Critical Appraisal of Research Articles Based on Clinical Research w/Urinary Catheter

CRITICAL APPRAISAL OF A RESEARCH ARTICLE CRITICAL APPRAISAL OF A RESEARCH ARTICLE 1 1 CRITICAL APPRAISAL OF A RESEARCH ARTICLE Critical Appraisal of a Research Article Name of the Student Name of the University Author Note Executive Summary The primary purpose of the below paper is to give a proper idea about the urinary catheter and the infection that may arise due to its use. Introduction 3 Background Studies 3 Results 7 Methodology 7 Result Summary 8 Application of

Running head: CRITICAL APPRAISAL OF A RESEARCH ARTICLE
Critical Appraisal of a Research Article
Name of the Student
Name of the University
Author Note

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Executive Summary
The primary purpose of the below paper is to give a proper idea about the urinary catheter
and the infection that may arise due to its use. It also critically appraises an article based on
clinical research with its correct method analysation, collection of data and its relation with
patients care and benefits. It described and proved that the use of water is an alternative
source of cleansing the medical device with no significant difference with antiseptics
example povidone-iodine before gynaecological surgery. The result showed no sign of
urinary tract infections but the growth of bacteria is found on both the groups. Lastly, the
paper describes the quality of result found from the article along with its application in
patients care.

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Table of Contents
Introduction................................................................................................................................3
Background Studies...................................................................................................................3
Results........................................................................................................................................7
Methodology..............................................................................................................................7
Result Summary.........................................................................................................................8
Application of the study.............................................................................................................8
Conclusion..................................................................................................................................9
References................................................................................................................................10
Appendix..................................................................................................................................12

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Introduction
A urinary catheter is a tube used in hospitals for drainage of the bladder. It is
generally introduced through the urethra that carries the urine out of the body (Feneley,
Hopley & Wells, 2015). However, insertion of this tube often leads to chronic infections in
the urinary tract, which may lead to blood infections, swelling or sores in the inserted area,
bladder spasms. Proper disinfection should be provided to the patients and routine cleaning
must be done to avoid infections. Antiseptics are applied upon the epidermal area to control
the growth of microorganisms. Water is used for cleaning due to its availability and cost-
effectiveness compared to any other solution. The primary purpose of the paper is to critically
appraise the article based on a comparison of the consequence of water and povidone-iodine
solution in cleaning the indwelling catheter in women before any gynaecological surgery
(Nasiriani & Kalani, 2009).
Background Studies
Catheters are ubiquitous medical equipment that is inserted in the body either for any
treatment of diseases or before any surgical operations. The insertion of this artificial device
often rises to many chronic infections due to its unhygienic state (Nicolle, 2014). Proper
drainage of the excreted urine must be outflowed from the body as well as from the tube to
inhibit the growth of harmful pathogens. The growth of organisms impairs the use of the
catheters due to detrimental effect. Modern science and technologies are rapidly increasing
which helps in performing complicated surgeries at a glance leading to the increase use of the
catheters. The device is used to observe the outflowed amount of the urine delivered just after
surgery and also helps in prompt healing of the patients. It is used in patients with hindrances

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for the elimination of urine, but sometimes inappropriate prolonged use may raise the risk of
both transmittable and non-infectious complications among the patient (Meddings et al.,
2017). The body is very prone to infections after any operations or a medication which leads
to the development and growth of many pathogenic bacteria (Parvizi et al., 2015). The two
most common diseases are urinary tract infection and bacteriuria. The catheter-associated
urinary tract infection takes place for the reason that urethral catheters inoculate
microorganisms into the bladder and uphold colonisation causing mucosal irritation. The
condition becomes very stressful for the patients and also delays the period of recovery along
with the high death rate (McCoy et al., 2015). Antiseptics are used in cleaning the cleaning of
this area to maintain hygiene state. However, it has been found that the use of any
disinfectants does not diminish the growth of pathogens, which causes infections in the
urinary tracts (McDonnell, 2017). It has also been established that the use of these antiseptics
also gives rise to hypersensitive reactions, which delay healing. The alternative can be the use
of water to sterilise the catheter tube and it is widely available as well as cost-effective. It
does not give rise to any sensitive reactions in the inserted area or the entire body. The study
is conducted to observe the rate of growth of microorganisms in comparison to cleaning with
povidone-iodine and water among the admitted women before the insertion (Nasiriani &
Kalani(2009).
The critical appraisals of the studies spoke about a few queries (Polit & Beck, 2013).
[ Also, Refer to the appendix section]. Among them, the discussion attention was given about
method applied, equal distribution of treatments used to the all the groups, the validity of the
result, the response of the treatment group as well as the control group, the analysing
techniques, the statistical methods used to find the outcome and the implication of the
finding.

