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Running head: LITERATURE REVIEW 1

LITERATURE REVIEW 2

Daily Chlorhexidine(CHG) Bath in Oncology Patients to Prevent Hospital Acquired Infections(HAIs)

Introduction Comment by Stacey Minor: This should be after the title from title age and should be bold

Daily Chlorhexidine(CHG) Bath in Oncology Patients to Prevent Hospital Acquired Infections (HAIs)

Health-care-associated infections (HAIs) are infection patients catch while hospitalized, are getting a mounting sum of attention. Substantial skin microbial occupation aids in the spread and growth of HAIs (Denny & Munro, 2017). According to Donskey and Deshpande, (2016), “Patients colonized or infected with health care-associated pathogens often carry the organisms on their skin. Such contamination may lead to infection when factors such as devices, catheters, and wounds provide a route for pathogens on skin to reach normally sterile sites”. For instance, Pagan, (2016) stated that approximately 250,000 CLABSIs manifest in patients with central lines every year. Expenses for treatment of CLABSI is between sixteen thousand ($16,000) to twenty-nine ($29,000) for each infection, the effect is prolonged hospitalization, and an increased percentage of death, up to 35%. Additionally, Waknine, ( 2013) also stated that notwithstanding prevalent application of evidence based practice , up to $9.8 billion is disbursed yearly for management of HAIs, hence infection from wound post operatively is the most expensive to treat..] Comment by Stacey Minor: Should have and between

Nevertheless, skin infection can correspondingly be a contributory factor to the spread of pathogens because of environmental peeling and transference to the hands of employees. Consequently, there is a solid validation for efforts to diminish the problem of microorganism on skin (Donskey & Deshpande, 2016, P 17). Therefore, the aim for this work is to evaluate previously written literatures supportive of the writer’s PICOT statement “In Adult Oncology patients, does daily bathing using chlorhexidine gluconate compared to use of soap and water affect the incidence of HAIs (CLABSI) throughout period of hospitalization”. This work will also categorically identify evidences in the peer reviewed literatures. Additionally, the outline, comparing of research questions, sample populations, limitations of the study, conclusion and recommendation will be part of this work.

Comparing of Research Questions

In every research answering the stated research problem is the most important aspect of the study. In the literatures reviewed, the writer noted that most of the stated problems are unique in their respective ways, but all established the need for eradicating/ preventing HAIs using daily CHG bath. Climo, Yokoe, and Warren, (2013) in their study questioned effectiveness of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections, the researchers used a randomized cross over trial to determine the effectiveness of bathing daily with CHG.

Likewise, in Choi, Park, Kim, and Park, J, (2015), the researchers focused on determining if daily bathing with chlorhexidine decreased hospital-acquired BSIs in critically ill patients. Obvious similarity exists in these studies irrespective of different HAIs there researched on, the daily use of CHG bath helped each of their selected sample population. Conversely, Raluji, Clay, and Yu, (2015) study determined if daily bathing with Chlorhexidine gluconate can decrease the rate of nosocomial infection in pediatric oncology patients. In like manner, the writer’s identified statement of problem is focusing on does daily bathing using chlorhexidine gluconate compared to use of soap and water affect the incidence of HAIs (CLABSI) throughout period of hospitalization. Somehow most of these studies have some similarity in their statement of problem. Comment by Stacey Minor: No intials

Comparing the sample population

Defining selected group of people to use in a study is a vital step in the process of conducting a study. In comparison, all the studies are conducted in hospital setting during admission. Each of the study evaluating effectiveness of daily bath with CHG in critically ill patients admitted in intensive care units respectively. Chen et al conducted their study using Meta-analysis of randomized controlled trials (RCTs) and quasi-experimental studies on ICU patients with ventilator days of 27,638, while Nine ICUs and bone marrow transplantation units in 6 hospitals were observed during their use of CHG impregnated wipes as against soap and water. Though two of the studies were conducted in oncology unit as this population have not been used before, one is pediatric while the other is adults. Nevertheless, all the study’s findings agree that daily bath with CHG can significantly reduce as well as prevent HAIs in their respective selected population.

