Name
Capella University
NURS-FPX8030: Evidenced-Based Literature: Search and Organization
Prof Name
September, 2024
Problem Statement
The patient safety issue identified for this evidence-based practice (EBP) project is the increasing incidence of medication errors in hospital settings, which can lead to significant adverse patient outcomes, among the consequences are prolonged hospital stays, increased healthcare costs, and in extreme cases, death (Santos et al., 2022). There are standardized procedures, and the safety systems integral to hospitals do not always seem to protect the patients, indicating a critical need for improved practices and interventions. The project aims to address this issue by investigating effective strategies to reduce medication errors through a systematic review of current literature. By focusing on evidence-based interventions, the goal is to enhance medication administration processes and ultimately improve patient safety and care quality within healthcare facilities.
PICOT Question
PICOT question, derived to address the problem, is as follows: Will the use of standardized infection control protocol in an ICU reduce the incidence of catheter-associated urinary tract infections (CAUTI) in adults with indwelling catheters over 2-3 months compared to current infection prevention practices?
Population (P): Adult inpatients with indwelling catheters in an ICU.
Intervention (I): Standardized infection control protocol for catheter care.
Comparison (C): Current infection control practices for CAUTI prevention.
Outcome (O): Reduce catheter-associated urinary tract infections (CAUTIs)
Time (T): 2-3 months
Evidence and Gap in Healthcare
The gap, therefore, identified here in health care is the inconsistency and variability in catheter care practices in the varied ICUs, which subsequently leads to the continued prevalence of CAUTIs despite clear guidelines (Kranz et al., 2020). Indeed, evidence points to standardized, evidence-based protocols for infection control-which would include timely removal of the catheter, high-grade hygiene, and educational training of staff in reducing the rate of CAUTI. Many hospitals lack the uniformity and adherence required to fully implement these protocols, including many preventable patient safety risks.
Narrative of Search Strategy
I used a systematic approach to retrieve the best evidence on the PICOT question of decreasing catheter-associated urinary tract infections (CAUTIs). To begin with, I found keywords that summarize the PICOT question, which include CAUTIs, infection control, ICU, catheter care protocols, and healthcare-associated infections (Obaid, 2021). I then combined these words using Boolean operators, either AND or OR, depending on whether it narrows or expands the search. Databases used include PubMed, CINAHL, and Cochrane Library, thus ensuring full coverage of peer-reviewed articles, guidelines, and systematic reviews. Filters were applied to limit the search results to the last five years to ensure the relevance of the evidence. Further refinements included limiting the search to full-text, peer-reviewed studies with exclusion of articles not providing information for the prevention of CAUTI in hospital settings.
Once preliminary results were obtained, inclusion and exclusion criteria were formulated. This researcher tended to give preference to those studies that included adult inpatients of the intensive care units, whose infection control protocols were tested using standardized methods, and where the result of CAUTI was reported. Those articles that did not restrict their activities to the ICU setting used only pediatric populations, or lacked information about interventions related to catheter care were excluded. The final selection was based on the strength of evidence, the methodological rigor of the study, and its relevance to the PICOT question. This strategy ensured that the literature review was comprehensive and conducted with studies that directly related to the problem in question: safety, CAUTIs, and critical care environments.
Appropriate Databases and Robust Keywords
A focused search through peer-reviewed health care and nursing databases, namely, PubMed, CINAHL, and the Cochrane Library, was conducted to retrieve the best available evidence on the reduction of catheter-associated urinary tract infections among patients in intensive care units (Goossen et al., 2020). Note: The databases were selected based on the extensive number of reliable peer-reviewed journals housed by the databases. Keywords used during the search are CAUTIs, infection control, ICU protocols, and healthcare-associated infections. Boolean operators combined the terms, refining the search to ensure relevance. Filters were applied in this search only to include articles from the last five years thereby ensuring current evidence to answer the PICOT question.
Inclusion/Exclusion Criteria for Articles
Articles would be selected to include studies published in the last five years, peer-reviewed, and directly relevant to catheter-associated urinary tract infections (CAUTIs) in intensive care units (ICUs). Articles that specifically dealt with the issues of infection control protocols, standardized catheter care, and healthcare-associated infections (HAIs) would be prioritized (Gad & Abdel Aziz, 2021). Studies that are not ICU-specific, irrelevant to infection control, or older than five years were excluded. Through the initial search, it was considered that six articles were relevant to the PICOT question to move the articles to the final stage of analysis. They were considered because they indicated how standardized interventions can reduce CAUTI rates in the area of the ICU nearest to the aim of the project in ensuring the implementation of patient safety through evidence-based practice.
NURS FPX 8030 Assessment 2 References
Gad, M. H., & AbdelAziz, H. H. (2021). Catheter-associated urinary tract infections in the adult patient group: A qualitative systematic review on the adopted preventative and interventional protocols from the literature. Cureus, 13(7). https://doi.org/10.7759/cureus.16284
Goossen, K., Hess, S., Lunny, C., & Pieper, D. (2020). Database combinations to retrieve systematic reviews in overviews of reviews: a methodological study. BMC Medical Research Methodology, 20(1). https://doi.org/10.1186/s12874-020-00983-3
Kranz, J., Schmidt, S., Wagenlehner, F., & Schneidewind, L. (2020). Catheter-associated urinary tract infections in adult patients—preventive strategies and treatment options. Deutsches Aerzteblatt Online, 117(6). https://doi.org/10.3238/arztebl.2020.0083
Obaid, N. A. (2021). Preventive measures and management of catheter-associated urinary tract infection in adult intensive care units in Saudi Arabia. Journal of Epidemiology and Global Health. https://doi.org/10.2991/jegh.k.210418.001
Santos, O. P. D., Melly, P., Hilfiker, R., Giacomino, K., Perruchoud, E., Verloo, H., & Pereira, F. (2022). Effectiveness of educational interventions to increase skills in evidence-based practice among nurses: the editcare systematic review. Healthcare (Basel, Switzerland), 10(11), 2204. https://doi.org/10.3390/healthcare10112204
Appendix: PRISMA 2020 Flow Diagram for Systematic Review
Steps for Identification of Studies through Databases
Name the Databases Used:
The following databases have been used to collate information for the systematic review:
- Databases that were searched for acquiring literature for this systematic review included PubMed, CINAHL, and the Cochrane Library, as these most closely link to healthcare and research studies and infection control.
- Thirty articles were determined to be relevant: twelve through PubMed, ten through CINAHL, and eight through the Cochrane Library.
- All of the articles were within the last five years to obtain the most current information about how to prevent CAUTI.
- The research question, guided through the PICO(T) framework, was about how a standardized infection control regimen impacts the incidence of CAUTIs in a hospital-based setting.
Several records were removed before screening; two were duplicates, and another two were excluded by automation tools, while the last one had an unknown reason for its removal.
- Title and abstract screening of twenty-five studies provided relevant details on the prevention measures of CAUTI, which include the management protocols for urinary catheters and hygiene interventions.
- Five articles were excluded because they did not provide the PICO(T) question that needs to be answered; thus, the result narrowed down to twenty reviews in full text.
- Twelve articles have been chosen and the source article was published in English in the past five years. All the articles chosen were solely related to the prevention of CAUTI.
- Such studies would explain intervention strategies, patient outcomes, and the effectiveness of standardized infection control practices.
This left eight articles excluded from full-text review, for a variety of reasons: three were focused in other settings than hospitals, two were unavailable as full texts, one was in a language other than English, and two failed rigorous peer review/methodology.
