifically in your overview. Evaluate the outcomes, identifying the validity and reliability. Discuss if the study contained any bias. Determine the level of evidence identified in the review. 250 Total available points = Rubric Score Grade points Low High Low 3.5 4.0 225 2.5 3.49 200 1.7 2.49 175 1.0 1.69 150 0.0 Comments: 1.00 0 etween 0 and 4) into yellow cells only in column F. d Clinical Question Search Average Excellent 3 4 N/A Score Weight Final Score Complete 0 5% 0.00 N/A Complete 0 10% 0.00 N/A Complete 0 10% 0.00 N/A Complete 0 10% 0.00 N/A Complete 0 5% 0.00 N/A Complete 0 5% 0.00 N/A Complete 0 10% 0.00 N/A Complete 0 10% 0.00 N/A Complete 0 10% 0.00 N/A Complete 0 10% 0.00 9 pages 10 pages 0 5% 0.00 Text, title page, and references page follow APA guidelines . Minor references and grammar errors Text, title page and references page follow APA guidelines. No grammar, word usage or punctuation errors. Overall style is consistent with professional work. 0 10% 0.00 100% 0.00 Final Score Percentage 4 Grade points Percentage High Low 250 90% 100% 225 80% 89.99% 200 70% 79.99% 175 60% 69.99% High 0 0.00% 150 0 59.99% Running Head: PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS PICOT Question Central Line-Associated Infections Courtney Pribonic Kaplan University 3/5/2017 1 PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 2 Introduction Patients hospitalized in intensive care units (ICU) sometimes suffer from central lineassociated infections (CLAI). These illnesses are mostly caused by microorganisms which act on the central venous catheters. As a way of eliminating this adverse effect, evidence based care has implemented various intervention techniques most of which are grouped as a bundle that comprises of various individual activities. This paper seeks to identify a suitable evidence-based care intervention for preventing CLAI among adult patients hospitalized in ICUs. PICOT Question In formulating and developing this research, a systematic review was mainly done on Cochrane database on studies tackling care and maintenance of the CVC published between 2010 and 2017, Scopus, PubMed, and the web of science. This was founded on the PICOT strategy question; “What are the best CLAI-related preventive and intervention measures implemented in adult patients who are hospitalized in an ICU?” The outcomes of the research after analysis presented bundles which included elements such as maximal barrier precautions and hand hygiene. Essentially, these were in the form of multidimensional strategies and programs such as impregnated bandages and catheters as well as the commitment of the staff to keeping facilities infection free (JC et. al., 2011). Treatment of critically ill patients depends on the Central Venous Catheters (CVC) by a significant percentage. For instance, in intensive care units, techniques such as the use of invasive devices and diagnostic procedures are utilized to trigger particular patient PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 3 complications like the health associated infections (HAI). However, there is a significant challenge in the ICU regarding prevention and control of nosocomial infections as a result of microorganisms (Blot, et.al, 2014). Evidence-Based Clinical Question Search Assignment

These organisms are usually multiresistant and create the need to use broad spectrum antibiotics. Therefore, the invasive procedures used in ICU to some extent complicate the control of infections. In this regard, the central line-associated infection (CLAI) is the major complication that incurs to the central venous catheters. The current intervention procedures for CLAI are in the form of bundles which are used wholesomely. This means that each package is implemented by carrying all the activities included in it and not just selecting a few. One of the commonly utilized technique is the care package. This bundle contains five elements which include; clean skin preparation with chlorhexidine, hand hygiene, avoidance of femoral sites, elimination of unnecessary catheters, and sterile barrier precautions during CVC. As per JC et al. (2011) methodology, the bundle was implemented along with a strong safety culture, education, and organizational strategies. Moreover, during implementation, information was collected for calculating the rates of infection and monitoring the level of adherence to hygiene. The results obtained a 2.d level of evidence. Another intervention is the quality technique which comprises of two different bundles. This particular response also has a strong focus on hand hygiene, and the two bundles included are the CVC insertion and CVC maintenance (Blot, et.al, 2014). CVC insertion has these elements; femoral vein avoidance, skin preparation with chlorhexidine, and maximal sterile barrier. On the other hand, the CVC maintenance bundle comprises of daily checks to ascertain the needs of CVC insertion, connection checking and assessment without the use of needles, and suitable bandage replacement techniques. Blot, et.al (2014) while implementing these interventions, he coupled the elements with educational programs which were PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 4 