DEVELOPING PICO 1
Developing a PICO Question
Nicole L. Gardner
Nursing Research 500
College of Nursing, Liberty University
Author Note
Nicole Gardner
I have no known conflict of interest to disclose. Correspondence concerning this article
should be addressed to Nicole Gardner. Email: nlgardner@liberty.edu
DEVELOPING PICO 2
Annotated Bibliography
1. Azar, J., Kelley, K., Dunscomb, J., Perkins, A., Wang, Y., Beeler, C. …Boustani, M.
(2019). Using the agile implantation model to reduce central line-associated bloodstream
infections. AJIC: American Journal of Infection Control, 47(1), 33-37.
https://doi.org/10.1016/j.ajic.2018.07.008
This article discusses that Central line-associated bloodstream infections (CLABSIs) are
among the most common hospital-acquired infections and can lead to increase patient morbidity
and mortality rates. Implementation of practice guidelines and recommended prevention bundles
has historically been suboptimal, suggesting that improvements in implementation methods
could further reduce CLABSI rates. The article describes the agile implementation methodology
and present details of how it was successfully used to reduce CLABSI.
2. Bell, T., MD, & O’Grady, N. P., MD. (2017). Prevention of central line-associated
bloodstream infections. Infectious Disease Clinics of North America, 31(3), 551-559.
doi:10.1016/j.idc.2017.05.007.
In this article it is discussed that central venous catheters (CVCs) are commonly used in
critically ill patients and offer several advantages to peripheral intravenous access. However,
indwelling CVCs have the potential to lead to bloodstream infections, with the risk increasing
with an array of characteristics, such as catheter choice, catheter location, insertion technique,
and catheter maintenance. Evidence-based guidelines have led to a significant reduction in the
incidence of bloodstream infections associated with CVCs. This combination of guideline
DEVELOPING PICO 3
implementation and newer technologies has the potential to further reduce morbidity and
mortality from infections related to CVCs.
3. Pronnovost, P. J., Watson, S. R., Goeschel, C. A., Hyzy, R. C., & Berenholtz, S. M.
(2016). Sustaining reductions in central line-associated bloodstream infections in
michigan intensive care units: A 10-year analysis. American Journal of Medical Quality,
31(3), 197-202. doi:10.1177/1062860614568647
This article describes the interventions that sustained low central line-associated
bloodstream infection (CLABSI) rates in the Michigan Keystone ICU Project. This analysis
included data from March 2004 to December 2013 for 121 intensive care units (ICUs) in 73
hospitals. The Keystone Project was a cohort collaborative with an improvement team in each
ICU. During the sustainability period, teams integrated the intervention into staff orientation,
collected and submitted monthly date, and reported infection rates to leaders. The annual mean
rate of blood stream infections dropped by 2.5 infections/1000 catheter-days in 2004 to 0.76 in
2014. A subset analysis found nearly double the percentage of ICUs with a mean rate of <1
infection/1000 catheter-days in 2013 compared to baseline. Active involvement of hospital
leaders and the Keystone Center as well as ongoing monitoring and feedback of performance
were important in sustaining results. These findings suggest that large scale improvement
projects can be sustained, establishing a new normal for care.
4. Lee, K. H., Coh, N. H., Jeong, S. J., Kim, M. N., Han, S. H., & Song, Y. G. (2018). Effect
of central line bundle compliance on central line-associated bloodstream infections.
Yonsei Medical Journal, 59(3), 376-382. doi:10.3349/ymj.2018.59.3.376
DEVELOPING PICO 4
This article focused their studies not only on patient of the intensive care unit, but also
from non-intensive care departments. The aim of this study was to evaluate the effect of
completing all of the central line bundle components on CLABSI rates. It went through the
exact bundle expectations: hand hygiene, use of maximum sterile barrier precautions, and the
selection of an appropriate site for central venous access. They studied 1672 patients over a 3
year timespan. Results showed that completing all of the components of the central line bundle
perfectly in each patient is essential for preventing CLABSIs. Infection prevention can improve
through education and training.
DEVELOPING PICO 5
P-I-C-O- Worksheet
I. Develop a clinical question using the PCIO format.
Patient/Problem/Phenomenon of Interest:
Infection in the central line of the patient. The population of interest specifically is adult men
and women patients in the intensive care unit.
Intervention:
Developing a CLABSI care bundle for patients who have central line.
Comparison: (if applicable)
No CLABSI bundle use
Outcome:
Reduction of CLABSI rates in the intensive care patient.
II. Write out your questions in sentence format:
Would a central line inserted peripherally rather than a chest location reduce the incidence of
CLABSI by 30-50% in adult men and women patients?
III. Identify search terms to select an article:
Central Line, CLABSI, Central Line Location, Bloodstream Infection,
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