Introduction
Evidence-based medicine is grounded in raising research questions and searching for answers to them by using scholarly articles with experimental data. It enables one to answer their research questions as precisely as possible, based on the facts, and such answers can be used for making medical decisions. In this paper, the efficiency of chlorhexidine gluconate in preventing central line-associated bloodstream infections (CLABSIs) in oncology patients will be explored using evidence from scientific research.
Evidence-Based Medicine and PICOT Model
An evidence-based approach is connected with the PICOT abbreviation, which shows five crucial elements of a clinical research question. There are:
- people, patients who are explored;
- interventions, drugs that should cure the disease;
- comparisons with the control group;
- outcome, whether the condition improved or not;
- timing of the experiment.
Three components of evidence-based clinical decision-making are research evidence, clinical expertise, and patient data (Melnyk & Fineout-Overholt, 2019). Together, they lead to the most objective facts possible, which, therefore, are closer to true, and relying on them can improve patients’ outcomes greatly. Therefore, it is better to use an evidence-based approach in answering research questions and making medical decisions, as it ensures that answers will be well-quality and useful.
The Question
In oncology patients, does cleaning with chlorhexidine gluconate prep help reduce bloodstream infections and bacterial infections associated with the central line as opposed to not using chlorhexidine? In this question, PICOT can be transcribed as follows:
- people are oncology patients;
- intervention is chlorhexidine usage;
- comparison with those who did not use it for cleaning;
- outcome is the reduction of bloodstream bacterial infections associated with the central line;
- time is six months.
Therefore, to answer the question, one needs to find articles describing trial results conducted with oncology patients and measuring whether chlorhexidine helps them cope with central line-associated bloodstream infections (CLABSIs). Articles, where other patients with conditions similar to oncology, such as lowered immunity, can also be used to evaluate chlorhexidine efficiency. Lastly, as all articles have various timings, it is important to elucidate whether six months is enough time for such patients to recover.
Databases Overview
There are several databases, both general and specific purpose, which can be used to locate oncology-related scientific medical articles. PubMed is a large database of over 35 million articles on various medical and biomedical topics. In addition, it has a very convenient and customizable search using keywords, year, topic, and author. Therefore, it can be useful to search for articles that support the question, and all four articles used in this paper were found via PubMed.
The National Institute for Cancer provides various tools and resources on its website, including databases for searching cancer-related articles and books. Lastly, Google Scholar, being a general-purpose database, can always be used to find an article. However, PubMed is much more well-suited for the search for medical articles, with its expanded search and focus on medical articles with experimental evidence.
Evidence Overview
There are several studies dedicated to chlorhexidine’s influence on CLABSI risk in oncology and other immunocompromised patients. The Jusino-Leon et al. (2019) trial supports the hypothesis that chlorhexidine gluconate usage in the form of regular bathing reduces the CLABSI rates significantly within the time of 10 weeks. Another randomized trial by Pallotto et al. (2019) shows that the regular usage of chlorhexidine baths decreases the central line infection rate by more than twice. In Prudowsky et al. (2022) research, a 4% chlorhexidine gluconate foam was shown to be the more cost-efficient solution with higher patient approval.
In addition, Hord and Dandoy (2021) explore the results of another study by Zerr et al. (2020), which concluded that chlorhexidine has no particular effect on oncology children with CLABSIs. They show that the study ended early and argue that additional studies are necessary to elucidate whether chlorhexidine is inefficient for oncology children, pointing out that chlorhexidine bathing may be beneficial. Therefore, there is evidence that chlorhexidine gluconate is actually helpful for immunocompromised patients, including oncology, and its effect appears much quicker than in 6 months.
Discussion and Conclusion
Evidence-based medicine gathers proof for medical intervention, including chlorhexidine cleaning, to evaluate its success. It uses scientific evidence from randomized controlled trials to gather facts about various interventions. The research question was to explore whether chlorhexidine gluconate decreases the CLABSI rates among oncology patients within six months of its usage. Oncology patients are immunocompromised and much more vulnerable to infections, including CLABSIs, and it is important to ensure their cleaning.
Several articles with evidence were found using PubMed, which is the best database to search for medical articles, as there are more than 35 millions of them with convenient search tools. According to them, chlorhexidine. gluconate is helpful for oncology patients, significantly reducing CLABSI rates. In addition, while there is a study that shows chlorhexidine’s inefficiency for oncology children, another study shows flaws in the original article, such as the early end of the experiment. As there are many other proofs that chlorhexidine is helpful, one can conclude that the answer to the research question is positive: CLABSI rates are reduced greatly due to chlorhexidine gluconate usage.
References
Hord, J. D., & Dandoy, C. E. (2021). Are we certain that chlorhexidine gluconate bathing is not beneficial in reducing central line associated blood stream infections among children with cancer or undergoing hematopoietic stem cell transplantation? Cancer, 127(15), 2811–2812. Web.
Jusino-Leon, G., Matheson, L., & Forsythe, L. (2019). Chlorhexidine gluconate baths: Supporting daily use to reduce central line–associated bloodstream infections affecting immunocompromised patients. Clinical Journal of Oncology Nursing, 23(2). Web.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice(4th ed.). Philadelphia Wolters Kluwer.
Pallotto, C., Fiorio, M., De Angelis, V., Ripoli, A., Franciosini, E., Quondam Girolamo, L., Volpi, F., Iorio, P., Francisci, D., Tascini, C., & Baldelli, F. (2019). Daily bathing with 4% chlorhexidine gluconate in intensive care settings: A randomized controlled trial. Clinical Microbiology and Infection, 25(6), 705–710. Web.
Prudowsky, Z. D., Bledsaw, K., Staton, S., Zobeck, M., DeJean, J., Johnson-Bishop, L., George, A., Steffin, D., & Stevens, A. (2022). Chlorhexidine gluconate (CHG) foam improves adherence, satisfaction, and maintains central line associated infection rates compared to CHG wipes in pediatric hematology-oncology and bone marrow transplant patients. Pediatric Hematology and Oncology, 40(2), 1–13. Web.
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. Web.