Literature Evaluation Table

The purpose of this assignment is to provide research evidence in support of the PICOT you developed for your selected topic.

Conduct a search for 10 peer-reviewed, translational research articles published within the last 5 years that demonstrate support for your PICOT. You may include previous research articles from assignments completed in this course. Use the “Literature Evaluation Table” provided to evaluate the articles and explain how the research supports your PICOT.

Once your instructor returns this assignment, review the feedback and make any revisions necessary. If you are directed by your instructor to select different articles in order to meet the assignment criteria or to better support your PICOT, make these changes accordingly. You will use the literature evaluated in this assignment for all subsequent assignments you develop as part of your evidence-based practice project proposal in this course and in NUR-590, during which you will synthesize all of the sections into a final written paper detailing your evidence-based practice project proposal.

PICOT:

Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	Article Title and Year Published	Research Questions/ Hypothesis, and Purpose/Aim of Study	Design (Quantitative, Qualitative, or other)	Setting/Sample	Methods: Intervention/ Instruments	Analysis/Data Collection	Outcomes/Key Findings	Recommendations	Explanation of How the Article Supports Your Proposed EBP Practice Project Proposal
Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., … Granger, B. B. (2021). Results of the Chlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line-associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial. Implementation Science: IS, 16(1), 45. doi:10.1186/s13012-021-01112-4. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	2021	CLABSI causes up to 28000 deaths yet it is preventable. Bathing with CHG has proved to reduce harm yet its uptake in the clinical setting is poor. The study aimed to evaluate the effect of the implementation of a multifaceted program on nurses’ compliance to the bathing process with chlorhexidine and documentation into electronic health records. The secondary objective was to determine the effects of the intervention on the rate of CLABSI.	Qualitative – Clustered-randomized design and clustering of units into 4 sequences using step wedge.	14 clinical units were used, 8 being university hospitals while 6 were hospitals in community settings.	Conducting education outreach feedback and auditing. Daily bathing of patients with Chlorhexidine gluconate (CHG). The study was guided by the Grol and Wasening model of Implementation	Champion nurses for infection prevention and control observed nurses providing CHG baths. The champion nurse documented the body parts bathed with CHG and conducted an audit while remaining anonymous. Data obtained was fed into RedCap for analysis. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	Compliance with the bathing process and the perception and knowledge towards bathing with CHG improved. There was a decrease in the rate of CLASI by 27.4% (Reynolds et al., 2021)	Conducting educational outreach, assessing feedback, and conducting periodic audits can improve knowledge and adoption of using CHG to bath patients thus leading to reduced CLABSI. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	This article is essential in improving nurses` knowledge about the process of bathing patients with CHG and its importance. Also, educating and engaging nurses in practice is essential in lowering CLABSI.
Urbancic, K. F., Mårtensson, J., Glassford, N., Eyeington, C., Robbins, R., Ward, P. B., … Bellomo, R. (2018). Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition. Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine, 20(2), 109–116. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29852849/	2018	CHG bathing reduces the rate of CLABSI as evidenced in many settings. The effectiveness of CHG had not been established in Australia. The objective was to the effectiveness of introducing CHG bathing in preventing CLABSI and multi-drug resistant organisms.	Sequential, single-centered observation study	The study was conducted in a tertiary Australian ICU. 4262 patients were included in the study	Bathing daily using CHG was compared with triclosan in preventing CLABSI	Nurses were observed as they conducted the bathing process. Clinical and microbiological data of patients were compared before and 12 months after the introduction of CHG bathing	The findings revealed a significant decrease in MRSA with minimal change in the rate of CLABSI (Urbancic et al., 2018). NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	The bathing process with CHG should be done appropriately	The result showed a reduced rate of MRSA which is a common cause of CLABSI. This research conquers with my PICOT in reducing CLABSI through reducing the rates of MRSA.
Denny, J., & Munro, C. L. (2017). Chlorhexidine bathing effects on health-care-associated infections. Biological Research for Nursing, 19(2), 123–136. https://doi.org/10.1177/1099800416654013	2017	Skin colonization with microbial leads to increased incidences of hospital-acquired infections including CLABSI. Appropriate use of CHG helps in preventing CLABSI. The purpose of the research was to assess the impact of CHG based on literature. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	A literature search of peer-reviewed articles	23 articles were reviewed	Comparison of different results from different pieces of literature concerning the effectiveness of bathing with CHG. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	A literature search from PubMed and CINANHL.	The results showed that incorporation of CHG bathing leads to reduced CLABSI, MRSA, and surgical site infections incidences (Denny & Munro, 2017).	CHG bathing should be standard practice that helps in preventing HAIs. Monitoring of resistance should also be monitored. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	The literature from this research reveals that the use of CHG is simple and effective in preventing CLABSI and therefore, should be incorporated into clinical practice to reduce the rate of infections. this will in turn reduce hospitalization time and cost of treatment.
Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining nurses’ perspectives and experiences. BMC Infectious Diseases, 17(1), 75. https://doi.org/10.1186/s12879-017-2180-8	2017	The hypothesis of the study was based on the assumption that daily bathing of ICU patients with CHG reduces the risk of HAIs. The objective was to assess facilitators and barriers to daily bathing while describing the process of bathing using CHG. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	Qualitative study using semi-structured interviews.	The study was conducted in a veterans administration hospital. 26 individuals working in the ICU were included in the study.	The bathing process was demonstrated while identifying the barriers and facilitators of the process. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	Data was collected using semi-structured interviews that lasted an average of 26 minutes. Qualitative content analysis was used for the analysis and coding of data.	The research revealed some barriers to bathing patients with CHG included workload, scheduling, and some patient factors including hypersensitivity, general hygiene, and patient refusal (Musuuza et al., 2017). Facilitators of the process included the availability of CHG soap, the policy of bathing with CHG daily, and reminders by nurse managers.	Addressing barriers related to patients, staff, and the organization should be done to improve the process of bathing. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	The study is useful in addressing some barriers and facilitators to CHG bathing. Putting in place measures that counter those barriers can lead to enhanced adoption of CHG bathing in ICU patients. This can result in decreased CLABSI while enhancing patient outcomes.
Zerr, D. M., Milstone, A. M., Dvorak, C. C., Adler, A. L., Chen, L., Villaluna, D., Dang, H., Qin, X., Addetia, A., Yu, L. C., Conway Keller, M., Esbenshade, A. J., August, K. J., Fisher, B. T., & Sung, L. (2020). Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children’s Oncology Group. Cancer, 127(1), 56–66. https://doi.org/10.1002/cncr.33271 Giri, V. K., Kegerreis, K. G., Ren, Y., Bohannon, L. M., Lobaugh-Jin, E., Messina, J. A., Matthews, A., Mowery, Y. M., Sito, E., Lassiter, M., Saullo, J. L., Jung, S.-H., Ma, L., Greenberg, M., Andermann, T. M., van den Brink, M. R. M., Peled, J. U., Gomes, A. L. C., Choi, T., … Sung, A. D. (2021). Chlorhexidine gluconate bathing reduces the incidence of bloodstream infections in adults undergoing inpatient hematopoietic cell transplantation. Transplantation and Cellular Therapy, 27(3), 262.e1-262.e11. https://doi.org/10.1016/j.jtct.2021.01.004	2020 2021	The hypothesis of the study was based on the fact that CHG reduced rates of CHG. However, its efficacy had not been tested in oncology patients or those undergoing hematopoietic stem cell replacement Bloodstream infections account for up to 45% of infections in patients undergoing allogeneic HC (Giri et al., 2021). The use of CHG in critically ill reduces the rates of infection. The objective of the study was to assess the impact of bathing with CHG on the adult patient undergoing allogeneic HCT.	Randomized, placebo-controlled trial Prospective cohort study	The study was carried out in 36 centers in Canada and the USA. Patients > 2 months and <22 rears were eligible for the study. 177 patients were enrolled in the study. The study was conducted at the Duke University Medical Center for 3 years. 192 patients were assessed while grouped into 4 categories.	Patients were grouped into 2 groups. One group was used as a control while the other group was bathed daily using CHG for 90 days. Patients were grouped into 4 based on the compliance to CHG use. Categories include high, medium, low, and none.	Blood cultures were performed on enrolled patients to determine the various causes of infections. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table Blood cultures were collected to assess the presence of infection. Analysis was done using a univariate trend. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	The result revealed minimal effects of CHG in reducing infections in patients undergoing allogeneic HCT. The group receiving CHG had a CLABSI rate of 5.44 compared to 3.10 in the control group (Zerr et al.). However, the study was stopped due to poor accrual. The results showed a reduced rate of bloodstream infection by 15.6% on those who frequently used CHG.	The use of CHG did not show much effect in cancer patients, however, more studies should be conducted to ascertain its effect. Premature stoppage of the study may have influenced the results negatively. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table Daily bathing of adults undergoing allogeneic HCT is beneficial should be implemented in patients with cancer. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	This study was useful in explaining some incidences when CHG use is not beneficial. This gives clear guidelines about the kind of patients that will benefit from a certain intervention. It also provided a platform on which future researches will be based. The research supports my PICOT question on the effectiveness of CHG in reducing CLABSI.
