WK7Assgn+EBP

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Walden University *

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Dec 6, 2023

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Introduction Critical appraisal is necessary to understand the research and to find out if that research is good enough for your topic. When we try to learn about various topic it is necessary that we can perform the good analysis of the research we want to use for the project. I have been currently working on the CAUTI. My focus was to get the detail information of CAUTI and to understand the reason why the patients are having CAUTI and what can we do to avoid this in future. During this process I had to make sure that I am looking after the correct research and am making the right choices that I can get for study. These steps of EBP process is knows as critical appraisal. We can utilize different level of evidence to discuss the critical appraisal of various quantitative research methodologies. (Melnyk & Fineout-Overholt, 2019). For students and other health care people to determine if the policy we have been practicing is correct and if there is anything more that we can do. Nursing is a vast subject and huge area of practice every single day we bring new changes to our practice, and it is necessary for us to understand weather the current practice that we are utilizing is the best practice. Critical appraisal is just not something where we find flaws on certain study, but it also means to find the worth to practice. ( Fineout-Overholt et.al, 2010) Purpose The main purpose of this assignment it to help us understand that the research we have selected is worthy of studying. It teaches us the steps to understand the critical appraisal and its importance for EBP. Learning about critical appraisal and finding the correct process will help us identify the right research for our study. © 2018 Laureate Education Inc. 2

Evaluation Table Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Artic Yin-Yin Chen, Mei-Man Chi, Yu-Chih Chen, Yu-Jiun Chan, Shin-Shang Chou, & Fu-Der Wang. (2013). Using a Criteria-Based Reminder to Reduce Use of Indwelling Urinary Cathetersand Decrease Urinary Tract Infections. American Journal of Critical Care, 22(2), 105–114. https://doi- org.ezp.waldenulibrary.org/10.4037/ajcc20 13464  Hollingsworth, J. M., Rogers, M. A. M., Krein, S. L., Hickner, A., Kuhn, L., Cheng, A., Chang, R., & Saint, S. (2013). Determining the noninfectious complications of indwelling urethralcatheters: a systematic review and meta-analysis. Annals of Internal Medicine, 159(6), 401–410. https://doi- org.ezp.waldenulibrary.org/10.7326/0003- 4819-159-6-201309170-00006 Fink, R., Gilmartin, H., Richard, A., Capezuti, E., Boltz, M., & Wald, H. (2012). Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for healthsystem elders hospitals. American Journal of Infection Control , 40 (8), 715–720. https://doi.org/10.1016/j.ajic.2011.09.017  Peng, D., Li, X., Liu, P., Luo, M., Ch Qiu, J., & Li, Y. (2018). Epidemiolog resistance of catheter-associated ur units: A systematic review and meta Infection Control, 46(12), e81–e90.h org.ezp.waldenulibrary.org/10.1016/ Evidence Level * (I, II, or III) Level I Level III Level VI Level I © 2018 Laureate Education Inc. 3

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Conceptual Framework Describe the theoretical basis for the study ( If there is not one mentioned in the article, say that here ).** This article has tried its best to explain the issue of catheter associated UTI. It has given an overview of the problems associated with UTI in hospital in systemic number setting where it states that 85% of UTI is associated with indwelling catheter. It also tries to explain why the catheter should be staying on the patient more than required. I choose this article as it has more information about the non-infectious complication resulting from urinary catheter and that lead to longer hospital stay and other infection related to it. This study tries to explain that in addition to the CAUTI use of catheter also causes genitourinary trauma. This non-infectious complication and overlooked and is not usually talked about. It gives a background information on CAUTI. AS per this article it states that 34% of the health care associated infections in the US, that’s associated with excess morbidity and health care cost. This article does not have does not give a very detail on the framework. But it also has background inform- mation on how the CAUTI number is very high on ICU patients as study Was performed on ICU patients Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). The conducted was a level I evidence. It included randomized controlled trial. Experimental study was done which included 2 respiratory intensive care units of tertiary referral medical center in Taiwan. These units were eligible for having indwelling urinary catheter patients however was chosen in random. Data sources used were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Conference Papers Index, BIOSIS Previews, Scopus, and ClinicalTrials.gov. This study is a systemic review and meta- analysis. This study is more of the clinical trials and observational studies assessing noninfectious complications of indwelling catheter. 1. It used an electronic survey to examine IUC care practices for CAUTI prevention. It includes types of equipment and alternatives and insertion and maintenance techniques. 2. Personal policies, education, and training. 3. Documentation, surveillance, and removal reminder. Eight electronic databases Were searched for eligible Studies. A meta-analysis Was performed to calculate The CAUTI incidences Per 1000 catheter days. Sample/Setting 2 units were selected which included 2990 bed of a medical Thirty-seven studies (2868 patient) were studied. 2 Patients were selected from the 75 acute care hospitals in the Nursing It does not have details about patient number . © 2018 Laureate Education Inc. 4

