Evidence Based Practice and Applied Nursing ResearchAshley CraigDecember 8, 2018Western Governors UniversityEvidence TableA1. Quantitative Article: Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler, A. P. (2015). Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA, 313(4), 369″378. or Introduction Infections that are acquired during a hospitalization stay cause many problems for hospitals as well as the patients. The hospital acquired infections (HAI’s) are connected with longer hospital stays, sometimes death, and high financial responsibilities.
Effort is made in preventing infections through practices and protocols designed to lower the spread of the bacteria. Some practices used around the globe include hand washing, bundles for insertion, and the separation of patients with diseases that can passed and require isolation. Chlorhexidine, a topical antimicrobial wash, that when used correctly to clean the skin, may decrease these chances of contacting and spreading these HAI’s (Noto, Domenico, Byrne, Talbot, Rice, Bernard, & Wheeler, 2015).Review of the Literature Nineteen references were provided by the authors.
Some were cited back to 2013, but most were dated up to 2015 to determine if daily bathing with chlorhexidine decreases the incidence of HAI’s. A study of 9,340 patients admitted to 5 different intensive care units in Nashville, Tennessee was conducted. All of the patients involved her bathed the same. No patient had different routines followed during this study, (Noto, Domenico, Byrne, Talbot, Rice, Bernard, & Wheeler, 2015).Discussion of Methodology The study performed was once-daily bathing of all patients with cloths soaked in chlorhexidine as the control. Bathing treatments were completed for a ten-week period followed by a two-week washout period during which patients were bathed with regular disposable cloths and soap. All manufacturer’s instructions, procedures and protocols were followed and documented (Noto, Domenico, Byrne, Talbot, Rice, Bernard, & Wheeler, 2015).Data Analysis During the chlorhexidine bathing period, fifty- five infections occurred. During the non-control bathing period, less than sixty infections were noted. After tweaking the baseline variables, not a huge difference between groups in the rate of the primary outcome was documented. Chlorhexidine bathing did not significantly change rates of HAI’s (Noto, Domenico, Byrne, Talbot, Rice, Bernard, & Wheeler, 2015).Researcher’s Conclusion Documented infections were determined using Centers for Disease Control standards by skilled infection control personnel, who were not made aware of the bathing assignment. According to the authors in this trial, daily bathing with chlorhexidine did not dramatically reduce the occurrence of HAI’s. These results do not support daily bathing of critically ill patients with chlorhexidine. It is not cost effective for hospitals or patients (Noto, Domenico, Byrne, Talbot, Rice, Bernard, & Wheeler, 2015).Quantitative: Researcher’s ConclusionsThe evidence presented in the journal article supported the researcher’s evidence by proving that Chlorhexidine bathing is widely practiced in the World but does not significantly reduce the infections rates in patients and is not cost effective. The data proved that the statistics were not high enough to support this type of bathing versus regular routine bathing with soap and water. It costs the health care facilities millions of dollars to use this on all patients that are immunocompromised or are critically ill. This is not a benefit that outweighs the risk type of situation. Avoiding the use of using chlorhexidine could save hospitals and many health care facilities millions of dollars without affecting clinical outcomes. Not only would it save the facilities a lot of money but would lower patient’s hospital bills as well. It would be a win for all parties involved. Quantitative: Protection and Considerations The doctors that oversaw this study had complete access to all the data in the study and take accountability for the integrity of the data. The doctors made sure the data analysis was accurate. All authors completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The study was permitted by the Institutional Review Board at Vanderbilt University with a waiver of consent. Human subjects were protected during the study. Patients were not included if they had cultural conflicts. All patients admitted to the cardiovascular, medical, neurological, surgical, and trauma ICUs during the study period were involved. Patients were excluded if they were known to have an allergy to chlorhexidine. If the treating physician thought bathing would be dangerous, the patients were excluded. Patient acceptance began in July of 2013. After the enrollment of the patients involved was completed, the researchers realized the size of this study might be of interest to others and registered the study on the internet at clinicaltrials.gov on January 8, 2014. They thought this would get more people interested in being a part of a research study. This arose before any data analyses were conducted. No data analyses were conducted during the study or prior to the trial registration (Noto, Domenico, Byrne, Talbot, Rice, Bernard, & Wheeler, 2015).Quantitative: Strengths and Limitations A strength of this study was that many patients were involved in this study from different units in the hospital such as the ICU, medical surgical units, and neuro floors. It was not unit specific. Another strength was that many races, male and female subjects, patients with different illnesses and patients with different abnormal lab values were all a part of this study. Some limitations of this study were that is was only ten weeks long. In my opinion, a twelve to twenty-week trial would have given significantly more information especially during different seasons in the hospital. For example, Florida has visitors from the other parts of the United States making their way down here to stay warm. This makes the elderly population busier in the winter months at the hospitals and other health care facilities. According to the study, elderly patients were prone to more infections acquired by the hospital.Quantitative: Evidence Application The evidence informs the nursing practice by doing what is in the best interest of the patient. It has changed the way nurses and other health care members of the team take care of their patients. Performing different studies, such as this study, helps the healthcare team learn and guide the team from the evidence to better patient care. As we can see the evidence supported in this study regarding chlorhexidine use was not beneficial to the patient or the hospital. Having the knowledge behind the evidence helps nurses come up with different strategies to apply when taking care of patients. Evidence based practice allows the nurses to use critical thinking skills rather than just using the exact same interventions on every patient. This allows for the interventions to be patient specific. The health care team depend on on the experience and proficiency to assess research finding that can benefit patients. The evidenced based practice should be implemented across the entire care team, not just nurses in order to have better future outcomes. Evidence TableB1. Qualitative Article: Loyland, B., Wilmont, S., Hessels, A. J., & Larson, E. (2016). Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities. Nursing Research, 65(2), 132″141. Background or Introduction There is necessity to expand infection control practices such as handwashing in health care facilities. Handwashing occurrences is disturbingly low in healthcare facilities, even though it is critical for the safety of the patients. For example, pediatric long-term care facilities provide many areas of medical care such as social, academic, and therapeutic activities to medically ill children. Despite this perilous population, little infection prevention research has been conducted. The authors in this article conducted a survey at the 2013 Pediatric Complex Care Association Annual National Conference in which the providers that worked at pediatric facilities reported infection prevention and control issues of greatest concern in a survey. This survey included the absence of top practice guidelines, including hand hygiene. After the study, some interventions included the installation of an electronic group monitoring system to measure the incidence of hand hygiene, education, and continuous monitoring of infection cases. Major change in this environment was needed after reviewing the results. One aspect is to ensure that healthcare workers have adequate knowledge on the importance of handwashing and how easy infection can spread during hands on patient care. It is important that we be fully aware of the knowledge, attitudes, and intentions of the staff. Consequently, the goal of this study was to identify possible blocks to hand washing and infection prevention perceived by staff (Loyland, Wilmont, Hessels, & Larson, 2016).Review of the Literature Over thirty references were used in this article. Most of the literature was interviewing nurses and identifying priorities in the health facilities working around critically ill children. Many of them had different beliefs and approaches on trying not to spread infection. The staff had different perceptions and education on proper hand hygiene. This article detailed many aspects on the interview conductions and how they watched the employees working. An interview guide featuring eight open-ended questions was developed with contribution from a multidisciplinary group of researchers aware with, but independent of, the existing project. (Loyland, Wilmont, Hessels, & Larson, 2016).Discussion of Methodology Different categories such as design, settings, interview guide, recruitment and interviews were used. This study involved interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers led the interviews using an interview guide with the eight open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted an investigation using an approach modified from the systematic text condensation method (Loyland, Wilmont, Hessels, & Larson, 2016).Data Analysis The approach guided the researchers through a process to assure consistency in stages of total immersion in the data and the identification of key words and phrases. The