6052A/NRSE 6052A: Essentials of Evidence-Based Practice

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De Miranda Costa, M., Santana, H., Saturno Hernandez, P., Carvalho, A., & Da Silva Gama, Z. (2020). Results of a national system-wide quality improvement initiative for implementing evidence-based infection prevention practices in Brazilian hospitals. Journal of Hospital Infection, 105(1), 24-34.  https://doi.org/10.1016/j.jhin.2020.03.005

Steffens, E., Spriet, I., Van Eldere, J., & Schuermans, A. (2019). Compliance with evidence-based guidelines for the prevention of central line-associated bloodstream infections in a Belgian home care setting: An observational study. American Journal of Infection Control, 47(6), 723-725.  https://doi.org/10.1016/j.ajic.2018.10.019

Conley, S. (2016). Central line-associated bloodstream infection prevention: Standardizing practice focused on evidence-based guidelines. Clinical Journal of Oncology Nursing, 20(1), 23-26.  https://doi.org/10.1188/16.cjon.23-26

Ting, J. Y., Goh, V. S., & Osiovich, H. (2013). Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: A four-year surveillance. Canadian Journal of Infectious Diseases and Medical Microbiology, 24(4), 185-190.  https://doi.org/10.1155/2013/781690

Evidence Level *

(I, II, or III)

Level II

Level I

Level iv

Level III

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

The basis of this study was triggered by the aim at Quality improvement approaches that could address Healthcare-Associated infections.

The research aimed to assess Belgian home care nurses and good practices that prevent central line-associated bloodstream infections.

The research aimed to develop EBP approaches for implementation to standardize best-using practices that could reduce CLABSI.

The basis of the research was propelled by increased cases of CLABSIs as a result of central.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

A QI cycle approach was deployed along with a Quasi-experimental design

Using a retrospective cohort design, the author retrieved data for 1073 patients for the last two years.

The author never stated the method used for study(Conley, 2016).

A retrospective observational approach was used to study NICU in BC women’s hospital along with SPSS version 19.0 (IBM Corporation, USA) for statistical analysis.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

Over 563 sample hospitals were used, leading to a total of 86837-bed participants for baseline assessment and 681bed in the 2nd assessment.

The study involved patients whom UVCs had been inserted and had been diagnosed central line associated bloodstream infection between July 2016 and December 2017.

none

The population sample was patients on 60 beds within the facility

Major Variables Studied

List and define dependent and independent variables

Independent.

Age

Gender

Dependent.

Healthcare-associated infections

Time

Age and gender were considered as the independent variables and good nursing practice as dependent variables.

Age and time

Women aged 25 and above and neonates were considered for the study.

Time.

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

Questionnaires were used to gather data from hospitalized patients and nurses handling them.

A QI cycle approach was used to ascertain the healthcare status for improvement.

a retrospective cohort design

A retrospective observational approach was deployed to collect data for the study.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

The data were analyzed using the quantitative approach, where 563 hospitals were evaluated.

Randomized controlled trials (RCTs) was used for the study. This was a purely quantitative approach in which 11 RCTs were composed of 5135 participants.

Not specified

The qualitative research method was used together with SPSS version 19.0 (IBM Corporation, USA) for statistical analysis to analyze and draw a conclusion on the data collected.

Findings and Recommendations

General findings and recommendations of the research

Hand hygiene and the existence of antimicrobial prescriptions were among the interventions that led to decreased healthcare-associated infections.

Healthcare facilities need to adopt the interventions mentioned above to curb increased cases of HAIs.

The study found that bundle application helps to reduce UVC associated bloodstream infections.

Heavy microbial colonization at catheter hub exposes patients to CLABSI

The result obtained indicated that median weight as well as gestational age of the neonates with central line associated bloodstream infections reduce over time. Neonates with extremely low birth weight were vulnerable to CLABSIs(Conley, 2016).

Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of the study?

What are the risks associated with the implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

The essence of this study was to find out best interventions that could be applied to reduce the burden of HAIs in various hospitals.

The primary strength of the study is that it collected adequate data from reliable sources and used Quasi experiment to assess the validity of the data collected.

The risk of this study is that it may expose researchers to infections.

Given that data was obtained from reliable sources, there is an increased possibility of implementing the practice.

The study provides insights on the central line associated infections and the essence of bundle application to reduce such infections.

The strength of the study is that it extensively assessed various hospitals and patients of different ages.

Disease contraction is one of the risks.

95% probability of adopting the said interventions(Conley, 2016)

Its worth was to find out major CLABSI predisposing factors and how to curb such factors.

The study never used any recognized method of study, data analysis, nor variables that could produce reliable results.

Given that the study never included required methods and approaches for the study, the feasibility will be as low as 15%

The research was quality and explored various factors leading to increased CLABSIs among the neonates and their mothers while in hospitals.

The strength of the study so that it focused on women and neonates, who are the most vulnerable population.

Its weakness is that it only concentrated on one centre.

The findings provide insights for adopting best practices that could reduce CLABSIs in healthcare facilities and the chances of this increase of its adoption and implementation.

Key findings

Hand hygiene monitoring and the use of antimicrobial prescription methods will help reduce HAIs.

Bundle applications effectively reduce UVC associated bloodstream infections among preterm infants.

The study concluded that nurses need to remain keen and attentive on the principles of practices of aseptic approaches that prevent CLABSI.

Multidisciplinary EB quality improvement and nurse collaboration significantly reduce CLABSIs.

Outcomes

Healthcare-related infections are accelerated with a lack of proper mechanisms and protocols that reduce hospital-acquired infections.

The results obtained indicated that there is a need for the improvement of strategies to prevent central line associated bloodstream infections(Conley, 2016).

Nurses should adhere to best practices that minimize infections.

The study adopted and implemented the policy of immediate wiping away excess chlorhexidine using normal saline to prevent exposure of delicate premature infants’ skin to the antiseptic solution.

General Notes/Comments

The QI cycle approach provides the framework that could be used to ensure patient safety is guaranteed while receiving medical care.

Randomized controlled trials (RCTs) generated results that could be used to implement better approaches to reduce the infection mentioned above.

I urge the author to make use of the available method of research to clary the finings better.

The research was well conducted with quality findings that could help reduce CLABSIs in hospitals.