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

Name

Capella university

NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner

Prof. Name

Date

Patient Safety Issue, PICO(T) Question and Evidence

Hospital Acquired Infections (HAIs) pose a threat to patients’ safety at the Memorial Regional Hospital especially in Intensive Care Units (ICUs). The incidence rates Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infections (CAUTI) and other HAIs have been on the rise, resulting in higher mortality, morbidities and increased health care costs. Internal data from Memorial Regional Hospital reveals CLABSI and CAUTI rates of 0.553 and 0.926 per 1,000 device days, respectively, in 2023, which exceed national benchmarks (Leapfrog, 2024).

The HAIs compromise patient safety, prolong recovery, and strain hospital resources, necessitating immediate intervention to reduce their incidence. Gaps in infection control practices, identified through staff interviews and internal data, contribute to the prevalence of HAIs in ICUs. External evidence supports the urgency for change. Peters et al. (2022) highlight the importance of hand hygiene, environmental cleanliness, antimicrobial stewardship, and staff education in preventing HAIs. CDC (2024) reports that one in 31 hospitalized patients acquire an HAI annually, resulting in over 72,000 deaths. The findings stress the need for multifaceted, evidence-based strategies to reduce HAIs and improve patient safety at Memorial Regional Hospital.

The PICOT Question

In ICU patients at Memorial Regional Hospital (P), how does the implementation of hand hygiene protocol (I), as compared to current practices (C), affect the rate of HAIs (O) over 12 weeks (T)?

Best Evidence Search Strategy

Establishing an efficient approach to developing the search terms is crucial to finding the most relevant evidence for the PICOT question about Memorial Regional Hospital and ICU patients and the impact of a comprehensive hand hygiene protocol on the rates of HAIs. In identifying the main components of the PICOT question, ICU patients are the population of interest, and a hand hygiene protocol and antimicrobial stewardship are the interventions of choice compared to the current practice in reducing HAIs and enhancing patient safety (Akkoc et al., 2021). PubMed, CINAHL, and the Cochrane Library databases were used, since these are rich sources of medical, nursing, and clinical research articles (Kuti et al., 2021). Such an approach guarantees access to the most relevant evidence for implementing such interventions in the ICU. The PRISMA flowchart is presented in the Appendix to outline the process of study identification and inclusion and exclusion criteria.

Databases and Keywords

Selecting appropriate databases and keywords is critical for conducting an effective search to gather the best evidence on the impact of a hand hygiene protocol and antimicrobial stewardship on HAIs in ICU patients. Databases such as PubMed, CINAHL, and the Cochrane Library were utilized for their extensive collections of high-quality clinical and nursing research (Kuti et al., 2021). Key search terms included “hand hygiene,” “Healthcare-Associated Infections (HAIs),” and “infection prevention.” Boolean operators like AND, OR, and NOT optimized the search by refining and expanding it to identify relevant studies that could guide quality improvement initiatives.

Inclusion and Exclusion Criteria

The selection criteria involved articles in English published after 2019 that compared the effects of hand hygiene and antimicrobial stewardship on HAIs in ICU patient populations. The inclusion criteria included studies with samples of ICU patients, reported at least one of the PICOT question’s outcomes, such as CLABSI and CAUTI rates, and contained evidence-based interventions. Studies performed outside the ICU were excluded, and studies with pediatric patients and those addressing other types of interventions other than hand hygiene were excluded (Raoofi et al., 2023).

According to these criteria and to ensure the quality of the articles selected, the authors screened and included 12 articles in the review. Only articles directly relevant to the issue were included in the review, thus proving the effectiveness of targeted interventions in decreasing HAIs and increasing patient safety (Raoofi et al., 2023). A total of 12 studies were retained as they provided information on the applicability of interventions in ICUs, which closely matched addressing HAIs at Memorial Regional Hospital.

References

Akkoc, G., Soysal, A., Gul, F., Kepenekli Kadayifci, E., Arslantas, M. K., Yakut, N., Bilgili, B., Ocal Demir, S., Haliloglu, M., Kasapoglu, U., & Cinel, I. (2021). Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system. The Journal of Infection in Developing Countries, 15(12), 1923–1928. https://doi.org/10.3855/jidc.14156 

CDC. (2024). HAIs: Reports and data. Centers for Disease Prevention and Control.gov. https://www.cdc.gov/healthcare-associated-infections/php/data/?CDC_AAref_Val=https://www.cdc.gov/hai/data/portal/index.html

Kuti, B. P., Ogunlesi, T. A., Oduwole, O., Oringanje, C., Udoh, E. E., & Meremikwu, M. M. (2021). Hand hygiene for the prevention of infections in neonates. Cochrane Database of Systematic Reviews, 21(7). https://doi.org/10.1002/14651858.cd013326.pub3 

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

Leapfrog. (2024). Hospital details table. Hospitalsafetygrade.org. https://www.hospitalsafetygrade.org/table-details/memorial-regional-hospital

Peters, A., Schmid, M. N., Parneix, P., Lebowitz, D., de Kraker, M., Sauser, J., Zingg, W., & Pittet, D. (2022). Impact of environmental hygiene interventions on healthcare-associated infections and patient colonization: A systematic review. Antimicrobial Resistance & Infection Control, 11(1), 1–9. https://doi.org/10.1186/s13756-022-01075-1 

Raoofi, S., Pashazadeh Kan, F., Rafiei, S., Hosseinipalangi, Z., Noorani Mejareh, Z., Khani, S., Abdollahi, B., Seyghalani Talab, F., Sanaei, M., Zarabi, F., Dolati, Y., Ahmadi, N., Raoofi, N., Sarhadi, Y., Masoumi, M., sadat Hosseini, B., Vali, N., Gholamali, N., Asadi, S., & Ahmadi, S. (2023). Global prevalence of nosocomial infection: A systematic review and meta-analysis. Public Library of Science, 18(1), e0274248. https://doi.org/10.1371/journal.pone.0274248

Appendix

Identification of Studies Via Databases and Registers

Search Strategy

• Selecting Databases: The search was done by using PubMed, CINAHL, and the Cochrane Library databases. These databases were selected based on their ability to provide coverage of biomedical and nursing literature, providing the best information on hand hygiene standards and HAI prevention in the ICU.
• Initial Search Results: A total of 25 records were identified across the selected databases. No additional records were found in registers or other sources.
• Screening Process: The first 25 records were excluded by reviewing the title and abstract of each record in order to evaluate relevance to the PICOT question. A total of 9 records were excluded after the screening due to irrelevance or poor quality.
• Eligibility Criteria: Only articles published after 2019 in English, peer-reviewed, and addressed at least one of the priorities, which included ICU patients, hand hygiene, or antimicrobial stewardship, were considered for inclusion in the review. Researches also had to provide quantitative outcomes as CLABSI and CAUTI rates. PICOT question excluded studies that occurred in settings other than the ICU, children, and interventions that were not within the scope of the question

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

• Excluded Studies: During the eligibility assessment, 2 reports were excluded due to incomplete data or lack of focus on the intervention.
• Included Studies: The review included 12 studies, offering robust evidence directly related to the PICOT question. The studies provided critical insights into the effectiveness of hand hygiene and antimicrobial stewardship in reducing HAIs in ICU patients.
• PRISMA Flow Diagram: A PRISMA flow diagram was developed to visually represent the identification, screening, and inclusion processes for the studies. The diagram reflects the records identified, screened, excluded, and included throughout the review process.