NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization

In the case of patients’ safety, the rise of Hospital-Acquired Infection (HAI) in Intensive Care Units (ICUs) is a major public health concern. ICU-Acquired Infections (ICU-AIs) only contribute to more than 30% of all HAIs and are, therefore, a significant concern for patient outcomes (Blot et al., 2022). More so, investigations show that ICU patients are exposed to contracting infections, particularly when they have invasive lines, ventilators, or surgical wounds, as such infections can escalate to sepsis or even a longer hospital stay (Chapman et al., 2021). The cost impact of HAIs in the U.S. ranges 28 billion to $ 46 billion each year because of longer hospital stays, greater use of antimicrobials, and the need for further medical interventions (Gidey et al., 2023).

A gap in the current practice at Cass Regional Medical Center (CRMC) is proactively illustrated by the fact that daily Chlorhexidine Gluconate (CHG) bathing, which has been reported to decrease infection rate, is not being done as required. To fill this gap, a formal structured quality improvement intervention of CHG bathing is required to improve the processes of care and safety of patients within the ICU (Johns Hopkins Medicine, 2024). 

The PICOT Question

In critically ill patients in the ICU (P), how does the implementation of daily CHG baths (I) compared to standard methods (C) affect the rate of HAIs and safety outcomes (O) over 10 weeks (T)?

Search Strategy for Best Evidence

Formulating a search strategy is critical in the identification of the most appropriate evidence to answer the PICOT question for CRMC concerning critically ill patients admitted to the ICU and the effect of daily CHG baths on HAIs. The key ideas of the proposed PICOT question are a critically ill patient in the ICU, the intervention of daily CHG bath, comparison with standard soap and water bath, the outcome of HAI reduction, and patient safety (Peixoto et al., 2024).

PubMed, CINAHL and the Cochrane Library were chosen for the search because they offer a vast collection of biomedical and nursing literature (Enticott et al., 2021). This systematic approach is designed to obtain the best possible evidence that would help to introduce CHG bathing in the ICU. The search summary is illustrated in the Appendix as a PRISMA chart, which details the identification, screening, inclusion, and exclusion of studies throughout the search process.

Databases and Keywords

Choosing the right databases and the right keywords is crucial in a successful search to obtain the best evidence about the feasibility of daily CHG baths in the ICU. Databases like PubMed database, CINAHL, and Cochrane Library were used (Enticott et al., 2021). Some strong key terms like Chlorhexidine gluconate, CHG bathing, ICU-acquired infections, hospital-acquired infections, critical care, and patient safety outcomes were used. Applying Boolean operators such as AND, OR, and NOT enhanced the search process and identified appropriate research to inform improvements to quality (Enticott et al., 2021).

Inclusion and Exclusion Criteria

Based on the PICO(T) question and the established search strategy, the inclusion criteria for the retained articles were as follows. Studies must meet the following criteria: the studies must be randomized controlled trials, systematic reviews, or meta-analyses issued in English; they must examine the implementation of daily CHG bathing compared to standard water and soap baths; they must report the incidence of HAIs as an outcome measure; and they are restricted to ICU or critical care units, and published in or after 2020 (Wanyama et al., 2021).

On the other hand, studies that were conducted outside hospitals, studies that did not report HAIs as an outcome of the intervention, studies written in other than English language, and any studies done and published before the year 2020 were excluded (Wanyama et al., 2021). Applying these criteria, 15 articles were selected for further analysis. All these articles provided strong evidence for the use of CHG bathing in decreasing HAIs in critical patients in the ICU environment.

References

Blot, S., Ruppé, E., Harbarth, S., Asehnoune, K., Poulakou, G., Luyt, C.-E., Rello, J., Klompas, M., Depuydt, P., Eckmann, C., Martin-Loeches, I., Povoa, P., Bouadma, L., Timsit, J.-F., & Zahar, J.-R. (2022). Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive and Critical Care Nursing, 70(103227). https://doi.org/10.1016/j.iccn.2022.103227

Chapman, L., Hargett, L., Anderson, T., Galluzzo, J., & Zimand, P. (2021). Chlorhexidine gluconate bathing program to reduce healthcare–associated infections in both critically ill and non–critically ill patients. Critical Care Nurse, 41(5), e1–e8. https://doi.org/10.4037/ccn2021340 

Enticott, J., Johnson, A., & Teede, H. (2021). Learning health systems using data to drive healthcare improvement and impact: A systematic review. Biomed Central Health Services Research, 21(1), 1–16. https://doi.org/10.1186/s12913-021-06215-8 

NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization

Gidey, K., Gidey, M. T., Hailu, B. Y., Gebreamlak, Z. B., & Niriayo, Y. L. (2023). Clinical and Economic Burden of healthcare-associated infections: A Prospective Cohort Study. Public Library of Science, 18(2), e0282141. https://doi.org/10.1371/journal.pone.0282141

Johns Hopkins Medicine. (2024, August 19). CHG bathing to prevent healthcare-associated infections. Hopkinsmedicine.org. https://www.hopkinsmedicine.org 

Peixoto, É. A. C., Poveda, V. de B., Gnatta, J. R., & Oliveira, R. A. (2024). Bathing with wipes impregnated with chlorhexidine gluconate to prevent central line-associated bloodstream infection in critically ill patients: A systematic review with meta-analysis. American Journal of Infection Control, 52(6), 731–738. https://doi.org/10.1016/j.ajic.2024.01.019 

Wanyama, S. B., McQuaid, R. W., & Kittler, M. (2021). Where you search determines what you find: The effects of bibliographic databases on systematic reviews. International Journal of Social Research Methodology, 25(3), 1–13. https://doi.org/10.1080/13645579.2021.1892378 

Appendix

Identification of Studies Via Databases and Registers

Search Strategy

• Selecting Databases: The most appropriate databases for the literature search were selected, including PubMed for biomedical literature, CINAHL for allied health, and the Cochrane Library for reviews and evidence-based resources. These databases ensure a comprehensive search for relevant studies on the topic.
• Initial Search Results: The initial search yielded 4 records from the selected databases and none from registers. The findings are illustrated in the PRISMA flow diagram located in the appendix.
• Screening Process: To refine the search, Boolean operators (“AND,” “OR,” “NOT”) were utilized to create a more targeted search strategy. This included combinations such as “Chlorhexidine AND ICU-acquired infections,” which helped to narrow the focus. The search was also limited to studies published within the last five years to ensure the relevance and currency of the evidence.

NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization

• Eligibility Criteria: From the studies identified, we applied inclusion and exclusion criteria based on relevance to the PICOT question. A total of seven studies were involved in the review after screening for their alignment with our PICO(T) framework.
• Excluded Studies: One report was omitted because it did not meet the predefined eligibility standards, which ensured that the remaining studies were pertinent to our intervention and patient population.
• Included Studies: Seven studies were ultimately included in the review. These studies were evaluated for quality, reliability, and relevance to our PICOT question, focusing on the effectiveness of CHG bathing in reducing HAIs in critically ill patients.
• PRISMA Flow Diagram: The PRISMA flow diagram visually represents the search process, detailing the number of records identified, screened, included, and excluded. This diagram serves as a transparent overview of our systematic approach to gathering the best available evidence.