03 Sep additional background information

•Ask a probing question, substantiated with additional background information, and evidence.
•Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
•Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
•Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.




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Weighing the Evidence


Barbadoro, P., Labricciosa, F. M., Recanatini, C., Gori, G., Tirabassi, F., Martini, E., & … Prospero, E. (2015). Catheter-associated urinary tract infection: Role of the setting of catheter insertion. American Journal Of Infection Control, 43(7), 707-710. doi:10.1016/j.ajic.2015.02.011




Barbadoro et al. (2015) conducted an epidemiological research using descriptive design study in an intensive care unit. This study aimed to describe the epidemiology of catheter-associated urinary tract infections (CAUTIs) in patients admitted to a surgical ward in Central Italy and to analyze the associated risk factors(Barbadoro et al. , 2015). The study sample included all 648 patients with an indwelling urinary catheter. Barbadoro et al. (2015) found that the majority of inappropriate catheter were placed during the emergency department visit. From 641 patients, 40 patient developed CAUTI, who were older patient and stay off the hospitalization and catheterization both were longer. The place meant of the catheter was different from the OR ( Barbadoro et al. , 2015). The study also revealed that the one-third of the hospitalized patients, Foley catheters were inserted without a physician’s order, and a documented rationale. Among the micro-organisms isolated in CAUTIs, the most common were Pseudomonas aeruginosa (41.5%), Klebsiella pneumoniae (19.5%), and Escherichia coli (12.2%); 82.5% of them were resistant to different classes of antibiotics. ( Barbadoro et al. , 2015).


The researchers carried out active surveillance program two times a week from January 2013 to December 2013 by the two trained physicians of the hospital hygiene service. All patient who dimwitted to the surgical department and needed Foley catheter were included in the surveillance( Barbadoro et al. , 2015). The CAUTI definition was in agreement with the Center for Disease Control and Prevention (CDC) definition of CAUTI and a catheterization duration of 4 days was selected as a threshold of significantly increased risk in CAUTI. The statistical analysis was done using a device utilization ratio by dividing the total number of catheter days by the ( Barbadoro et al. , 2015). Multiple logistic regression models were developed to analyze and evaluate the risk factors and the outcomes.



The formulated conclusion by researchers was depended on so many different variables which include age, sex, duration of the catheter, and place of insertion. However, they did not use the technique of Foley insertion in their variables.



The weakness of their study analysis was the statical approach of research. Statistical approaches to research are far from perfect which can produce serious distortions and misleading conclusions. Researchers often find evidence that two variables are highly correlated, but that does not prove that one variable causes another( Robinson,2017). For instance: It has been demonstrated in the study that if the folly catheter has been placed in the OR, the rate of CAUTI is rare or less. On the other hand, if it was included in the ER the rate of CAUTI is higher compared to the rate of OR CAUTI. It is tempting to conclude that if the catheters were placed in the OR fewer chances of developed CAUTI. Which does not mean to prevent CAUTI, we need to focus on the place for CAUTI not the technique of the placement. If the nurses would have taken proper precaution and maintain sterile technique of foley insertion, the rate of CAUTI would have gone down in the ER.


Further research study would be needed to clarify that setting plays the crucial role in developing CAUTI; however, reflecting the importance of hand hygiene and proper aseptic insertion techniques as critical determinants in CAUTIs prevention.



Barbadoro, P., Labricciosa, F. M., Recanatini, C., Gori, G., Tirabassi, F., Martini, E., & … Prospero, E. (2015). Catheter-associated urinary tract infection: Role of the setting of catheter insertion. American Journal Of Infection Control, 43(7), 707-710. doi:10.1016/j.ajic.2015.02.011


Robinson, N (2017, April 04). What Are the Disadvantages of a Statistical Analysis? Retrieved May 01, 2017, from http://classroom.synonym.com/disadvantages-statistical-analysis-8471854.html
second paper that needs response:For this week’s discussion, I choose the article titled “Chlorhexidine, tooth brushing, and preventing ventilator-associated pneumonia in critically ill adults” by Munro et al. (2007). Munro et al. (2009) conducted the research with a primary purpose analyzing the effects of providing oral care with mechanical which is using a toothbrushing, pharmacological which is using chlorhexidine (CHX) and the combination of both tooth brushing and CHX on the development of VAP as well as prevention. The research found that there was a reduction of VAP with chlorhexidine oral care and patient’s susceptibility to VAP was increased with used of tooth brushing.

For this study, four hundred fifty-seven ICU’s mechanically vented patients were selected where they use 2×2 factorial design with a randomized controlled trial method for data collection. Maximum days patient stayed in the research was seven days where the oral culture was obtained during 1st,3rd,5th and 7th days to find out Clinical pulmonary infection Score (CPIS). Considering CPIS score from 0 to 12, CPIS >6 refers to diagnostic pneumonia and CPIS <6 refers to free or absence of pneumonia. Descriptive statistics was used to summarize the characteristics of the participants (Munro et al., 2009). CPIS values were compared by treatment team with the use of analysis covariance and portion of patients in each group was compared with the use of logistic regression (Munro et at., 2009).

An interim analysis was done with Bonferroni correction used for adjusting P (Munro et al., 2009).There was three treatment group such as T1(119 patient), T2 (113 patient), T3 (116 patient) and one control group as C (123 patient). Oral care with 0.12 % CHX was given twice a day to T1, the only tooth brushing three times a day to T2, both toothbrushing and CHX twice a day to T3. Later, the CPIS values were compared with these treatment group and found that the incidence of VAP was decreased by day three with the use of CHX. From the study, it was found that the use of tooth brushing did not have any effect on VAP and CHX. With pneumonia at baseline, 24% of T1 group developed pneumonia by day 3. With the result and findings, it is concluded that CHX is effective in reducing the development of VAP whereas the tooth brushing is not.

Statistical analysis, the reliability of conclusion and significance and implementation of the study are considered important parts of any research design (Rohrig, Prel & Blettner, 2009). With all the qualities, it does have some weakness too. There is not any clear information related to sample selection criteria so as to determine the bias. There is increased the risk of attrition bias as the statistics and reasons for inclusion/exclusion/withdrawal differs in each arm of the study. The study lacks any statistical significance even though the study concluded that the use of CHX in oral care reduces VAP. Researchers can use multiple variables, more alternative interventions, include participants who are lifelong intubated, use or more other types of oral care with or without toothbrushing for further investigate the research.

References

Munro, C. L., Grap, M. J., Jones, D. J., McClish, D. K., & Sessler, C. N. (2009). Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. American Journal Of Critical Care: An Official Publication, American Association Of Critical-Care Nurses, 18(5), 428-437. doi:10.4037/ajcc2009792


Rohrig, B., Prel, J. B., & Blettner, M. (2009). Study design in medical research. Dtsch Arztebl Int, 106(11): 184–9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695375/pdf/Dtsch_Arztebl_Int-106-0184.pdf