Name
Capella University
NURS-FPX8030: Critical Appraisal of Evidence-Based Literature
Prof Name
September, 2024
Critical Appraisal of Evidence-Based Literature
Critical evaluation of evidence-based literature is the process through which the relevance, quality, and credibility of research studies are evaluated to inform clinical practice, especially in addressing patient safety issues (Patelarou et al., 2020). In EBP, critical appraisal tools like the CASP tool, help in developing an understanding of the applicability, bias, and methodological rigor of studies. This process will enable healthcare workers to determine the best evidence that is available and very necessary when coming up with interventions to deliver to clients with a view to improving patient outcomes. For instance, assessing a study through a qualitative, quantitative, or mixed approach would be the basis for the selection of proper evidence-based interventions. This review aims to identify and address a patient safety issue through a rigorous review of peer-reviewed articles from the last five years, using the refinement of PICO(T) to guide the scope of the study. In the end, recommendations for interventions should be both evidence-based, as taken from the best practices that can be found in scholarly literature, as well as feasible within an organization.
Summary of the Healthcare Safety Problem
Two of the infections that pose a threat to patient safety in Johns Hopkins Hospital are Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections (CDI). These infections continue to pose threats to patient safety, prolong lengths of stay, increase treatment costs, and heighten mortality rates. Both types of infection remain challenging infections on both surgical and medical-surgical units, even as infection control programs continue unabated. More improved strategies for infection control are necessary to decrease prevalence while improving the overall outcomes of the patients. The interventions evidenced should aim at reducing infections through both prevention and transmission-based reduction.
PICO(T) Research Question
In patients admitted to Johns Hopkins Hospital (P), does a hospital-wide antimicrobial stewardship program compared with standard infection control practices (I) alter the rates of MRSA and Clostridium difficile infections (O) over a six-month period (T)?
Patient Population (P): Patients admitted to Johns Hopkins Hospital
Intervention (I): Implementation of a hospital-wide antimicrobial stewardship program
Comparison (C): Institutional standard infection control practices
Outcome (O): Reduction of the incidence rate of MRSA and Clostridium difficile infection
Time (T): Six months
Thesis Statement
For six months, standard institutional infection control practices were compared with an intervention to reduce the rates of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium Difficile (C. difficile) infection.
This study aims to critically discuss the increasingly reported cases of Methicillin-resistant Staphylococcus aureus and Clostridium Difficile infections at Johns Hopkins Hospital, critically review the current literature on infection prevention strategies, and offer evidence-based recommendations for interventions toward the improvement of patient safety and decrease in infection rates within the hospital (Leas et al., 2023).
Critical Appraisal and Selection of Tool
To appraise the literature, I’ll be using the CASP tool, which is well-suited to fulfill all criteria in assessing the validity, relevance, and trustworthiness of research studies in particular within the field of health care. Furthermore, the CASP tool provides an easy-to-follow and structured approach to the analysis of qualitative and quantitative studies, where there is a comprehensive assessment of the method, bias, sample size, results, and application to practice. This tool was selected as it allows a critical overall appraisal of the evidence, which will enable a move to the identification of high-quality research, potentially informing evidence-based interventions for patients regarding issues such as MRSA and Clostridium difficile infections. Moreover, this CASP tool ensures that the studies reviewed are credible and relevant to the clinical context at Johns Hopkins Hospital, and it is therefore a good choice for the evaluation of literature relevant to infection prevention.
Annotated Bibliography
Shukla, S., Cortez, J., Renfro, B., Kartikeya, M., Timmons, C., P. Sireesha, N., Hazboun, R., Dababneh, R., Hoopes, C., VanRavestein, J., McCarter, Y., Middlebrooks, M., Ingyinn, M., Alvarez, A., & Hudak, M. L. (2020). Charge nurses taking charge, challenging the culture of culture-negative sepsis, and preventing central-line infections to reduce NICU antibiotic usage. American Journal of Perinatology, 39(08), 861–868.https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0040-1719079
The study by Shukla et al., (2020) aims to establish the effectiveness of broad-based ASP in acute care hospitals as it relates to the rates of infections, including Methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile infections (CDI). This cross-sectional retrospective cohort design compared infection data of 20 hospitals from before the implementation of the ASP to after the implementation for a period of two years. The outcomes of this study translated to decreases of 25% for MRSA and 30% for CDI. This work highlights the effectiveness of targeted antimicrobial stewardship and contributes to the body of literature by emphasizing the importance of ASP as a worthwhile strategy for infection prevention, notably in the acute care environment.
