Evaluating a Systematic Review on CLABSI Prevention

This assignment tasks you with critically evaluating a systematic review published in Brown's 'Evidence-based Nursing: The Research-Practice Connection'. The review focuses on quality improvement interventions for preventing central line-associated bloodstream infections (CLABSI). Your analysis should cover the credibility of the conclusions, their clinical significance, and applicability to nursing practice. You will also determine if implementing the review's recommendations in your setting is feasible and how you would measure patient benefit.

Article Appraisal
Systematic Review with Narrative Synthesis
APA Formatted Citation:
Blot, K., Bergs, J., Vogelaers, D., Blot, S., & Vandijck, D. (2014). Prevention of central line–
associated bloodstream infections through quality improvement interventions: a systematic
review and meta-analysis. Clinical Infectious Diseases, 59(1), 96-105.
Synopsis
1. What organizations or persons produced the systematic review (SR)?
Trish M. Perl, Section Editor, Koen Blot, Jochen Bergs,Dirk Vogelaers, Stijn Blot,and
Dominique Vandijck
- Faculty of Medicine and Health Sciences, Ghent University
- General Internal Medicine, Ghent University Hospital, Ghent
- Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium
- Burns, Trauma and Critical Care Research Centre, The University of Queensland,
Brisbane, Australia
2. How many persons were involved in conducting the review?
o Six persons
3. What topic or question did the SR address?
o Examination of whether quality improvement of interventions reduces rates of
central line associated bloodstream infections among adults in Intensive Care
units
4. How were potential research reports identified?
o Medline search engine was used from the year 1995-June 2012 using search
terminologies, and extra studies were identified from references lists and using
Ovid and Science database
5. What determined if a study was included in the analysis?
Reproduced with permission from: Brown, S. J. (2018). Evidence-based nursing: The research-practice connection
(4th ed.). Burlington, MA: Jones & Bartlett Learning.
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o Studies used followed interrupted time series, controlled , non controlled or
randomized control trial studies which complied with Cochrane Effective Practice
and Organization of care group.
6. How many studies were included in the review?
o 43 studies were included in the review
7. What research designs were used in the studies?
o Randomized controlled study designs were used
8. What were the consistent and important across-study’s conclusions?
o 41 studies showed decreased infection rates at (OR, 0.39 [95% CI, .33–.46]; P
< .001). Thus across many studies in the review shows that quality improvement
interventions of central line bloodstream infections among patients.
Credibility Yes No Not
Clear
Was the topic clearly defined? Yes
Was the search for studies and other evidence comprehensive
and unbiased? Yes
Was the screening of citations for Inclusion based on explicit
criteria? Yes
*Were the included studies assessed for quality? Yes
Were the design characteristics and findings of the included
studies displayed or discussed in sufficient detail? Yes
*Was there a true integration (i.e., synthesis) of the findings- not
merely reporting of findings from each study individually? Yes
*Did the reviewers explore why differences in findings might
have occurred? Yes
Did the reviewers distinguish between conclusions based on
consistent findings from several good studies and those based
on inferior evidence (number or quality)?
Yes
Which conclusions were supported by consistent findings from two or more good or high-quality
studies? List
- From the reviews, half of the trials showed implementation of health infection prevention
checklist compliance thus reducing the infection rates.
- 28 studies in the study further reported utilization of devices before and after
cauterization process, compliance preventions and increased duration of catherization
which marked reduction of incidence levels.
Reproduced with permission from: Brown, S. J. (2018). Evidence-based nursing: The research-practice connection
(4th ed.). Burlington, MA: Jones & Bartlett Learning.
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All Some No
ARE THE CONSLUSIONS CREDIBLE? Yes
Clinical Significance Yes No Not
Clear
*Across studies, is the size of the treatment or the strength of the
association found or the meaningfulness of qualitative findings
strong enough to make a difference in patient outcomes or
experiences of care?
Yes
Are the conclusions relevant to the care the nurse gives? Yes
All Some No
ARE THE CONCLUSIONS CLINICALLY
SIGNIFICANT? Yes
Applicability Yes
Does the SR address a problem, situation, or decision we are
addressing in our setting? Yes
Are the patients in the studies or a subgroup of patients in the
studies similar to those we see? Yes
What changes, additions, training or purchases would be needed to implement and sustain a
clinical protocol based on these conclusions? Specify
- Nurses should be offered refresher courses in hospital settings on quality improvement
interventions.
- Nursing care manuals for quality control is essential thus developing a small pamphlet
detailing quality improvement intervention is key to be used by nurses in hospital
settings.
Yes No Not
Clear
Is what we will have to do to implement the new protocol
realistically achievable by us (resources, capability,
commitment)?
Yes
How will we know if our patients are benefiting from our new protocol? Specify
- Through reduction in infection rates associated with central line associated blood stream
infections.
Reproduced with permission from: Brown, S. J. (2018). Evidence-based nursing: The research-practice connection
(4th ed.). Burlington, MA: Jones & Bartlett Learning.
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All Some No
ARE THESE CONCLUSIONS APPLICABLE TO OUR
SETTING? Yes
SHOULD WE PROCEED TO DESIGN A PROTOCO
INCORPORATING THESE CONCLUSIONS? Yes
Comments
- Developing quality improvement protocols is key in ensuring that quality is maintained in
health care process. Thus strengthening hospital checklist is key in ensuring that critical
quality care process are adhered by the nurses to achieve insignificant levels of infections
among nurses. Adoption of quality interventions and replacing in nursing care is key in
reducing the levels of infections on patients.
Reproduced with permission from: Brown, S. J. (2018). Evidence-based nursing: The research-practice connection
(4th ed.). Burlington, MA: Jones & Bartlett Learning.
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