The number and characteristics of patients, attrition rate, etc. center in Taiwan. Patient were random who got admitted in the same unit. The unit was Respiratory intensive care unit. Study was made on importance of indwelling catheter, how often the catheter is used and benefits of removing catheter on time. investigators worked independently and reviewed all the abstracts and obtained full- text articles. After all, potentially relevant full-text articles and abstracts were identified. A third party was involved to resolve disputes. Improving the care of the Healthsystem Elders (NICHE) system. The only numbered detail I could find out was the study was made within ICU patients. Major Variables Studied List and define dependent and independent variables Independent variable include age(male/female), time the catheter was in place on patient, i:e removed earlier than 7 days or more than 7 days, Dependent variable includes CAUTI found in RICU. Independent variables used were age (18 years and older) and sex. Dependent variable would be urological procedures, urogynecologic procedures. Independent variable includes wearing gloves, handwashing, maintaining sterile barrier and sing a no-touch insertion technique. Use of silver-coated catheters. Independent variables are used which includes the types of bacteria’s Measurement Identify primary statistics used to answer clinical questions ( You need to list the actual tests done ). Descriptive statics was used that included demographic data of the participants (mean age and sex). Intention to treat analysis was performed. They also used IBM SPSS statistics 17 software. Fisher exact test was utilized. Continuous variable data was analyzed by using t test or the Mann- Whitney test. Means and ranges was utilized. The level of statistical significance was set at P<.05. Studies were sorted into categories which included short-term catheterization in patients without spinal cord injury, long term catheterization in patient without SCI, and catheterization in patients with SCI. “The proportion of patients who had bladder cancer, bladder stones, blockage, false passage, gross hematuria, accidental removal, urine leakage, or urethral Use of correct techniques like using gloves, handwashing and maintaining sterile barrier. Training about the aseptic technique was made during the hiring of the nurses. The measurement was sole dependent on the different number of studies used to come to the conclusion. © 2018 Laureate Education Inc. 5

stricture was then pooled using random-effects models.” (Hollingsworth et.al, 2013) Data Analysis Statistical or Qualitative findings ( You need to enter the actual numbers determined by the statistical tests or qualitative data ). he incidence of unspecified UTIs in the intervention group (21.8%) and the control group (32.8%) differed significantly in the intention-to-treat analysis (RR, 0.66; 95% CI, 0.45- 0.98; P = .04) The incidence of CAUTIs per 1000 catheter days was decreased by 79% (RR, 0.21; 95% CI, 0.05-0.87; P = .03) in the intervention group. the risk for CAUTI in the treatment contamination group (duration of catheterization >7 days, 34.9%) was 3.52 times (95% CI, 2.05-6.04; P < .001) higher than the risk of the per- protocol group (duration of catheterization ≤ 7 days, 27.9%). Short-term catheterization Leakage occurred most often (pooled estimate, 10.6% [95% CI, 2.4% to 17.7%]) (24, 29, 30), followed by gross hematuria (pooled estimate, 4.7% [CI, 0.0% to 10.0%]) (28, 30) and accidental removal (pooled estimate, 4.0% [CI, 0.0% to 8.6%]) (24, 29, 30). The frequency of catheter blockage associated with short-term catheterization was 5.0% (CI, 1.7% to 10.4%) in 1 study. Long term catheterization Accidental catheter removal was observed more frequently among inpatients (70.2% [CI, 56.3% to 82.2%]) (36) than outpatients (pooled estimate, 7.3% [CI, 0.0% to 25.3%]) (31, 55). Although catheter blockage also occurred more Not a detail data analysis and study were found on this article. Further research is required. “ The total weighted CAU catheter days was 7.78. G (47.46%), fungi (27.81%) bacteria (19.06%) were i (27.4%), Escherichia spp and Enterococcus spp (1 frequent pathogens. Candida albicans, Candid and Candida glabrata we itraconazole , with resista 53.0%, and 59.7%, respe displayed high rates of re (87.3%), ciprofloxacin (71 (71.2%). Enterococcus sp resistance to erythromyc (76.7%), and levofloxacin (73.8%). (Peng et.al, 2018). © 2018 Laureate Education Inc. 6