researchers associated notes of their initial analyses to develop a better understanding of their understanding of the data. The researchers then established consensus through many discussions on separate occasions. These emerging thematic categories were discussed in meetings with the field researchers who collected the data to enhance precision. After agreement on the thematic framework, the researchers relistened and reread the data for systematic notion. At this stage, the two researchers negotiated the organization and priorities of the empirical data into subthemes and thematic categories by example splitting subthemes covering two or more distinct phenomena and lumping subthemes representing same issues (Loyland, Wilmont, Hessels, & Larson, 2016). Finally, official feedback was given to the participating facilities (Loyland, Wilmont, Hessels, & Larson, 2016).Researcher’s Conclusion Infection prevention and control offer many challenges for medically fragile children who require complex medical care. Three recommendations have developed from this qualitative study. First, educational offerings in pediatric facilities must contain information regarding achievable infection prevention strategies. Second, workflow patterns need to be carefully evaluated to recognize systems and procedures to reduce cross-contamination. For instance, the adjustment to help staff rank highest risk contacts and make entirely informed choices about prevention strategies are essential (Loyland, Wilmont, Hessels, & Larson, 2016). Third, hand hygiene products are crucial when coming in contact with children. Sometimes conveniently located dispensers may be hard to reach. For example, personal sized bottles of hand sanitizer would greatly simplify hand hygiene (Loyland, Wilmont, Hessels, & Larson, 2016).Qualitative Researcher’s Conclusions The evidence presented in the journal article supported the researcher’s evidence. Care providers presented valuable insights, which were generally consistent with previous studies from other facilities. There were several opinions across the three sites, although some differences were recognized between the work groups. Many conflicts and blaming others mentalities were reported. The employees wanted to blame each other or the facility. One of the findings from this study was that there was a misunderstanding concerning hand hygiene recommendations, use of soap versus sanitizer, and universal isolation precaution protocol. Many staff members stated that they wanted more dispensers available if sinks were not an option, more education, and hands-on practical guidance (Loyland, Wilmont, Hessels, & Larson, 2016).Qualitative: Protection and Considerations The protection of human subjects and cultural considerations were protected during the interviews and audio recordings. The employees were interviewed in private rooms after they consented. Their answers remained confidential. Each interview was diverse, offering opportunities for employees of different cultures, race, and sex. This study was not mandatory if they did not want to participate. Qualitative: Strengths and LimitationsStrengths in this study were that they interviewed many employees and used audio recording to conduct this study. regarding hand hygiene practice that were from different departments. It was not just regarding clinical staff, but clerical staff as well. It gave the study more information and proved that hand washing or lack of hand washing was not just noted with nurses or aides. Clerical and educational staff, such as teachers, and different types of therapists had issues with training, knowledge, and lack of sanitizer stations on the wall. Some limitations were that those employees who were interviewed were prepared to spend time to participate during the dates that the interviewers were on site. As with random volunteers in any study, it is possible that they would have answered differently, then the ones that were employed at the facility because it would be on the spot and not when they were prepared. The employees were most likely influenced to answer a certain way because it was their place of employment.Qualitative: Evidence ApplicationEvidence informs nursing practice to make a better workplace for the employees and what is safe for the critical patients. This study helped the facilities know where they were lacking in knowledge and education from their employees. It involved nursing staff, teachers, and other members of the team. It helped them conduct a study to find out what the needs and wants were of their employees to make a better workplace. If they provide the employees with the things that they need to provide a safe and better workplace, it is a win for all parties involved. In this case, it will give the opportunity for them to have better hand hygiene. ReferencesLoyland, B., Wilmont, S., Hessels, A. J., & Larson, E. (2016). Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities. Nursing Research, 65(2), 132-141. doi:10.1097/nnr.0000000000000136Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler, A. P. (2015). Chlorhexidine Bathing and Health Care”Associated Infections. Jama, 313(4), 369. doi:10.1001/jama.2014.18400