Deep Sternal Wound Infections

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Literature Searches

An important step in the EBP process is reviewing the current body of literature to better understand the subject or topic in which you are interested. By conducting a review of the literature, you are building foundational knowledge about the topic; later, you can use this background to build new insights. Developing a strong grasp of a topic can only be garnered by taking the time to thoroughly search for relevant information and resources.

For this Discussion, you will practice searching the literature to find evidence on a specific topic.

To prepare:

Choose a simple search term(s) relating to a topic of your PICOT question.
Review the information on the evidence hierarchy discussed in Chapter 2 of the course text, in the article, “Facilitating Access to Pre-Processed Research Evidence in Public Health,” and in the multimedia presentation “Hierarchy of Evidence Pyramid,” found in this week’s Learning Resources.
Review the information on the Walden Library’s website, “Levels of evidence.” Take a few minutes to explore the different types of databases available for each level of evidence and focus on the meaning of filtered and non-filtered resources.
Conduct a literature search in the Walden Library on your selected topic using the databases that you reviewed. Use at least one database for each of the three levels of filtered information and at least one unfiltered database. Record the number of hits that you find at each level of the hierarchy of evidence.
Select one article from the results at each level of the hierarchy. Compare the articles based on the quality and depth of information. What would be the value of each resource if you were determining an evidence-based practice? Deep Sternal Wound Infections

By Day 3

Post a summary of your search. Describe what topic you selected, the search term(s) that you used, and the number of results found at each level of the hierarchy. Compare the types of information found in the articles from different levels and the value of the information from each level. Highlight a useful tip that you could share with your colleagues about conducting an effective literature search.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message. Deep Sternal Wound Infections

My PICOT Question

In cardiac patients who have thoracic surgery, what are the effects of antibacterial soap baths and bacitracin prophylactic nasal swabs on preventing or decreasing Deep Sternal Wound Infections (DSWI)?

Classmate Post #1

Tabitha L

As a nurse conducting efficient research to improve practice is highly essential. Nurses must keep up with current evidence-based practice to be aware of changing guidelines and recommendations. In this discussion, the literature search based on the PICOT question, of ‘for patients receiving antibiotics, does the use of probiotics reduce the occurrence of Clostridium difficile when compared to patients receiving antibiotics without probiotics?’.

To begin my search, I simply entered ” Clostridium difficile” “probiotics” “prevention’” into the Walden Library. To aid in the process of narrowing search results, I altered the timeline to only present results from 2013-2018 to ensure no outdated results would appear. Setting a distinct time frame is essential to avoid using data that may no longer be relevant because of newer results. This search gave me a total of 229 results. Next, I filtered through results using the ‘peer-reviewed scholarly journals’. This filtering of results will help articles that have been written by experts and reviewed by experts unbiasedly. Adding peer-reviewed scholarly journals did narrow the results down to 163 results. However, the filter did leave lower level hierarchy evidence unfiltered evidence such as randomized trials that is the highest level of unfiltered infection according to “Hierarchy of Evidence Pyramid”. In this randomized controlled trial it was concluded, “Due to the low incidence of antibioticassociated diarrhoea in both groups, no conclusion can be made on the efficacy of L. reuteri DSM 17938 on AAD in hospitalized Bulgarian children,” (Georgieva, Pancheva, Rasheva, Usheva, Ivanova,& Krassimiram, 2015). This result makes answering the original question quite difficult to answer.

To further my search, I attempted to locate filtered information. From my previous results I was able to find a systematic review, which is the top of the evidence pyramid. This research leads me to more definite answers. “Four different types of probiotics were found to be effective for primary prevention of CDI (S. boulardii, L. casei DN114001, the mixture of L. acidophilus and Bifido. bifidumand the mixture of L. acidophilus, L. casei and L. rhamnosus),” (MacFarland, 2015). While this research seems to provide more definite answers, it does also state, “More clinical experience with these four probiotics might be recommended to confirm if they are effective in larger populations of patients,” (MacFarland, 2015). Deep Sternal Wound Infections

While the systematic review by MacFarland was able to provide more definite research data than the controlled trial there was still a plethora of search results to go through. By selecting the “title” option for my keywords, it narrowed my results down to a total of eight along with the previous filters. This search brought me to a literature search writing, which concluded, “The probiotic formulation containing these three lacto-bacilli strains (L. acidophilus CL1285, L. casei LBC80R, L. rhamnosus CLR2, Bio-K+) is a promising example of how a probiotic was used to prevent serious healthcare-associated infections such as CDI. This probiotic is well characterized, has an excellent safety profile, and, when applied in hospitals, showed reductions in CDI rates, sometimes sustained over years. More research is recommended for probiotics in the prevention of CDI,” (Macfarland, Ship, Auclair, & Millette, 2018).

After reading several different results such as those discussed. I was able to conclude that a common answer to my question, ‘for patients receiving antibiotics, does the use of probiotics reduce the occurrence of Clostridium difficile when compared to patients receiving antibiotics without probiotics?’ was while probiotics seem to have a beneficial effect on preventing C-diff infection more research needs to be conducted.

In conclusion, it is essential that nurses know how to conduct literature searches. Understanding how to narrow searches by using filtering tools and keywords is crucial along with selecting a specific time frame. Understanding the different hierarchies of evidence is also important in understanding how to interpret information.

References

Laureate Education (Producer). (2012). Hierarchy of evidence pyramid. Baltimore, MD: Author.