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often in hospitalized patients (pooled estimate, 44.4% [CI, 28.3% to 58.7%]) (34, 36) than in outpatients (pooled estimate, 28.7% [CI, 8.8% to 71.1%]) (37, 55), the frequency of leakage or incontinence was highest in outpatients (pooled estimate, 52.1% [CI, 28.6% to 69.5%]) (33, 37, 55). The frequency of gross hematuria among outpatients with long- term indwelling urethral catheters was reported by 1 study as 43.6% (CI, 32.8% to 54.7%) (37). Patient with SCI The pooled frequency of gross hematuria in patients with SCI was 13.5% (CI, 3.4% to 21.9%) (42, 53, 54). For false passage and bladder cancer, the pooled frequencies were 3.1% (CI, 0.0% to 6.3%) (43, 47, 54) and 1.0% (CI, 0.0% to 3.0%) (40, 42, 49, 53), respectively. The frequency of accidental removal in patients with SCI was reported by 1 study to be © 2018 Laureate Education Inc. 7

46.7% (CI, 22.9% to 71.3%) (55). Findings and Recommendations General findings and recommendations of the research Finding states that reducing the CAUTI can also decrease medical expenses with addition to safeguard patient. Early removal of catheter can decrease the incidence of CAUTI. Using system reminder to help health care find patients who has urinary catheter and can perform required action. Using reminder intervention decreased the mean duration of catheterization by 37%, resulting in 2.61 fewer days of catheterization per patient, it also shortened duration of catheterization by 0.35 to 4 days. UTIs was reduced significantly (6.8%-7.5%; P < . 05). Finding from this study includes the importance to find out other complication that health care workers encounter with indwelling urinary catheter. Indwelling urinary catheter causes CAUTI but we also need to understand that letting in catheter for longer causes trauma that might lead to more further non-infectious complication causing patient to stay longer in the hospital. Wearing gloves -97%. Handwashing -89% Maintaining sterile barrier -81% No-touch insertion technique -73% Use of silver coated catheter- 59% Never using catheter secure device -4% Urethral meatal care – 43% of the hospital Nurse training during hiring – 64% of hospital Systems for IUC removal were implemented – 56% of hospital. Finding includes the the different types of infectious bacteria’s that has resistance to antibiotic we can see in the CAUTI Appraisal and Study Quality Systemic reviews are very important to get the detailed information about the research. This research practice has This study includes systemic review and meta-analysis. This study and has used systemic methods to obtain the answers Strength of this research was that it included simple information about the CAUTI and importance of handwashing and wearing gloves. To have an understanding About the type of bacteria’ And fungi that we can find with CAUTI. © 2018 Laureate Education Inc. 8

Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? given us the number of catheters associated infection among the RICU patients. It teaches us that the early removal of catheter decreases the risk of infection. Strength of this study is it gives detailed information about the infection caused by catheter and gave us study that would help us decrease the number by early removal of the catheter. Limitation includes research has been done only among the RICU and that included more of the respiratory failures. Requirement of patient’s to be in the specific ICU bed and the use of catheter. Using catheter will also risk the patient on getting more infection. I work in COVID PCU at this time which includes almost the same kind of patient ratios i:e respiratory failure. to specific clinical trials. It has observational study made by combing various other studies and learning from them. Strength of this study is it includes bunch of information and knowledge from various other articles and journals. Limitation however includes the differences that we can find between different studies despite it includes heterogeneity. It rarely has most information about the CAUTI but it supports the idea of having indwelling catheter on patients usually harms on patient health. It supports the patient safety. Very limited answers were obtained. Did no find any detail information to provider a good critic. Strength of the study Includes the detail infor- mation about the infection we can see in the patient with CAUTI. Limitation includes that the study is sole based on research made by other individual. We won’t be able to see the actual progress of the experiment. This experiment gives me more information about the epidemiology of pathogens. Risk of getting CAUTI in hospitalized patient. Might not have enough information about CAUTI and Provide correct teaching during hiring. Nurses are the key to maintain the Epidemiology of pathogen And antimicrobial © 2018 Laureate Education Inc. 9

