NUS90120 Develop A Searchable Clinical Question

Central Line Associated Blood Stream Infection (CLABSIs) are the leading form of Healthcare Associated Infections (HAIs) within Australia, causing an alarming source of morbidity, mortality and cost (Haque et al., 2018). Central Venous Access Devices (CVADs) are frequently used in Intensive Care Units (ICUs) for the administration of intravenous fluids, medications, vasoactive agents, haemodynamic monitoring, haemodialysis and parental nutrition. On average, 4000 CLABSIs are detected yearly within Australian ICUs, totalling and estimated cost of $36.26 million and mortality rate of 12-15% (Entesari?Tatafi et al., 2015). According to the Victorian Hospital Acquired Infection Surveillance System (VICNISS) the current Victorian ICU CLABSI rates are considered low at approximately 0.7 infections per 1000 line days although, impetus for ICUs to attempt to decrease their CLABSI rates to zero on cost and mortality alone is compelling (Spelman et al., 2017)

Current literature supports the Bundles of Care (BOC) approach regarding the insertion and maintenance of CVADs, with data claiming the BOC can reduce CLABSIs by 50% (Jamous et al., 2019). Bundles are defined as a combination of evidenced-based interventions that if adhered to correctly have shown to improve patient outcomes and prevent the incidences of CLABSIs (Allahbachayo, 2022). An additional approach to the initial CLABSI BOC, includes daily chlorhexidine washes for ICU patients older than 2 months old with CVADs insitu (Buetti et al., 2022). Daily Chlorohexidine washes are supported by VICNISS and have been rated ‘high’ in the reduction and prevention of CLABSIs (Gupta et al., 2021). Although, data presented by (Denkel et al., 2022) states there was no significant difference in the rates of CLABSI between a soap-and-water and daily chlorohexidine gluconate bathing trial.

To examine literature a PICO (Population, Intervention, Comparison, Outcome) framed question has been formulated to assist in finding information relevant to current evidence-based practice. This mnemonic has been selected as it is most widely used in quantitative research (Eriksen & Frandsen, 2018).

Below is a formulated PICO question.

In Adult Patients admitted to Intensive Care Units (ICUs) who receive Central Venous Access Devices (CVADs) what is the effect of daily Chlorohexidine Gluconate (CHG) washes in comparison to regular Soap-and-Water in the reduction of incidences of Central Line Associated Blood Stream Infections (CLABSIs)?

The population focus would be consistent with Adults admitted to ICU who receive CVADs. Interventions undertaken would include bathing patients daily in CHG whilst having a CVAD insitu in comparison to bathing patient daily in regular Soap-and-Water whilst having a CVAD insitu. The outcome would assess what mode of bathing would reduce the incidences and likelihood of developing a CLABSI.

The PICO researchable questioned was searched during July 2023 in the databases Medline and Cumulative Index to Nursing Allied Health Literature (CINAHL). The Medline search strategy can be referred to in Appendix A Table 1, whereas the CINAHL search strategy can be referred to in Appendix A Table 2.

The key concepts identified for the Medline search were adapted to corresponding terms in CINAHL. Every individual key concept was supplemented with relevant key words.

Key words where found by developing a list of different ways words could be expressed. Alternative key words were found was by using a thesaurus to identify synonyms, utilising alternate search engines such as Google Scholar and The University of Melbourne discovery database to scan results for alternate phrases, and to examine relevant abstract and articles for alternative words, phrases and subject headings.

Where appropriate, key words have been truncated. Truncation is useful for finding singular and plural forms of words and variant endings. Truncations are displayed in both Medline and CINAHL databases by an asterisk (*).

Double quotation marks were also used when using Medline and CINAHL to ensure inclusion of the whole phrase searched. Phrase searching decreases the number of the results and makes results more relevant (Bramer et al., 2018)

Open, closed and hyphenated compound words have been expressed individually to ensure the phrase is captured regardless of its presentation.

Key words were then grouped together by the Boolean operator OR and then combined with key concepts by Boolean operator AND to generate the search.

The search results on both databases were limited to articles that were written in the English language as well as articles published during the last five year. The full search strategies are included as Appendix A.

After the search strategies mentioned above were utilised, Medline Database produced 11 relevant articles where as CINAHL produced 15. All articles founded were highly concise and relatable to the formulated PICO searchable question.

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