MacFarland, L. (2015). Probiotics for the Primary and Secondary Prevention of C. difficile

Infections: A Meta-analysis and Systematic Review. Antibiotics, Vol 4, Iss 2, Pp 160-178

(2015), (2), 160. doi:10.3390/antibiotics4020160

McFarland, L., Ship, N., Auclair, J., & Millette, M. (2018). Review: Primary prevention of

Clostridium difficile infections with a specific probiotic combining Lactobacillus Deep Sternal Wound Infections

acidophilus, L. casei, and L. rhamnosus strains: assessing the evidence. Journal Of

Hospital Infection, 99443-452. doi:10.1016/j.jhin.2018.04.017

Georgieva, M., Pancheva,R., Rasheva, N., Usheva,N., Ivanova, L., & Krassimira, K. (2015). Use

of the probiotic Lactobacillus reuteri DSM 17938 in the prevention of antibiotic-

associated infection in hospitalized Bulgarian children: a randomized, controlled trial.

Journal Of IMAB,21(4), 895-900. doi:10.5272/jimab.2015214.895

Classmate Post #2

Samantha A

Initial Post

COLLAPSE

Initial Post –

My PICOT question was: In traumatic brain injured patients requiring an external ventricular drain (EVD), does the utilization of chlorhexidine (CHG) dressing versus a standard occlusive, sterile dressing help decrease the risk of all EVD infections for the duration of the patient’s required time of EVD therapy. In choosing a simple search term I initially started complicated and progressively simplified my search criteria. In each level of evidence and the corresponding database, my search terms initiated with, chlorhexidine dressings preventing external ventricular drain infections. Utilizing this search criteria was too specific and too new of a concept to result in any articles within the systematic review databases, the critically-appraised topics, critically-appraised individual articles, and in the unfiltered databases. I thus, simplified my search criteria to external ventricular drain infections, where I found 36 articles in the critically-appraised topics through the Annual Review database, 3 articles in the Evidence Based Nursing database, none in the systematic review databases, and 11 in the CINAHL Plus unfiltered database. From the articles found utilizing the search criteria of the external ventricular drain infections, mostly unrelated articles to my very specific PICOT question was found. For the purpose of this discussion board I further simplified my search criteria to chlorhexidine dressings. Deep Sternal Wound Infections

Upon simplifying my search criteria to chlorhexidine dressings, I was able to produce at least one article per level of evidence and the corresponding databases. In the Cochrane Database of systematic Reviews, one article populated from my CHG dressing search. Systematic reviews are completed by a impressive, comprehensive literature review, in which a specific clinical question is asked (Walden University, 2012). The poorly executed studies are eliminated and practice suggestion is made based on the remaining well done studies (Walden University, 2012). The article explained the data collection, analysis, bias, quality of evidence, included and excluded studies, and summary of findings with primary and secondary outcomes (Lai, 2017). Furthermore, this article had two review authors independently assess the controlled trials eligibility and the risk associated bias within each randomized controlled trila (Lai, 2017). In reference to the critically-appraised topics, which consist of multiple research studies on a particular topic I found one article utilizing the search term CHG dressing (Walden University, 2012). The article came from the Annual Review and focused on national statistics reviewing a decision-analysis model and The Dressing Study (Chandra & Chong, 2014). Next, I used the CHG dressing search criteria in the Evidenced-Based Nursing database of critically-appraised individual articles resulting in seven articles. These articles evaluate and provide a synopsis of specific research studies (Walden University, 2012). The article I reviewed was a meta-analysis which included randomized controlled trials of CHG dressing versus site care and the results evaluating prevention of bacteria colonization on the catheter and prevention of catheter associated blood stream infection (Lorente, 2014). Finally, I searched the CINAHL Plus unfiltered database and found 75 articles about CHG dressings. In unfiltered databases, the individual owns the responsibility to review the articles for validity and reliability (Walden University, 2012). In the CINAHL Plus database the article I reviewed was a case study at University College London Hospital focusing on two patients in one cardiac intensive care unit (Jeanes & Bitmead, 2015).

After beginning my search term as specific I found a lack of articles in the higher levels of evidence databases, once I simplified my terms to an intervention that has been around for greater than two years I was able to find at least one article per level of evidence. As the level of evidence decreased there are more articles to be found, which raises the question of validation and reliability, especially when searching the unfiltered databases. A useful tip to share when conduction an effective literature search is to analyze the specific nature of your research question in relationship to the level of evidence that will be present. The more specific the question the less availability at the higher levels of evidence, the more recent the practice change you are researching, as well, will result in less related articles at the higher levels of evidence. This raises great caution to the researcher, the more specific and more recent the search criteria is the more the research must rely upon lower levels of evidence in unfiltered databases. This requires the researcher to analyze each article and verify the reliability and the bias within each article.

References

Chandra, S. & Chong, D. (2014). New cost-effective treatment strategies for acute emergent situations. Annual Review of Medicine, (65) pgs 459-469

Jeanes, A., & Bitmead, J. (2015). Reducing bloodstream infection with a chlorhexidine gel IV dressing. British Journal Of Nursing, 24S14-S19. doi:10.12968/bjon.2015.24.Sup19.S14

Lai, N. M. (2017). Antimicrobial dressings for the prevention of catheter-related infections in newborn infants with central venous catheters. Cochrane Database Of Systematic Reviews, (1), doi:10.1002/14651858.CD011082.pub2

Lorenet, L. (2014). Review: chlorhexidine-impregnated dressings reduce risk of colonisation of central venous catheters and risk of catheter-related bloodstream infection. BMJ Journals 18(3). doi:10.1136/eb-2014-101959

Walden University. (2012). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=…