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Key findings Methods that can be applied to decrease the CAUTI. detail information about the use of the catheter. catheter and prevent infection. resistance of catheter- associated UTI. Outcomes Patient centered care. Patient safety and satisfaction. Decrease in the loss of hospital economy. Patient centered care. Non-infectious catheter associated complications can be very much as common as CAUTI. Patient satisfaction and improvement in infection associated with catheter. CAUTI was mainly caused by gram-ve bacteria that had resistan- ce to antibiotics. General Notes/Comments This study is very helpful in getting the facts on CAUTI and the use of reminder intervention and decreasing CAUTI. The study can have both pros and cons. I am not able to get detail information about the CAUTI but it supports the idea of harm the indwelling catheter can cause. It did have a very limited information about simple topics but did mention the keys words like using good training on wearing gloves and handwashing. Learning about these Epidemiology of pathogen can be important to get into problem solving of CAUTI and UTI. © 2018 Laureate Education Inc. 10

conclusion Studying about evidence base practice and its importance during the health care has given us knowledge and idea about the importance the research. Above mentioned template has given a brief idea about the research that I have made and its worthiness for my study subject. © 2018 Laureate Education Inc. 11

References Fineout-Overholt, E. , Melnyk, B. M. , Stillwell, S. & Williamson, K. (2010). Evidence-Based Practice Step by Step: Critical Appraisal of the Evidence: Part I. AJN, American Journal of Nursing, 110 (7), 47-52. doi: 10.1097/01.NAJ.0000383935.22721.9c. Fineout-Overholt, E. , Melnyk, B. , Stillwell, S. & Williamson, K. (2010). Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence: Part II. AJN, American Journal of Nursing, 110 (9), 41-48. doi: 10.1097/01.NAJ.0000388264.49427.f9. Melnyk, B. M., & Fineout-Overholt, E. (2019). Critically appraising quantitative evidence for clinical decision making.Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.,pp124-125).). Philadelphia, PA: Wolters Kluwer Yin-Yin Chen, Mei-Man Chi, Yu-Chih Chen, Yu-Jiun Chan, Shin-Shang Chou, & Fu-Der Wang. (2013). Using a Criteria-Based Reminder to Reduce Use of Indwelling Urinary Cathetersand Decrease Urinary Tract Infections. American Journal of Critical Care, 22(2), 105–114. https://doi- org.ezp.waldenulibrary.org/10.4037/ajcc2013464 Hollingsworth, J. M., Rogers, M. A. M., Krein, S. L., Hickner, A., Kuhn, L., Cheng, A., Chang, R., & Saint, S. (2013). Determining the noninfectious complications of indwelling urethralcatheters: a systematic review and meta-analysis. Annals of Internal Medicine, 159(6), 401–410. https://doi- org.ezp.waldenulibrary.org/10.7326/0003-4819-159-6-201309170-00006 Fink, R., Gilmartin, H., Richard, A., Capezuti, E., Boltz, M., & Wald, H. (2012). Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for healthsystem elders hospitals. American Journal of Infection Control , 40 (8), 715–720. https://doi.org/10.1016/j.ajic.2011.09.017 Peng, D., Li, X., Liu, P., Luo, M., Chen, S., Su, K., Zhang, Z., He, Q., Qiu, J., & Li, Y. (2018). Epidemiology of pathogens and antimicrobial resistance of catheter-associated urinary tractinfections in intensivecare units: A systematic review and meta-analysis. American Journal of Infection Control, 46(12), e81–e90.https://doi-org.ezp.waldenulibrary.org/10.1016/j.ajic.2018.07.012 © 2018 Laureate Education Inc. 12

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