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Literature Evaluation Table

Change Topic (2-3 sentences): Daily Chlorhexidine(CHG) Bath in Oncology Patients to Prevent Hospital Acquired Infection(HAI)

Criteria

Article 1

Article 2

Article 3

Article 4

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Raluji, C., Clay, K., & Yu, L.

Journal of Pediatric Hematology Oncology

32(5), 315-321. Retrieved from https://www.tandfonline.com/doi/full/10.3109/08880018.2015.1013588?scroll=top&needAccess=tru

Chen, W., Cao, Q., Li, S., Li, H., & Zhang, W

Journal of Thoracic Disease

7(4), 746-753 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419331/

Dzaher, A.

Retrieved from https://today.mims.com/hospital-acquired-infection--hai---nurses--roles-in-infection-preventions

Pagan,J

https://www.oncologynurseadvisor.com/ons-annual-congress-2017/chg-bathing-reduces-clabsis-in-patients-with-central-lines/article/662126/

Article Title and Year Published

Daily Bathing with Chlorhexidine and Its Effects on Nosocomial Infection Rates in Pediatric Oncology Patients

2015

Impact of daily bathing with chlorhexidine gluconate on ventilator associated pneumonia in intensive care units: a meta-analysis.

2015

Hospital-acquired infection (HAI): nurses roles in infection preventions

2016.

Significant Reductions in CLABSIs Achieved with Daily Chlorhexidine Bathing in Oncology Population.

2016

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

To determine if daily bathing with Chlorhexidine gluconate can decrease the rate of nosocomial infection in pediatric oncology patients.

To assess whether daily bathing with chlorhexidine gluconate (CHG) would significantly result in the reduction of Ventilator Associated Pneumonia

Not Indicated

Not indicated

Design (Type of Quantitative, or Type of Qualitative)

Retrospective study

A meta -analysis

Not indicated

Not indicated

Setting/Sample

Pediatric Oncology unit

Adults patients from medical, surgical, trauma, and combined medical-surgical ICUs

All setting

Adult Oncology Unit

Methods: Intervention/Instruments

Competency training: staff /patient/ family education are key component of the intervention.

A key feature of the Grades of Recommendations Assessment Development and Evaluation (GRADE) method was used to assess the quality rather than individual study

Patient Education

Universal precaution practices

Make best use of aseptic techniques

Promotion of hand hygiene

Cleaning and disinfection practices

Champion team, staff education, and patient education and instructions.

Analysis

Awareness on the need for daily bathing with CHG in pediatric oncology patients with central lines.

The impact of daily bathing with CHG to prevent health-care associated infection (HAI), such as CLABSI, SSI, multi-drug resistant organisms (MDROs) acquisition, has been well investigated in some clinical trials. However, this studies’ statistical analysis indicates its efficacy among critical ill patients undergoing mechanical ventilation

Not Indicated

Not indicated

Key Findings

The results suggest that daily bathing with Chlorhexidine is effective in reducing the rates of infections in pediatric oncology patients, especially those older than 12 years of age.

It was found that daily bathing with 2% CHG impregnated cloth or wipes would also decrease VAP risk among critical ill patients in ICU settings.

Not applicable

Not applicable

Recommendations

The study warrants further investigation with a prospective randomized study to validate the results.

This study also needs additional well-designed large studies were required for the validation of this association.

Not applicable

Not applicable

Explanation of How the Article Supports EBP/Capstone Project

It is well known that oncology patients are at an increased risk of nosocomial infection. This study shows that CHG bathing reduced the ID of nosocomial fever in pediatric oncology patients, and this is consistent with my EBP project.

Oncology patients sometimes are admitted in ICU and might require mechanical ventilator, for that reason the study supports my EBP project

It is the unique role of the nurses to ensure patients are not infected while being treated in the hospital, the roles of the nurses in preventing hospital acquired infection is necessary in my EBP project.

This study is in consistent with the writer’s EBP Project, the population discussed in the article is relevant to the capstone project.

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Article 5

Article 6

Article 7

Article 8

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Climo, M., Yokoe, D., & Warren, D. Journal of Vascular Surgery, 57(6), 1719-1720. doi:10.1016/j.jvs.2013.04.015

Karcz, A., Kelley, K., Conrad, J., & Cox, E. American Journal of Infection Control,43(6), S8. doi:10.1016/j.ajic.2015.04.020

O'Horo, J. C., Silva, G. L., Munoz-Price, L. S., & Safdar, N.