disseminated via teaching videos, conferences, and surveillance processes. The evidence level attained was 2.d. The study by the Institute for Healthcare Improvement (IHI) as stated by Perin et.al (2016) focused on the significance of implementing all significant elements that are included in all bundles. In this regard, the study proposed that a list is used to monitor and evaluate the applicability of the elements in caring for ICU adult patients. From the study’s finding, it was found that when compliance and adherence to efficient implementation of all items of a bundle is high, the rates of infection within adult patients in ICU reduces significantly. The EBP level of evidence of this research was 3e. This technique is similar to the use of multidimensional approach in preventing CLAI in ICU patients. This includes combining elements from various bundles and applying them at once (Berenholtz, et.al, 2014). In practice, the elements considered most includes combining a bundle of intervention, outcome surveillance, education, infection and feedback rates, performance feedback, and process surveillance. Their level of evidence is often 2.c. This study shows that different types of care bundles can be used as EPB Interventions for Prevention of central line-associated infections in ICU/CCU. However, both of them revolve around having high levels of hygiene. This means that microorganisms responsible for causing various central line-associated infections in ICU such as complications of the central venous catheters are propagated via unhygienic practice (Latif, et.al, 2015). However, it is evidence that the care bundle comprises of elements which are vital for preventing these infections. However, the elements on their own are not highly efficient, and they need to be coupled with strong safety culture, education, enabling organizational strategies, strong staff engagement, and surveillance processes. Evidence-Based Clinical Question Search Assignment

PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 5 Conclusion The three studies made offer ways to prevent central line-associated infections among patients hospitalized in ICUs. Two of the studies showed that implementation of good care practice leads to a reduction in rates of central line-associated infections in ICU/CCU. In this regard, the best care measures come from the bundle which includes CVC maintenance and insertion and vital strategies such as engagement and education of the staff, surveillance process, and safety culture. These are features associated with the care bundle. Therefore, it is evidence that the care bundle which comprises insertion cleaning with chlorhexidine, femoral site avoidance, strict hand hygiene, and catheter removal as soon as it becomes unnecessary is the best intervention for preventing CLAI among adult patients hospitalized in intensive care units. References Berenholtz, S. M., Lubomski, L. H., Weeks, K., Goeschel, C. A., Marsteller, J. A., Pham, J. C., … & Yang, T. (2014). Eliminating central line–associated bloodstream infections: a national patient safety imperative. Infection Control & Hospital Epidemiology, 35(01), 56-62. Blot, K., Bergs, J., Vogelaers, D., Blot, S., & Vandijck, D. (2014). Prevention of central line– associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clinical Infectious Diseases, ciu239. JC, O., GL, S., N, S., O’Horo, J., Silva, G., & Safdar, N. (2011, January 1). Anti‐infective locks for the treatment of central line‐associated bloodstream infection: A systematic review and meta‐analysis (Provisional abstract). Retrieved March 6, 2017, from http://onlinelibrary.wiley.com/o/cochrane/cldare/articles/DARE12011007506/frame.html PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 6 Latif, A., Kelly, B., Edrees, H., Kent, P. S., Weaver, S. J., Jovanovic, B., … & Berenholtz, S. M. (2015). Implementing a Multifaceted Intervention to Decrease Central Line– Associated Bloodstream Infections in SEHA (Abu Dhabi Health Services Company) Intensive Care Units: The Abu Dhabi Experience. infection control & hospital epidemiology, 36(07), 816-822. Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016). Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Revista Latino-Americana de Enfermagem, 24. PICOT Question Central LineAssociated Infections Courtney Pribonic Kaplan University 3/25/2017 Introduction This data analysis focuses on • Explaining key clinical questions for searching in the database. • Clearly defining database findings and outputs. • Systematic review of evidence levels. • Descriptive analysis of the study based on the PICOT question. PICOT Questions The studies PICOT question was • “What are the best CLAI-related preventive and intervention measures implemented in adult patients who are hospitalized in an ICU?” The development of the PICOT question was based on; • There are high chances of ICU patients suffering from CLAI. • Most CLAI are caused by microorganisms. • CLAI causing microorganisms act on the central venous catheters. Evidence-Based PICOT Questions Evidence-Based Clinical Question Search Assignment

