Critical Appraisal of a Research Paper on Catheter Associated Urinary Tract Infection

This critical appraisal evaluates a research paper on Catheter Associated Urinary Tract Infection (CAUTI) and its impact on hospital patients. The paper addresses the issue of spread of infection in hospitals and the efficacy of the intervention. The study used a control case study method and analyzed the standard guidelines for catheter insertion. The results showed a significant reduction in the prevalence of CAUTI among ICU patients after the intervention. The paper is relevant for healthcare professionals and researchers.

Running head: CRITICAL APPRAISAL
Critical Appraisal
Name of Student
Name of University
Author Note

1CRITICAL APPRAISAL
Section A: Are the results of the trial valid?
Did the study address a clearly focused issue?
-Yes
Comment:
The given paper addresses the problem of spread of infection in hospitals, where the patients are
susceptible urinary tract infection after administration of indwelling catheter, which increases
morbidity and morbidity (Galiczewski & Shurpin, 2017).
Did the authors use an appropriate method to answer their question?
-Yes
Comment:
The author of this paper used the method of control case study which would help determine the
effect of Catheter Associated Urinary Tract Infection (CAUTI) (Galiczewski & Shurpin, 2017).
The method was separated into two segments, Phase I and II. The research conducted the first
phase trial by collection of previous data, which determines the rate of urinary catheter
associated infection as well can usage of those catheters in healthcare settings. The author also
analyzed the standard guidelines that are implemented while administering such procedures. The
phase II of the method involves of commencing interventional procedures and observing the
insertion procedure utilized (Galiczewski & Shurpin, 2017).

2CRITICAL APPRAISAL
Were the cases recruited in an acceptable way?
-Yes
Comment
No such gender bias was noticed in the selected sample, the distribution of the sample size and
the results of the Chi square test was equal. The cases are defined properly; the selected sample
was amongst the hospital inpatients of the ICU who required catheter insertion without any well
defined ethnic or racial bias (Cortes & Mohri, 2014). The selection was procedure was not well
defined just based on the selection method of convenience sampling. Only those patients were
selected who had requirement for the catheter. The sample size was selected for adults over 18
years of age. The selected sample size is 140 patients in one hospital. This is a fairly sound for a
control case study. The calculation was based on the procedure of Statistical Package for the
Social Sciences Software (SPSS) version 22 (Allen, Bennett & Heritage, 2014).
Were the controls selected in an acceptable way?
-Yes
Comment
No such selected bias was mentioned which would have compromised the authenticity of the
research, the sample size was mentioned or no ethnic or racial preference was shown which
showed a holistic approach to the research (Khan, 2011). The only specialization was that all the
members of the sample size were under the observation of ICU unit with urinary catheter
indwelling requirement and all the members were above eighteen. There were no such observed
non-respondents in the sample. The population was not random but quasi-experimental, where

3CRITICAL APPRAISAL
thee members of the sample have the same chances of being involved in the intervention. The
sample was sufficient.
Was the exposure accurately measured to minimize bias?
-Cannot be told
Comment
The authors accurately measured the exposure of the sample on the research. The patients were
all above 18 years of age and the experiment was performed with consent. The authors relied on
peer reviewed journals to understand the prevalence of urinary tract infection in patients who
required catheter insertion. The validation of research method was not specified. The cases and
controls were put in same scenario. Blinding feasibility was not specified in the research paper.
The temporal correction was not specified (Craig et al., 2012).
Aside from the experimental intervention, were the groups treated equally?
-Yes
Comment
The control was equally treated in the sample who were undergoing the catheter insertion.
Another group was implanted who tracked the efficiency of the procedure. This was done by the
practitioners. No such requirement for considering the genetic, socio-economic and
environmental factors among the sample was required in this research.

4CRITICAL APPRAISAL
Have the authors taken account of the potential confounding factors in the design and/or in
their analysis?
-Cannot be told
Comment
Cannot be specified in this context.
Section B: What are the results?
How large was the treatment effect?
The paper provided the result, which verified no alteration in employment rates, however,
CAUTI prevalence lowered from 2.24 to 0 for thousand catheter days. So, it can be said that the
analysis was appropriate based on the initial question in hand. The association between the
exposure and outcome was quite strong as there was significant reduction in the outcomes after
the intervention. There was significant reduction in the urinary tract infection appearance among
ICU patients after the intervention, so it can be said that the research did make a difference in the
vigilance procedure (Austin, 2011).
How precise was the estimate of the treatment effect?
Statistically there was a significant difference as the p value was less than 0.05 for the average
infection rate in the sample of the patients. So, the answer is yes, the authors considered all the
components that might potentially lead to CAUTI. The effect of subjects who did not participate
cannot be mentioned, as the procedure was done to already existing patients of the
hospitalization (Siemsen, Roth & Oliveira, 2010).

