Research Critiques and PICOT Statement Final DraftShalom782
Running head: CHLORHEXIDINE BATHING 1
CHLORHEXIDINE BATHING 2
Research Ethics and Evaluating Qualitative Research
· No contractions in APA writing.
· You discuss what the authors “should” do, but what did they actually do?
· You will need to increase your critique statements about how well the authors do at presenting the information in each section. Were they adequate or is there information missing? What could they have done better?
The article “Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature” by Curtis and Abhishek focuses on the effects of chlorhexidine bathing on the patient’s skin. According to Donskey & Deshpande (2016), Chlorhexidine is described as a cat ionic bisbiguanide antiseptic which alters the integrity of the microbial membrane. Potent spermicidal activity in chlorhexidine is induced under altered chemical and physical conditions such as altered PH, elevated temperature, and an addition of ethanol. Under the normal skin conditions, chlorhexidine doesn’t have activity against the bacterial spores. Also, chlorhexidine is used in various antiseptics, preservative, and disinfectant applications. Daily chlorhexidine bathing is associated with a decrease in VRE on the skin; it’s used as a strategy of reducing the dissemination of healthcare linked pathogens. Chlorhexidine bathing is easy to implement since it entails the substitution the standard soap-and-water bathing. Chlorhexidine bathing has a broad-spectrum activity, and it represents the horizontal infection prevention strategy which potentially reduces the dissemination of various pathogens (Donskey & Deshpande, 2016).
Additionally, daily chlorhexidine bathing has effects on colonization as well as infection with pathogens. It reduces gram-negative and gram-positive bacteria as well as Candida spy on the skin. Bacteria and Candida spy on the skin is also associated with a reduction in infection or colonization of pathogens. Chlorhexidine has beneficial effects when applied using cotton cloths with 4% or 2% chlorhexidine solution and 2% chlorhexidine-impregnate cloths (Donskey & Deshpande, 2016).
The article reviews various randomized trials on the effect of chlorhexidine bathing on infections acquired in a hospital setup. First, a non-blinded crossover trial was conducted to determine the effect of daily chlorhexidine- impregnated washcloths bathing on MDROs (multidrug-resistant organisms) acquisition as well as the frequency of hospital-acquired bloodstream infections. The experiment results indicated that hospital-acquired bloodstream infection and MDRO acquisition rates reduced by 28 percent and 23 percent respectively. The bloodstream infection reductions were associated with a decrease in infections with coagulase-negative staphylococci. The second trial was a multicenter, cluster-randomized crossover experiment which involved critically ill babies in 10 ICUs. It was established that chlorhexidine bathing significantly reduced bacteremia (Donskey & Deshpande, 2016)
The third trial is a rational cluster-randomized, cross-over research which involved adults in five ICUs in a tertiary care health center. The experiment outcome showed that there was no difference between the control group and chlorhexidine in the primary outcome which was composed of nosocomial infections, including CDI, ventilator associated pneumonia, catheter-associated urinary tract infection, and CLABSIs.
Additionally, there was no association between chlorhexidine bathing and reduction in secondary outcomes like clinical cultures yielding MDROs, blood culture contamination, and hospital-acquired bloodstream infections. The last trial is Thailand’s randomized open-label controlled trial which involved four medical ICUs. The results indicated that there is no difference in the outcomes which include length of hospital and intensive care stay, hospital-acquired infection, and colonization with MDROs. The experiment's negative results may be attributed to the presence of gram-negative bacilli in the ICUs (Donskey & Deshpande, 2016).
In this study, the researchers should weigh the benefits and risks to which the participants are exposed to ensuring their welfare and rights are protected. All the participants should be informed about the project’s purpose and should participate voluntarily. Permission should be sought when recording interviews; the participants should be assured that their responses will be kept confidential and that their identity will not be identified in any publication or report. All members who agree to take part in the research should sign a document which shows that they have agreed to participate voluntarily (Willett, 2015).
Additionally, the nurses should use a utilitarian approach when making decisions; they should be clear on what is a good and bad consequence. In the past, this has been defining as material gain, happiness, satisfaction of desires and knowledge. The other question that needs to be addressed is “whose good is being promoted.” Where the patient is not exposed to the risk of physical harm by not having the bath, the nurses’ justification can reflect ethical parochialism, or promotion of good institution through client conformity and maintaining good air (Willett, 2015).
Application in nursing practice
An increase in MDRO (multi-drug resistant organisms) like vancomycin-resistant Enterococcus (VRE) and Acinetobacter baumannii has limited the available number of effective antibiotics for treatment, thus increasing health care costs, patient morbidity, and mortality, and prolonging hospital stay. The concept that these infections can be prevented has led to the development of strategies as well as therapies to reduce infection rates. On such strategy is daily patient bathing with CHG (chlorhexidine gluconate). According to Donskey & Deshpande (2016), CHG has been used to control cross infections (used as a decolonization therapy). Also, due to its broad-spectrum antimicrobial effects, CHG is used to disinfect the patient’s skin for intravascular catheter insertion and surgical procedures. Chlorhexidine gluconate is used to kill fungi, bacteria, and some viruses. CHG, unlike other antiseptics, has the residual antibacterial activity that prevents secondary environmental contamination and reduces microbial colonization of the patient’s skin. Daily bathing with chlorhexidine gluconate decreases the physicians’ hand contamination, patient bacterial skin colonization, as well as environmental surface contamination. Cleaning the skin of ICU patients daily with Chlorhexidine reduces frequencies VRE (vancomycin-resistant Enterococcus) and multi-drug resistant Acinetobacter baumannii (Donskey & Deshpande, 2016).
Donskey, C. J., & Deshpande, A. (2016). Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: a review of the literature. American journal of infection control, 44(5), e17-e21.
Willett, K. (2015). Evaluation of Chlorhexidine Bathing Practices in Trauma/Surgical Intensive Care Units.