• Population: adult patients admitted in ICU. • Intervention: The physician’s role in ensuring clean and hygienic conditions in the ICU. • Comparison: hospital management’s role in educating physicians and patients on how to limit the spread of CLAI especially through utilisation of proper care bundles. • Outcome: there are better elimination chances when physicians and nurses are involved in implementing care bundles for minimizing CLAI in ICU • Time: perioperative time can include a week worthy of training and teaching. Database Search Questions • What is the CLAI prevalence level in adult patients admitted in ICU? • What are the probable risky factors for CLAI in adult patients at a hospital? • What are the major types of CLAI in adult patents? • How do microorganisms survive in ICU and other hospital environments? • What are the most effective intervention measures for CLAI in hospitals? Databases Used These nursing and health information databases were utilised; • Cochrane database. -Care and maintenance of the CVC • Scopus. Care bundles for preventing CLAI • PubMed. CLAI risky factors • Web of science. Other evidence based practise information. The resech limited itself to sources developed between 2010 and 2015. Database Results • About 23.3% of adults admitted in ICU develop other complications. • Most risky factors for CLAI include general hygiene, contained air and water systems, antibiotic resistance. • Current causes of CLAI are Microbial presence and antibodies resistance • Common types of CLAI include; Catheter-associated urinary tract infections, Surgical site infections, Bloodstream infections, Pneumonia, Clostridium difficile • Enhancement of hospital hygiene, proper antibiotics selection, clean air and water systems, improved knowhow by patients and physicians are some of the best CLAI intervention techniques. Statistical Database Results • There is at least one CLAI infection daily in one out of 25 hospitals. • As per the CDC (2014), there was a 50% reduction in catheter-associated urinary tract infections (CAUTI) between the years 2010 and 2014. • No reduction in catheter-associated urinary tract infections (CAUTI) between 2010 and 2014 • There was a general decline in ICU CLAI infection between 2013 and 2014. This included ✓17% reduction in surgical site infections (SSI), ✓8 % reduction in hospital-onset Clostridium difficile (C. difficile), ✓13 % reduction in hospital-onset methicillin-resistant. Research Strategy Descriptive Study • Preliminary observation were done on database sources. • The study utilized a case study approach. • Hospitals were selected randomly. • All the Hospitals were from USA. • All hospitals had specialised care units such as the ICU Statistical Output • The total number of hospitals randomly selected were 27. • The groping of the hospitals was based on the outcomes of the outputs from the database search. • The database search outcomes were subjected to group (chain-P) factor analysis rating. • The study analysed the 27 hospitals based on the chain-P group analysis. • The results showed that 20 of the 27 individual P-technique analyses had witnessed signs of hospital related infection. Level of Evidence • Level one • level two. Involved searching information Evidence was obtained from the in these databases ✓ Cochrane database ✓Scopus, ✓PubMed, ✓ the web of science. ✓the CDC (centre for disuse control) website. ✓Selected subject hospital’s websites. Conclusion And Recommendations • CLAE and hospital associated infections are present in the health care facilities. • Specific avoidance based care need to be adopted to solve CLAI issues. • Best CLAE interventions includes ✓Implementation of the care bundle ✓Utilizing preventive nursing practice. • Despite the CLAE dominance, the reported reduction of ICU related hospital infection offers hope for achieving zero percent CLAI in hospitals. References • JC, O., GL, S., N, S., O’Horo, J., Silva, G., & Safdar, N. (2011, January 1). Anti‐infective locks for the treatment of central line‐associated bloodstream infection: A systematic review and meta‐analysis (Provisional abstract). Evidence-Based Clinical Question Search Assignment

Retrieved March 6, 2017, from http://onlinelibrary.wiley.com/o/cochrane/cldare/articles/DARE-12011007506/frame.html • Latif, A., Kelly, B., Edrees, H., Kent, P. S., Weaver, S. J., Jovanovic, B., … & Berenholtz, S. M. (2015). Implementing a Multifaceted Intervention to Decrease Central Line–Associated Bloodstream Infections in SEHA (Abu Dhabi Health Services Company) Intensive Care Units: The Abu Dhabi Experience. infection control & hospital epidemiology, 36(07), 816-822. • Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016). Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Revista Latino-Americana de Enfermagem, 24. • Berenholtz, S. M., Lubomski, L. H., Weeks, K., Goeschel, C. A., Marsteller, J. A., Pham, J. C., … & Yang, T. (2014). Eliminating central line–associated bloodstream infections: a national patient safety imperative. Infection Control & Hospital Epidemiology, 35(01), 56-62. • Blot, K., Bergs, J., Vogelaers, D., Blot, S., & Vandijck, D. (2014). Prevention of central line– associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clinical Infectious Diseases, ciu239 … Evidence-Based Clinical Question Search Assignment