Infection Control & Hospital Epidemiology,33(03) 257-267. doi:10.1086/664496 1

Choi, E. Y., Park, D., Kim, H. J., & Park, J. Annals of Intensive Care, 5(1). doi:10.1186/s13613-015-0073-9

Article Title and Year Published

Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection

2013

Daily Bathing of Pediatric Inpatients with Chlorhexidine Gluconate to Prevent Hospital Acquired Infections

2015

Efficacy of Daily Bathing with Chlorhexidine for Reducing Healthcare-Associated Bloodstream Infections

2012

Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis

2015

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

To evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections

To evaluate the effectiveness of daily bathing of pediatric Inpatients with Chlorhexidine Gluconate to prevent hospital acquired infections

To assess the efficacy of daily bathing with chlorhexidine (CHG) for prevention of healthcare-associated bloodstream infections (BSIs).

To determine if daily bathing with chlorhexidine decreased hospital-acquired BSIs in critically ill patients.

Design (Type of Quantitative, or Type of Qualitative)

Cluster-randomized, nonblinded crossover trial

Not indicated

Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies

A meta-analysis of randomized controlled trials

Setting/Sample

Nine intensive care and bone marrow transplantation units in six hospitals

Pediatric Inpatient

Medical, surgical, trauma, and combined medical-surgical intensive care units (ICUs) and long-term acute care hospitals

Intensive care unit

Methods: Intervention/Instruments

Daily bathing of patients with either nonantimicrobial washcloths (control) or washcloths impregnated with 2% chlorhexidine gluconate (intervention) during the initial 6-month study period, followed by daily bathing with the alternate product during the second 6-month period.

A multidisciplinary team was formed combining leadership with frontline staff to implement a robust CHG bathing implementation plan. Multi-modal education was formulated which consisted of key content including the rationale for CHG bathing, contraindications, talking points, frequently asked questions, patient/family education, and references. 

Data on patient population, diagnostic criteria for BSIs, form and concentration of topical CHG, incidence of BSIs, and study design were extracted

The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched to identify randomized controlled trials that compared daily bathing with chlorhexidine and a control in critically ill patients.

Analysis

Some characteristics were examined to evaluate the nature of infectious process and Continuous variables were examined with the use of two-sample t-tests and linear regression modeling, and categorical variables were examined by means of Fisher's exact test.

Not indicated

To compare the efficacy of these modes of administration, a subgroup analysis was performed with healthcareassociated BSI as the outcome

The random-effects model because it accounts for variation among studies, in addition to sampling error within studies

Key Findings

The findings of this study evaluating daily bathing with chlorhexidine support the results of previous single-center trials suggesting that bathing with chlorhexidine reduces the transmission of and the risk of hospital-acquired bloodstream infections among patients in ICUs and bone marrow transplantation units

A successful implementation of daily CHG bathing for pediatric inpatients can help reduce hospital acquired infections and provide significant cost savings to the hospital

Existing data support the practice of daily bathing with CHG for decreasing healthcare-associated BSIs and CLABSIs

Daily bathing with chlorhexidine was associated with reductions in the rates of measured hospital-acquired BSI without significant complications in critically ill patients.

Recommendations

Further studies are needed to rule out high level resistance organism to CHG

Further studies are needed to evaluate the use of CHG, in conjunction with other initiatives in the effort to prevent HAIs.

Further research is needed to determine whether this strategy has a role in other intensive care environments or non–intensive care environments

Further multinational, multicenter RCTs are required to overcome the limitations of the meta-analysis.

Explanation of How the Article Supports EBP/Capstone

The article supports the writer’s EBP project because a multicentered approach was used for the survey and proved the efficacy of daily CHG bathing in preventing HAI.

The article is in line with the writer’s capstone project as it was able address the effectiveness of daily CHG in preventing HAI (CLABSI).

The EBP in this article supports that of the writer’s Capstone project by proving the efficacy of bathing with CHG daily can reduce HAI

This article highlights how CHG bathing is effective in reducing HAI and this supports the writer’s EBP project

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