Lowe, C. F., Lloyd-Smith, E., Sidhu, B., Ritchie, G., Sharma, A., Jang, W., Wong, A., Bilawka, J., Richards, D., Kind, T., Puddicombe, D., Champagne, S., Leung, V., & Romney, M. G. (2017). Reduction in hospital-associated methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus with daily chlorhexidine gluconate bathing for medical inpatients. American Journal of Infection Control, 45(3), 255–259. https://doi.org/10.1016/j.ajic.2016.09.019		The study aimed at evaluating the effectiveness of CHG bathing in reducing MRSA in noncritical patients. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	Prospective crossover study	The study was conducted in a Canadian academic hospital for 8 months	CHG was used on a group of patients while the controls bathed using water and nonmedicated soap.	Blood cultures and lab results were used as data. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	The results showed that 58% of individuals complied with CHG bathing. The rate of hospital associate MRSA decreased by 55% for those who complied with CHG compared to 36% for controls (Lowe et al., 2017).	Daily bathing with CHG in noncritical patients is effective in reducing MRSA and vancomycin-resistant Enterococcus (VRE).	The research is useful in stressing the efficacy of chlorhexidine overuse of nonmedicated soap in the prevention of infection. My PICOT assesses the same effect.
Reagan, K. A., Chan, D. M., Vanhoozer, G., Stevens, M. P., Doll, M., Godbout, E. J., Cooper, K., Pryor, R. J., Hemphill, R. R., & Bearman, G. (2019). You get back what you give: Decreased hospital infections with improvement in CHG bathing, mathematical modeling, and cost analysis. American Journal of Infection Control, 47(12), 1471–1473. https://doi.org/10.1016/j.ajic.2019.07.003 NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	2019	the hypothesis of the study was based on previous results that demonstrated the impact of CHG in reducing the rate of HAIs. The objective of the study was to determine the effects of reduced HAIs on the cost of care. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	Mathematical analysis using Markov Chain.	The study compared to different studies that showed reduced incidences of CLABSI CAUTIs.	The cost of caring for patients with CHG verse those without was compared	The study revealed that reduction of HAIs by 32% attributed to the use of CHG lead to reduced cost of care by $815,301.75 (Reagan et al., 2019).	Compliance with CHG bathing is beneficial in reducing the cost of treatment and should be implemented in the care of critically ill patients.	The finding from the research conquers the objectives derived from my PICOT which aim at reducing cost through reducing infection rates. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	Understanding the impact of reduced infection on the reduction of cost of care is essential in encouraging healthcare workers to adhere to simple rules to save the lives of patients.
Eggimann, P., Pagani, J.-L., Dupuis-Lozeron, E., Ms, B. E., Thévenin, M.-J., Joseph, C., Revelly, J.-P., & Que, Y.-A. (2019). Sustained reduction of catheter-associated bloodstream infections with the enhancement of catheter bundle by chlorhexidine dressings over 11 years. Intensive Care Medicine, 45(6), 823–833. https://doi.org/10.1007/s00134-019-05617-x		The study hypothesis was based on evidence from prospective randomized control that demonstrated the positive impact of using CHG in reducing CLABSI.	Real-world data study in a stepwise manner.	The study was carried out in Switzerland in the ICU of Centre Hospitalier Universitaire Vaudois (CHUV) and another referral hospital. Only available patients were studied irrespective of their conditions. The study was done from 2006 to 2018.	The intervention was provided in a step-wise model. Catheter bundle care was observed with a gradual introduction of CHG in care. CHG gel and sponge dressing were used.	Data regarding the length of stay in the hospital and ICU were collected from each patient. SAPS II score was used. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	The results revealed a progressive decrease in the rate of CLABSI over time with the introduction of CHG over the eleven years (Eggimann et al., 2019).	The use of CHG in the catheter bundle showed a reduction in the rate of CLABSI. This recommends for its daily use in caring for patients. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	This study was useful in expanding the importance of CHG in caring for the patient. Knowledge from this study can be used in improving care to reduce infection rates.
Patel, P. K., Greene, M. T., Jones, K., Rolle, A. J., Ratz, D., Snyder, A., Saint, S., & Chopra, V. (2019). Quantitative results of a national intervention to prevent central line-associated bloodstream infection: A pre-post observational study: A pre-post observational study. Annals of Internal Medicine, 171(7_Suppl), S23–S29. https://doi.org/10.7326/M18-3533		CLABSI is still prevalent in most hospitals in the USA. The goal of the study aimed to evaluate the effects of multimodal interventions in the reduction of HAIs	Observational study using clustered non-randomized trial in 3 cohorts of the hospital.	The study included 462 hospitals, 24 within Colombia district with other hospitals in rural and urban centers	The nursing staff was provided with knowledge about the care of patients through webinars, videos, and interaction with experts. A device proven to reduce the rate of HIAs was used on patients. NUR 550 Evidence-Based Practice Project: Evaluation of Literature Table	Data was collected using tabulations. Further information was retrieved from hospital records. The results were compared at pre and post-interventional periods.	At the beginning of the study, the CLABSI rates were at 71.4 per 1000 catheter days. During the intervention and post-intervention period, the rate of CLABSI reduced to 0.80 per 1000 catheter days (Patel et al., 2019). Device utilization rate decreased during and after the study.	The multimodal approach is effective in reducing the rates of CLABSI when used appropriately. More research was to be done to show the efficiency of the device in reducing HAIs. NUR 550 Evidence-Based Practice Project: Evaluation of Literatu

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Literature Evaluation Table