Practice Issue Worksheet
List the topic and include the citation for the systematic review you have selected:
Skin antisepsis for reducing central venous catheter-related infections
Lai, N. A., Lai, N. M., O’Riordan, E., Chaiyakunapruk, N., Taylor, J. E., & Tan, K. (2012). Skin antisepsis during catheter insertion for reducing central venous catheter related infections. Cochrane Database of Systematic Reviews, 7(10), 1-14. doi:10.1002/14651858.cd010140.
What is the practice issue you have identified related to the topic you have chosen?
The CVC (also known as central venous catheter) is used in numerous cases when it comes to monitoring certain health indicators or controlling the intake of medication, nutrition or blood products. The practice issue consists in the fact that catheter is susceptible to being colonized by microorganisms. In perspective, this leads to blood infections and increases the occurrence of morbidities and the costs of health care.
Define the scope of the practice issue:
On a bigger scale, the scope of the practice issue was to analyze the existing evidence regarding the effectiveness of antiseptic treatments. The goal was to apply the latter on people’s skin and identify if this intervention helped to reduce the occurrence of infections connected to the use of central venous catheters.
Evidence Summary Worksheet
Directions: Please type your answers directly into the worksheet.
Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:
The problem was reviewed in May 2016. The researchers addressed a number of medical databases in order to find the data regarding the utilization of skin antiseptics and included a total of 13 randomized control trials in their research. The ultimate number of CVCs was 3446, and the majority of the studied population were adults (expert hospital or intensive care units) (Lai et al., 2016). The magnitude of the problem can be expressed by the number of catheters because almost half of the studies did not indicate the number of patients that were assessed throughout the research and some of the patients had more than one CVC (Lai et al., 2016). The significance of the problem can also be explained by the fact that some of the studies were funded by the government and some pharmaceutical companies.
Type the complete APA reference for the systematic review article you chose from the list provided, It must be relevant to the practice issue you described above.
Lai, N. A., Lai, N. M., O’Riordan, E., Chaiyakunapruk, N., Taylor, J. E., & Tan, K. (2012). Skin antisepsis during catheter insertion for reducing central venous catheter related infections. Cochrane Database of Systematic Reviews, 7(10), 1-14. doi:10.1002/14651858.cd010140.
Identify the objectives of the article.
The objective of the article was to assess the use of antiseptics and their effectiveness when applying them together with CVCs.
Provide a statement of the questions being addressed in the work and how they relate to your practice issue:
The question that is addressed in the paper revolves around the impact of antiseptic treatments on the patients with central venous catheters (for instance, the question of whether it reduces mortality or not and other similar questions).
Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.
The interventions were analyzed by the authors of the article on the basis of the existing evidence. First, the researcher did not find any significant differences between cleansing/ no cleansing approach to the treatment (Lai et al., 2016). Therefore, there were no particular recommendations regarding the use of catheters or antibiotics and the prevalence of blood infections. Second, the authors analyzed the use of chlorhexidine and did not find any critical variances in the infection rates among the patients with CVC. Nonetheless, this treatment is recommended because it helps to reduce the occurrence of blood infections and the ultimate process of colonization (Lai et al., 2016). Moreover, the occurrence of bloodstream infections is also mitigated. The authors of the article did not provide any recommendations regarding the use of chlorhexidine but claimed that the difference between these two treatments is almost impalpable and it cannot be explicitly stated if antiseptic skin cleansing influenced the occurrence of mortality and morbidities.
Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper.
If we take into consideration the strength of the evidence, we may see that the comparison between povidone-iodine and chlorhexidine solution provides us with the most robust results. Nonetheless, one should remember that the strength of these antiseptic solutions was approved by a relatively small number of catheters (Lai et al., 2016). Additionally, each of the comparisons was supported by a limited number of trials. This means that even though the findings of the study are significant, they cannot be interpreted in a confident manner. Another finding of the study consisted in the fact that the amount of obtained data was insufficient to reach a verdict regarding the statistical significance of the results of the conducted research. It was also identified by the authors of the research that the small number of trials adversely impacts the validity of the research results (this can also be connected to a limited number of catheters). Therefore, Lai et al. (2016) were concerned by the amount of bias generated by their research and could not make a univocal conclusion regarding the effect of small studies that were analyzed within the framework of the presented research.
Outline evidence-based solutions that you will consider for your project.
- The use of chlorhexidine solutions when performing antiseptic treatment of CVCs
Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project.
One of the key limitations of the study consists in the fact that the quality of evidence most probably hints at an increased level of bias in the results of the study. The risks of applying antiseptics when dealing with CVCs should be studied further, and it should be noted that this particular aspect may become the most influential among others if this research has to be used in practice. The variance in the results that can be met in the reports cannot be abided, so it is critical to assess all the available evidence before making any claims. It is also pivotal to take into consideration the case when multiple catheters are assigned to a single patient but are regarded to as separate units.