Clinical Question
Research Question
The formulation of this research question was done based on a PICOT etiology format. The research question for this study is: For hospitalized adult patients, does reduce days of an indwelling catheter compared to a prolonged catheter decrease CLABSI rates in a medical-surgical unit?
The population (P) is hospitalized adult patients undergoing medical surgery. The issue of interest (I) is reducing the period of indwelling catheter insertion in the hospitalized patient. The comparison (C) is made with prolonged catheter insertion beyond the required duration. The outcome (O) is the reduced number of CLABSI rates and readmission in a medical-surgical unit.
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Purpose of Paper
Hospital-acquired infections are increasingly becoming common in hospitals while causing rapid morbidity and mortality as well as the high cost of hospital stay. The central line-associated bloodstream infection (CLABSI) is one of the hospitals acquired infection that has been responsible for a high rate of hospital-acquired infections. Historically, CLABSI was viewed as a normal consequence of hospitalization. However, the prevalence of this infection and its risk of becoming a potentially life-threatening infection has raised a concern and a need to prevent it. Physicians and nurses contribute to the development of this condition among hospitalized patients through inappropriate use of the devices. As a result, there is a need for an evidence-based approach to decrease the incidence of CLABSI in hospitals. The purpose of this paper is to assess the different studies conducted on CLABSI and use then to answer the clinical question. The paper used library databases to search for peer-reviewed research articles on this topic.
Search Strategy
Search Terms
The research for this paper was conducted to collect data on the issue from previous studies on this topic. We carried out a retrospective literary search and data analysis using two approaches as a way of getting triangulating data. The literary search focused on all articles between 2000 and 2019. It provided an opportunity to obtain large qualities of data on the issue of hospital-acquired infections within a short time.
The keywords and search terms used in this search included the following: CLABSI, indwelling CVC, hospital-acquired infection, neurological intensive care unit, and quality improvement.
Library Database
A systematic method review was conducted using the identified search terms to get more information on CLABSI and its effect on patients. The library databases used to collect data included CINAHL, EBSCO, and Medline. The search focused on getting articles that report on hospital-acquired infections and patient outcomes.
Availability of Articles
There were more than 35 articles in the library databases that addressed the issue of CLABSI and hospital-acquired infections. These articles comprised of both research and non-research articles from 2000 to 2019. These articles matched the search terms and keywords cued into the database.
Refinement Decisions
Changed Decision
The group changed a search strategy by altering the search words, using peer-reviewed articles and focusing articles that are less than five years old. The refinement entailed removing the non-research evidence on the use of catheters in preventing CLABSI and focused on the peer-reviewed research evidence that can help answer the clinical question.
The Rationale for Changing Decisions
The decision to change the search strategy was to get articles that are specific to answering the clinical research question. The refinement allows selecting two articles that were specific in how to reduce hospital-acquired infections using the right methods. At the same time, the decision was made since previous search terms were not specific enough to generate proper articles.
Availability of Articles
Eight research articles were available after the refinement strategy that was less than five years old and mostly peers reviewed. The article comprised the keywords and search items on how to prevent hospital-acquired infections.
Final Articles
Among the eight articles, we selected the first two that helped address the clinical question on CLABSI infection among hospitalized patients. The two articles were selected to provide the necessary information because they had results from previous research studies on the same topic. The two articles contained information on the evidence-based approaches to decrease the incident of CLABSI in hospitals
Levels of Evidence
The first research evidence is by Victor, Kalaivani Ramakrishnan, Easow & Venugopal (2019) conducted to identity the CLABSI rates post-intervention and compare them with the retrospective data. Researchers compared the CLABSI rates in patients when a bundled care approach was implemented with the rates before its implementation. As such, it was a quantitative study through experimentation to determine the effectiveness of a treatment method.
This article addressed the topic by showing that CLABSI infection rates can reduce with a strict adherence to bundle care and proper education of the ICU physicians. The study helped determine the best way of dealing with hospital-acquired infections. It qualifies as a level 1 evidence that involved a systematic review of randomized trials.
The second study was by Abdelmoneim, Ibrahim, Ahmed & Mohammed (2020) that studied the occurrence of CLABSI at pediatric intensive care units. This was a prospective observational study that involved 109 patients in pediatric intensive care units with a central venous catheter (CVC) inserted. The patients were observed for six months testing for CLABSI for any symptoms that a patient shows.
This article addressed the topic by explaining how to use the catheter for hospitalized patients. Results from the study showed no correlation between the CVC site and CLABSI development in a patient. In essence, this quantitative study helped understand the prevention of hospital-acquired infections. It qualifies as a level 2 evidence that involved observational study with dramatic effect.
Summary
The search was conducted to understand how reducing the period of catheter insertion can help reduce the prevalence of CLABSI in hospitalized patients. This was a retrospective study that used several keywords and searches terms to identify two articles that provided information on the clinical question. The selected articles from the library database showed how an indwelling catheter can be used to prevent hospital-acquired infections such as CLABSI.
Reference
Abdelmoneim, H. M., Ibrahim, H. M., Ahmed, A. R., & Mohammed, K. A. (2020). Incidence of Central Line-Associated Blood Stream Infection in Pediatric Intensive Care Unit (PICU). The Egyptian Journal of Hospital Medicine, 78(1), 136-141.
Victor, P. C. M., Kalaivani Ramakrishnan, M. H., Easow, J. M., & Venugopal, J. (2019). An Intervention Based Prevention of Catheter-Associated Blood Stream Infection in Adult Critical Care Unit. J Pure Appl Microbiol, 13(4), 2209-2214.
