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PICO Paper: Reflection of Research

Adetunji O Ojo

Ferris State University

Abstract

This paper will provide a detailed analysis of how nursing leader utilizes research findings; this includes the dissemination of information and data from research to application in designated settings. It will also provide an insight into the strengths and limitations of research findings using fair and balanced criteria, which will in turn facilitate improvement in application of evidenced-based practice. There were more than 80,000 central line associated bloodstream infection every year, and these infections were caused mostly by Staphylococcus aureus, Candida spp, and aerobic gram-negative bacteria that entered the bloodstream via the catheter skin contact. This information is important when designing ways and means to prevent bloodstream infections and preserve patient’s safety in acute care setting.

PICO Paper: Reflection of Research

When new ideals are introduced into a clinical setting, nursing leaders are expected to understand what brought about the change and why. Adequate knowledge of clinical decisions and rationales behind it is important to nursing professionals and ensuring that changes are made based on sound scientific based research requires that nurses interpret research findings and use the resulting evidence-based result to support nursing decisions. The purpose of this assignment is to identify nursing professional knowledge and the appropriate dissemination of the knowledge for professional practice.

PICO Question

PICO question format is a consistent way to design a researchable question. This includes the population involved in research, interventions during research, control population or medium during research, and the outcome of the research (ncbi.nlm.).

The PICO question for this research is ”Does Anti-microbial port protector on a central line cap after placement versus central line cap alone reduce central infection as evidenced by reduced bloodstream infection and decreased central line replacement in acute care hospitals?”

Acute care patient population utilize central line mostly due to the seriousness of patients illness, non-compatibility of peripheral intra venous access with medications ordered, or sometimes the type and length of intra venous medication administered (Heisler, 2013). The high use of central lines in acute care is also responsible for increased health-care associated infection including central line associated bloodstream infection (CLABSI). These studies were conducted with the hope of reducing bloodstream infections caused by central line placement and maintenance. Since healthcare acquired infection (HAI) is responsible for extended stay, treatment complications or death, it is necessary to prevent central line infections which is responsible for 23% of all healthcare acquired infections nationwide (Sagana et al, 2012).

Research Findings

Nursing professionals understand the demands of the nursing profession, especially in acute care settings and therefore strive to impact in nurses the importance of providing care with patient safety as accompanied goal. The usual practice of using alcohol scrub to disinfect central line cap before and after access was thought to be inadequate in prevention of bloodstream infection, therefore some healthcare settings introduced an additional way of protecting patients by using alcohol impregnated cap after each line access. This is done in addition to saline flushing and 15 seconds scrub with alcohol. This led to the debate about which practice will be best appropriate for patient safety with regards to reduced bloodstream infection.

Collaboration with other healthcare professionals is very important when there is an issue that threatens the well-being of patients, and this is why proper handling and dissemination of information is a key part of policy or practice improvement. There are three types of audiences namely general public, policy makers and the press (NCI, 2011), therefore the channels involved in professional and peer information handling is completely different from other audiences. The information in research analysis and findings presentation has to pass all the professionally induced tests including environment, subjects, equipment and measurement, result and recommendations for practice. A professional nurse should be able to implement rapid critical appraisal of study to determine its level of evidence, how well it was conducted and how useful it is to practice before it is recommended for clinical setting. The clinical significance of the result will determine its impact in the healthcare setting, and this is also known as “worth to practice” after appraisal (Fineout-Overholt et al, 2010).

The findings of the studies from PICO question were overwhelmingly supportive of the use of anti-microbial impregnated caps in central line along with alcohol scrub before and after access.

Infectious Disease Society of America (IDSA) poster of 2012 exposed the weakness of alcohol scrub on screw caps of central line because of their intricate surface details and corrugated internal components (Alasamari et al, 2012). The detailed report on the study conducted to evaluate the efficacy of alcohol impregnated port protector in reducing central line associated bloodstream infection shed some light on the weaknesses of alcohol pad wipe for 15 seconds. The 15-second rule led to non-compliant from overworked staff, and it stressed the advantages of using anti-microbial port protector in all patients to provide additional protection when alcohol scrubs were not done or not properly done. The study did not produce statistically significant results but did produce clinically significant outcome, although the greatest desire of researcher is to produce both (Nieswiadomy, 2012)

Another study compared anti-microbial port protector with standard end cap in immunocompromised patients. The cross-sectional study covered a total of 3,005 central line days with only one central line infection in intervention group compared to 16 infections from 6.851 days in standard cap use. The last study showed that the use of alcohol pad scrub alone may not prevent bacteria entry as evidenced by the microscopic pictures of standard cap showing multiple bacteria colonization after scrubbing with alcohol for 15 seconds. This study is unique due to the introduction of 15 controlled connectors contaminated with colony forming Enterococcus faecalis, 30 connectors with conventional caps disinfected with 70% alcohol, and 60 connectors with antiseptic cap.