Turoldo, F., Longo, A., Sala, M., Valentini, D., De Vita, N., Toniutti, S., Zuppel, L., & Maximova, N. (2024). Nurse-driven interventions reduce central line-associated bloodstream infection close to zero in one pediatric oncologic facility: a single-center retrospective observational study. Nursing Reports, 14(4), 2668–2679.https://www.mdpi.com/2039-4403/14/4/197
On the other hand, a study by Turoldo et al.,( 2024) sought to find out if intensifying infection control measures would lessen the incidence of Clostridium difficile infection in surgical units, specifically if strict hygiene and environmental cleanliness were observed. The RCT was conducted in five hospitals, where the experimental groups received enhanced protocols, while others were administered standard care. Units that enhanced their protocols recorded an incidence rate reduction of 40% in CDI for six months compared to those adhering to standard procedures. This research contributes to understanding rigorous infection control measures in surgical environments due to the significant reduction of infections within those environments. It supports the need for high-intensity, customized interventions within hospital units at risk.
Teesing, G. R., Erasmus, V., Petrignani, M., Koopmans, M. P. G., Graaf, M. de, Vos, M. C., Klaassen, C. H. W., Verduijn, A., Schols, J. M. G. A., Richardus, J. H., & Voeten, H. A. C. M. (2020). Improving Hand hygiene compliance in nursing homes: protocol for a Cluster Randomized Controlled Trial (HANDSOME Study). JMIR Research Protocols, 9(5), e17419.https://www.researchprotocols.org/2020/5/e17419
Teesing et al., (2020) discussed the impact of compliance with hand hygiene served in reducing the risk of MRSA infection in healthcare settings. The study consisted of a prospective observational study. They monitored adherence to hand hygiene practices among healthcare workers in 15 hospitals. The study thus established the presence of direct proportionality between the rates of compliance and the incidence rate of MRSA infections. The incidence rate of MRSA infections was observed to have declined by 35% in hospitals whose compliance levels exceeded 90% compared to those with lower means of adherence. This research adds to the extant literature in pointing out the significance of proper and consistent hand hygiene practice in infection control, thereby underlining the imperative importance of establishing this as a fundamental aspect of infection prevention strategies both at the hospital-wide level and in any other healthcare setting. Together, these studies provide very strong evidence for the use of stringent infection control practices to reduce hospital-acquired infections.
The CASP tool can be utilized to judge the quality of available resources concerning nursing research, especially in terms of patient safety and antibiotic stewardship. It assesses the validity, reliability, and applicability of research studies, thus providing a structured framework that can guide an overall assessment of their quality.
Long, H. A., French, D. P., & Brooks, J. M. (2020). Optimizing the value of the Critical Appraisal Skills Programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine & Health Sciences, 1(1), 31–42. SAGE Journals. https://journals.sagepub.com/doi/10.1177/2632084320947559
The first piece that I am going to critically review with the CASP tool is a systematic review by (Long et al., 2020) which discussed patient safety culture across healthcare organizations. The review brought together numerous studies and provided information on how leadership and organizational culture determine the outcomes of patient safety. The CASP tool identifies the evaluation of the research question to verify that it is clear, the study design appropriate, and the conclusions valid. In this regard, the review was well structured applied strict criteria for inclusion, and synthesized evidence from various sources, strengthening its credibility. Besides, the studies show that organizations with a good safety culture have fewer patient harm events reported, therefore proving the claim that engagement in leadership is a fundamental concept in the creation of a safe culture.
Seljemo, C., Viksveen, P., & Ree, E. (2020). The role of transformational leadership, job demands, and job resources for patient safety culture in Norwegian nursing homes: A cross-sectional study. BMC Health Services Research, 20(1), 1–8. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05671-y
Another related study includes that of (Seljemo et al., 2020), which elaborates on the role that nursing leadership plays in creating a culture of safety. The study adopted the mixed-method approach, combining the quantitative surveys with the qualitative interviews. The methods of the investigation include both the leadership practices and how their influence dictates the patient’s safety. The CASP tool appraises the research design’s methodological quality; in this case, the inclusion of both qualitative and quantitative methods would ensure that the studied phenomenon is understood from a wide perspective. The overall finding from this study was that effective communication, transparency, and accountability among nursing leaders in the service were crucial factors in promoting good practice of patient safety. More significantly, combining data sources and the clarity of the objectives of this research lend sufficient weight to the findings of this study, in reinforcing the idea that strong leadership is an integral part of patient safety.