Comparing the Limitations of the Studies Comment by Stacey Minor: Heading should be bold

Discussing limitations in studies remains important as it represent unprejudiced challenges encountered by the researchers that needs to be addressed in subsequent study. Some constraints can result to disruption of the real outcome / findings in a study. In Raluji, Clay, & Yu, (2015), the limitation is associated to the findings of the study which suggests that daily bath with CHG is effective in reducing the rates of infection in older pediatric oncology patients (from 12 years down), unfortunately the effect was not tested on younger oncology pediatric patients. Donskey, & Deshpande, (2016) experienced challenges in their research as some of the ICU patients have large abdominal wound hence making the application of CHG a difficult task. Also, in Wang & Layon, (2017), [patients randomized to the control group received soap and water bath every other day, whereas those randomized to the experimental group received CHG every other day. However, the methods describe patients receiving “ad hoc baths” with soap and water on an as-needed basis. For example, if a patient needed to be cleansed of feces, urine or blood, a bath was performed with soap and water. How many of these ad hoc baths were performed in the soap and water vs the CHG group was not documented]. This resulted to a twist in the result of the studies. In all compliancy and team engagement remain the most challenging aspect of the studies to overcome as it increases the validity of the findings when all the necessary variables are in place Comment by Stacey Minor: Outside of the parenthesis this should be the word and

Conclusion Comment by Stacey Minor: Make bold

Currently, improved cognizance of the illness and possible death caused by HAIs have resulted to intense deterrence measures. Besides the idea of preventing the problems associated to HAIs for the sake of the patients, various nations including United States are developed a policy that HAIs should be, fundamentally, “never events”. In quest to use this strategy nationwide there have been incredible improvement in HAI stoppage, by means of evidence-based “bundles” entailing teaching associated with insetting and removing the devices, specifications, empowering nurses and other interdisciplinary team, and the use of CHG baths (Wang &Layon, 2016). Hence this calls for additional studies in using other sample population such as oncology patients as most articles focused on intensive care units. Moreover, most studies were conducted using meta-analysis and review of other literatures, this calls for further work to ascertain for sure that HCG bath is the end to HAIs.

References

Chen, W., Quan Cao, Li, S., Li, H., & Zhang, W. (2015). Impact of daily bathing with chlorhexidine gluconate and ventilator associated pneumonia in intensive care units: A meta-analysis. Journal of Microbiology, Immunology and Infection48(2), S58-S59. doi:10.1016/j.jmii.2015.02.125

Choi, E. Y., Park, D., Kim, H. J., & Park, J. (2015). Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis. Annals of Intensive Care5(1). doi:10.1186/s13613-015-0073-9 Comment by Stacey Minor: Capitalize Comment by Stacey Minor: Page numbers?

Climo, M., Yokoe, D., & Warren, D. (2013). Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection. Journal of Vascular Surgery57(6), 1719-1720. doi:10.1016/j.jvs.2013.04.015 Comment by Stacey Minor: Capitalization is wrong

Denny, J., & Munro, C. L. (2017). Chlorhexidine Bathing Effects on Health-Care-Associated Infections. Biological Research For Nursing19(2), 123-136. doi:10.1177/1099800416654013 Comment by Stacey Minor: Capitalization is wrong

Donskey, C. J., & Deshpande, A. (2016). Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature. American Journal of Infection Control44(5), e17-e21. doi:10.1016/j.ajic.2016.02.024

Raulji, C. M., Clay, K., Velasco, C., & Yu, L. C. (2015). Daily Bathing with Chlorhexidine and Its Effects on Nosocomial Infection Rates in Pediatric Oncology Patients. Pediatric Hematology and Oncology32(5), 315-321. doi:10.3109/08880018.2015.1013588 Comment by Stacey Minor: Capitalization

Waknine, Y. (2013). Hospital Infections Cost Billions Study Shows. Retrieved from https://www.medscape.com/viewarticle/810372 Comment by Stacey Minor: Capitalization is wrong and when there is no journal named the title should be italicized

Wang, E. W., & Layon, A. J. (2017). Chlorhexidine gluconate use to prevent hospital acquired infections—a useful tool, not a panacea. Annals of Translational Medicine5(1), 14-14. doi:10.21037/atm.2017.01.01