5CRITICAL APPRAISAL
Do you believe the results?
-Yes
Comment
The study results are not set up in a randomized control trial, but the statistical value cannot be
denied which minimized the infection rate to null. Chance factor is important in this paper as the
patients who were in the sample size were all given catheter insertions (Willett, 2012). The
environmental criteria was not considered, which could mean that the hospital setting was not
very sanitary and the staff were not skilled to perform the insertion procedure alone. But, the
overall presentation of the paper was believable. According to the Bradford Hill criteria, the
assessment of epidemiological studies is dependent of nine factors. The factors are “Strength,
Consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment and
analogy”. These factors influence the outcome of the data statistics (Schünemann et al., 2011).
Section C: Will the results help locally?
-Yes
Comment
Paper presents a very alarming issue regarding the hygiene of the insertional procedures of
catheters in a hospital. This would create more interventions in local healthcare facilities, which
will require more intervention to make sure that the practitioners are more vigilance (Wilson et
al., 2010).
Do the results of this study fit with other available evidence?
-Yes

6CRITICAL APPRAISAL
Comment
Author performed systematic review, which showed enough evidence that is a common problem
in healthcare facilities. According to a research published in Nature, in 2010, this form of
infection is very commonly noticed in healthcare setting where patients after hospitalization
under UTI following a catheter insertion. This kind of infection is the most common in
community hospitals, which spreads from one patient to another. The epidemiological study
reflects on the prevalence of CAUTI among different hospitals (Foxman, 2010). This shows that
the author of this peer has enough proof, which made them conduct this research.

7CRITICAL APPRAISAL
References:
Allen, P., Bennett, K., & Heritage, B. (2014). SPSS statistics version 22: A practical guide.
Cengage Learning Australia. Retrieved from:
http://researchrepository.murdoch.edu.au/id/eprint/31055/
Austin, P. C. (2011). An introduction to propensity score methods for reducing the effects of
confounding in observational studies. Multivariate behavioral research, 46(3), 399-424.
doi: 10.1080/00273171.2011.568786
Cortes, C., & Mohri, M. (2014). Domain adaptation and sample bias correction theory and
algorithm for regression. Theoretical Computer Science, 519, 103-126.
https://doi.org/10.1016/j.tcs.2013.09.027
Craig, P., Cooper, C., Gunnell, D., Haw, S., Lawson, K., Macintyre, S., ... & Thompson, S.
(2012). Using natural experiments to evaluate population health interventions: new
Medical Research Council guidance. J Epidemiol Community Health, jech-2011.
DOI:10.1136/jech-2011-200375
Foxman, B. (2010). The epidemiology of urinary tract infection. Nature Reviews Urology, 7(12),
653. https://doi.org/10.1016/B978-0-12-384978-6.00036-4
Galiczewski, J. M., & Shurpin, K. M. (2017). An intervention to improve the catheter associated
urinary tract infection rate in a medical intensive care unit: direct observation of catheter
insertion procedure. Intensive and Critical Care Nursing, 40, 26-34. doi:
10.1016/j.iccn.2016.12.003

8CRITICAL APPRAISAL
Khan, J. A. (2011). Research methodology. APH Publishing Corporation. Retrieved from:
https://books.google.co.in/books?id=8FPMP7vIFtMC&printsec=frontcover&dq=Khan,
+J.+A.+(2011).+Research+methodology.
+APH+Publishing+Corporation.&hl=en&sa=X&ved=0ahUKEwiU3cCC9sPaAhUSSI8K
HVZ4B-EQ6AEIKzAB#v=onepage&q&f=false
Schünemann, H., Hill, S., Guyatt, G., Akl, E. A., & Ahmed, F. (2011). The GRADE approach
and Bradford Hill's criteria for causation. Journal of Epidemiology & Community
Health, 65(5), 392-395. doi: 10.1136/jech.2010.119933
Siemsen, E., Roth, A., & Oliveira, P. (2010). Common method bias in regression models with
linear, quadratic, and interaction effects. Organizational research methods, 13(3), 456-
476. https://doi.org/10.1177/1094428109351241
Willett, W. (2012). Nutritional epidemiology. Oxford University Press. Retrieved from:
https://books.google.co.in/books?
hl=en&lr=&id=rE6nBAAAQBAJ&oi=fnd&pg=PP2&dq=Willett,+W.+(2012).
+Nutritional+epidemiology.
+Oxford+University+Press.&ots=gyv27fuFOo&sig=iqy67Uig048LkhD9y5k3OhDw1Vk
#v=onepage&q=Willett%2C%20W.%20(2012).%20Nutritional%20epidemiology.
%20Oxford%20University%20Press.&f=false
Wilson, M. G., Lavis, J. N., Travers, R., & Rourke, S. B. (2010). Community-based knowledge
transfer and exchange: Helping community-based organizations link research to
action. Implementation Science, 5(1), 33. https://doi.org/10.1186/1748-5908-5-33

9CRITICAL APPRAISAL