Naegle, M. A., Kelly, L. A., Embree, J. L., Valentine, N., Sharp, D., Grinspun, D., Martin, V. P., Crawford, C. L., & Rosa, W. E. (2023). American Academy of Nursing consensus recommendations to advance system-level change for nurse well-being. Nursing Outlook, 71(2), 101917.https://linkinghub.elsevier.com/retrieve/pii/S0029655423000015
Last, an analysis of the American Nurses Association’s Project Naegle et al., (2023) Firstline initiative on antibiotic stewardship provides evidence of a proactive method of improving patient outcomes. Such a project focuses greatly on training and resource support provided to nurses to enhance knowledge about the use and practices of antibiotics. Using the CASP tool, the above analysis may be performed by looking at the quality of the resources of the initiative through the research underpinning it, its objectives, and strategies for its implementation. The materials used by the ANA are current evidence and best practices; it is indicative of her commitment to supporting nursing professionals in managing antibiotic resistance. This ensures that what is being given follows evidence-based guidelines, thus ensuring relevance and effectiveness in resources given, supporting high-quality care for patients.
Interventions Used to Improve or Solve the Patient Safety Problem
Implementing a Comprehensive Infection Prevention Bundle:
A comprehensive infection prevention bundle would be a major intervention that healthcare facilities have to undertake in their pursuit of minimizing SSIs and CLABSIs (Blot et al., 2022). The approach employs a combination of several evidence-based practices aimed at addressing infection control as a whole. Some components will include stringent hand hygiene, proper sterilization, and antimicrobial use, tailored according to the specific needs of the institution. Studies have proved that such packages lead to substantial decreases in infections. This, therefore directly results in better patient outcomes and the quality of their care.
Enhanced Education and Training Programs:
Better education and training sessions should be aimed at properly equipping healthcare providers with the best skills for working toward effective implementation of infection control policies. The education and training programs ensure that the healthcare workers are updated with the most current knowledge on infection control practices, compliance, and guideline-based evidence (Torbjørnsen et al., 2021). By holding frequent workshops and training sessions with high engagement, the employees of the facility may be empowered with knowledge regarding the risks of infection and equipped with practical skills related to keeping an aseptically clean environment. There is anecdotal evidence from studies that education is directly proportional to adherence to infection control measures within healthcare facilities, and this reflects fewer cases of SSI and CLABSIs.
Regular Audits and Feedback Mechanisms:
Audit and feedback systems are also an important requirement in infection prevention practices within healthcare settings. Such audits, through a structured review of adherence to established protocols, may identify many gaps in practice and areas for improvement (Reynolds, 2020). Coupled with feedback when appropriate, they allow the teams to assume personal responsibility for infection control in a proactive manner that may assist in developing accountability as well as improving communication among the staff. Evidence has indicated that facilities that are assessed regularly and are subsequently provided with constructive feedback have a lower infection rate. Its role is essential for monitoring and evaluation in any effort concerning infection prevention.
Summary
Hence, this summary is an articulation of critically discussing the issue that affects surgery sites and central line-associated bloodstream infections in healthcare settings in general, but specifically at the Mayo Clinic. This can be explained by referencing a PICOT question through a comprehensive prism, such as efficacy in a multifaceted infection prevention bundle against standard infection control practices. An endeavor to synthesize the existing literature has shed light on the requirement for more focused interventions such as providing improved education and training programs to healthcare professionals with scheduled audits and feedback mechanisms toward accountability and better adherence (Spaulding et al., 2019). The evidence states that it would be judicious to implement only the evidence-based approach in order to bring about a significant reduction in the rates of infections thereby enhancing patient safety along with the quality of treatment. Finally, the proposed interventions aim at creating a comprehensive framework that can support better infection control practices resulting in improved health outcomes for surgical care patients.