The results showed massive transmission of microorganisms in all 15 controlled connector, 20 of 30 conventional caps disinfected with 70% alcohol showed microorganism entry and only 1 of 60 connectors with antiseptic cap showed the presence of microorganism (Menyhay & Maki, 2006). The findings above led credence to the additional benefit of antimicrobial impregnated protector in acute care setting as evidenced by reduced microorganism which in turn led to decreased bloodstream infections. The study also emphasized the protection provided by antiseptic port protector even in the presence of heavy contamination with microorganism.

The protection provided by antiseptic port protector in the presence of heavy contamination is a good reason for it to be utilized in healthcare settings especially where patients with central lines are often exposed to multiple sources of pathogens including caregivers, are laying on soiled bed before cleaning, and dragging the end-caps around for days before change. The port protector will serve as a barrier to bacteria entry when not in use. This should be done in addition to other means to prevent bloodstream infections including the removal of nonessential catheters, meticulous hand hygiene, daily review of device necessity, and chlorhexidine skin prep.

Recommendations to Improve Quality and Safety

Central line catheter hub maintenance is traditionally performed by nurses and additional means of preventing infections in the hospital setting including, but not limited to using antimicrobial port protector is vital to promotion of quality care and has beneficial effect on patient care outcome. One of the essential components of central line care bundle designed against central line infection is provision of maximum barrier, in addition to this is disinfecting the cap before and after use with alcohol scrub. The introduction of antiseptic port protector will produce physical barrier and chemical disinfection, which will promote safety at a lower cost when compared to cost of HAIs treatment.

The most important benefit from these studies supporting the use of antimicrobial port protector is the protection offered the patients in acute care settings. Patients with infected central lines cost about $45,000 to treat which is a financial burden to our healthcare delivery, also when we take into consideration the mortality rate of 25% from bloodstream infection; the use of port protector for prevention of infection is surely a good ideal (Moureau, 2013).

Conclusion

A qualitative or quantitative research should be conducted in a manner that is consistent with appropriate design, testing and measurement to be valid. A good example is the Wakefield project linking Measles, Mumps, and Rubella (MMR) vaccine to Autism, which was retracted in 2010 after the validity of the research was analyzed and proven to be unethical and inappropriate (Brown et al. 2012). The dangers posed by substandard research and result includes mistrust of medical personnel as evidenced in Brown and colleague’s (2012) report that parents do not want to agree to immunization until proof that the vaccination is evidenced based and safe. In the light of this, research design, execution and implementation should be validated by nurse professionals to preserve the integrity of research findings, therefore communication and collaboration by nursing leaders plays a key part in the implementation of research findings. The success of research findings, analysis and implementation depends on how the information was shared among nursing professionals; effectively communicated findings will impact the healthcare settings more and is more likely to produce beneficial outcome for patients (Nieswiadomy, 2012, p. 268). The process of research critique, analysis, and implementation is uniform and consistently adhered to by researchers; this is why the number of studies or projects does not determine reliability or validity of a research, but the uniformity, quality, and consistencies of a research does promote reliability (Fineout-Overholt et al, 2010).

The articles referenced for PICO question were critically appraised; findings analyzed and peer reviewed before the implementation of alcohol impregnated central line port protector. The company that manufactures the port protector was granted clearance by Federal Drug Administration (FDA) to start mass production of active port disinfecting caps, after receiving similar clearance in 2007 for production of the passive port protector. The new product will reduce infection within a shorter period of time compared to the earlier version (FDA, 2012).

References

Brown, K. F., Long, S. J., Ramsay, M., Hudson, M. J., Green, J., Vincent, C. A., Kroll, J. S., . . Sevdalis, N. (2012). UK parents’ decision-making about measles-mumps-rubella (MMR) vaccine 10 years after the MMR-autism controversy: a qualitative analysis. Vaccine, 30, 1855–1864. doi:10.1016/j.vaccine.2011.12.127

Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B., Williamson, K.M. (2010b). The process of synthesis: seeing similarities and differences across the body of evidence. Critical Appraisal of the Evidence: Part 11, AJN,

Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B., Williamson, K.M. (2010a). An introduction to gathering, evaluating, and recording the evidence. Critical Appraisal of the Evidence: Part 1, AJN, July, 2010, vol 110, No. 7

Heisler, J. (2013). Central line: Why is it necessary? Retrieved from

Moureau, N. (2013). Winning the war on CLABSIs: The Role of Education and New Technology. Retrieved from

Menyhay, S.Z., & Maki, D.G. (2006). Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infection Control Hospital Epidemiologist.

Nieswiadomy, R.M. (2012). Foundations of nursing research (6th Ed.). Upper Saddle River, NJ: Pearson.

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