NURS FPX 8030 Assessment 3 References
Blot, S., Ruppé, E., Harbarth, S., Asehnoune, K., Poulakou, G., Luyt, C.-E., Rello, J., Klompas, M., Depuydt, P., Eckmann, C., Martin, 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://www.sciencedirect.com/science/article/pii/S0964339722000301?via%3Dihub
Leas, B. F., Pegues, D. A., & Mull, N. K. (2023). Active surveillance culturing of clostridioides difficile and multidrug-resistant organisms: methicillin-resistant staphylococcus aureus, carbapenem-resistant enterobacterales, and candida auris: rapid response. PubMed; Agency for Healthcare Research and Quality (US).https://www.ncbi.nlm.nih.gov/books/NBK604049/
Long, H. A., French, D. P., & Brooks, J. M. (2020). Optimizing the value of the critical appraisal skills program (CASP) tool for quality appraisal in qualitative evidence Synthesis. Research Methods in Medicine & Health Sciences, 1(1), 31–42. SAGE Journals.https://journals.sagepub.com/doi/10.1177/2632084320947559
Naegle, M. A., Kelly, L. A., Embree, J. L., Valentine, N., Sharp, D., Grinspun, D., Martin, V. P., Crawford, C. L., & Rosa, W. E. (2023). American Academy of nursing consensus recommendations to advance system-level change for nurse well-being. Nursing Outlook, 71(2), 101917. https://www.nursingoutlook.org/article/S0029-6554(23)00001-5/fulltext
Patelarou, A. E., Mechili, E. A., Ruzafa, M., Dolezel, J., Gotlib, J., Skela, B., Ramos, A. J., Finotto, S., Jarosova, D., Smodiš, M., Mecugni, D., Panczyk, M., & Patelarou, E. (2020). Educational interventions for teaching evidence-based practice to undergraduate nursing students: A scoping review. International Journal of Environmental Research and Public Health, 17(17), 6351.https://www.mdpi.com/1660-4601/17/17/6351
Reynolds, S. (2020). Using audit and feedback to improve compliance with evidence-based practices. American Nurse. https://www.myamericannurse.com/using-audit-and-feedback-to-improve-compliance-with-evidence-based-practices/
Seljemo, C., Viksveen, P., & Ree, E. (2020). The role of transformational leadership, job demands, and job resources for patient safety culture in Norwegian nursing homes: a cross-sectional study. BMC Health Services Research, 20(1), 1–8. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05671-y
Shukla, S., Cortez, J., Renfro, B., Kartikeya, M., Timmons, C., P. Sireesha, N., Hazboun, R., Dababneh, R., Hoopes, C., VanRavestein, J., McCarter, Y., Middlebrooks, M., Ingyinn, M., Alvarez, A., & Hudak, M. L. (2020). Charge nurses taking charge, challenging the culture of culture-negative sepsis, and preventing central-line infections to reduce NICU antibiotic usage. American Journal of Perinatology, 39(08), 861–868.https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0040-1719079
Spaulding, E. M., Marvel, F. A., Jacob, E., Rahman, A., Hansen, B. R., Hanyok, L. A., Martin, S. S., & Han, H. R. (2019). Interprofessional education and collaboration among healthcare students and professionals: a systematic review and call for action. Journal of Interprofessional Care, 35(4), 1–10. https://www.tandfonline.com/doi/full/10.1080/13561820.2019.1697214
Teesing, G. R., Erasmus, V., Petrignani, M., Koopmans, M. P. G., Graaf, M. de, Vos, M. C., Klaassen, C. H. W., Verduijn, A., Schols, J. M. G. A., Richardus, J. H., & Voeten, H. A. C. M. (2020). Improving hand hygiene compliance in nursing homes: protocol for a cluster randomized controlled trial (handsome study). JMIR Research Protocols, 9(5), e17419. https://www.researchprotocols.org/2020/5/e17419
Torbjørnsen, A., Hessevaagbakke, E., Grov, E. K., & Bjørnnes, A. K. (2021). Enhancing student’s learning experiences in nursing programs: An integrated review. Nurse Education in Practice, 52, 103038.https://www.sciencedirect.com/science/article/pii/S1471595321000743?via%3Dihub
Turoldo, F., Longo, A., Sala, M., Valentini, D., De Vita, N., Toniutti, S., Zuppel, L., & Maximova, N. (2024). Nurse-driven interventions reduce central line-associated bloodstream infection close to zero in one pediatric oncologic facility: a single-center retrospective observational study. Nursing Reports, 14(4), 2668–2679.https://www.mdpi.com/2039-4403/14/4/197