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1.True randomisation is a method where positive randomization need that groups mission
cannot be expected in advanced (DiCenso, Guyatt &Ciliska, 2014). Here, in this case, the
patients were randomly assigned in both water and povidone groups before the performance
of the experiment. The experiment follows true randomisation assessment where the
researchers were unaware of the results.
2. In the paper, the method used is a single-blinded randomised trial where only the
researchers know that what kind of treatment is given and accordingly results are obtained.
The women who were admitted in the hospital and undergoing gynaecological surgery were
single-blinded for this experiment. Here, the correct randomised method is applied for each
participates in the group (Tipton et al., 2014).
3.The treatment was similar at the starting point as all demographic data were collected from
the women were subjected to tap water for cleaning, and other groups were subjected to the
cleaning with povidone-iodine. The aim main of the group division was to observe and
compare the growth of the microorganisms when water and povidone solution were used to
clean catheterization in women inserted just before the gynaecological surgery.
4. The patients who were women, in this case, was blind about the experiments. The
evaluators were not blind to the treatment assignment. The system is also known as a single-
blinded randomised trial experiment.
5. No, the investigators were not blind in delivering the treatment. The evaluators aimed at
comparing the growth of UTI’s and bacteriuria after the insertion of the catheters. The nurses
were appointed to collect the sample of urine to observe the growth of the organism. The
investigators also trained them for maintaining and using the right procedure.
6. Yes, the assessor of the experiment were blind to the project as the culture evaluators were
not in contact with the patients who were subjected to the investigation. The testing for the

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growth of microorganisms is done by the laboratory testing method by culturing in an agar
plate, and the isolation is done by colony formation. The technique applied is useful and easy
to identity.
7. The treatment group was treated identically. In this case, the catheters that were cleaned by
water is treated as a control group. All the baseline experiments were the same for both the
groups like a collection of data. The patients with consuming antibiotics and pregnant
women were excluded from the study.
8. Yes, all the steps of the experiments were effectively followed, and it was found that from
group division, data collection, the finding of the results, and analysis was completed. It was
established from the study that no significant difference was found between the water and
povidone-iodine group.
9. The results of the groups were identified and evaluated individually, and it was found that
no significant difference was found in the growth of the UTIs and bacteriuria in both the
group.
10. The results were collected by laboratory testing from both groups equally. 3ml of urine is
removed from each patient in each group and cultured in blood agar plate followed by serial
dilution. The value to cfu greater than 103 per/ml is reflected as bacteriuria, and the greater
than 105 is considered as urinary tract infections. The results are given information’s about
few microorganisms when subjected to povidone-iodine and water. The results were also
analysed by statistical methods which makes it useful and valid.
11. The outcomes were measured and analysed realistically by statistical method. Twelve
patients were excluded from the study because as of irrelevant result. Data were analysed for
60 patients. No such significant difference was found between the two groups.

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12. Yes, the data was analysed by a proper method. The analysis is done with the help of
software named SPSS with complete analytic and descriptive statistics. The methods used for
examination of the pathogens are Fishers and Chi-square at the level p=0.01, which is reliable
and correct for any research purposes (Nasirian & oh re Kalani, 2009). The Fishers test is
useful and reliable in measuring the association between two categories (Kosambi, 2016) and
the Chi-square test is useful in identifying any changing in the observation between the
distributed groups (McKenzie, 2014). Here, the two categories are the water group and
povidone group.
13. The trial design was appropriate for this purpose as it is a single-blinded randomised
control trial was done for this purpose. Here, no such deviations in the study were followed.
This RCT eradicates bias in the experiment which was followed by the evaluators.
Results
The results established in the article are, the bacteria found in the group with iodine
solution are mainly bacilli (gram-negative aerobic), streptococcus and staphylococcus
whereas in water Escherichia coli, Enterococcus and Staphylococcus aureus was found. The
groups were similar and equally distributed. The data analysis also method revealed that there
is no significance exists between the growth of organisms in the two groups. The patients
with no symptoms of bacteria are observed, and no positive results were found.
Methodology
The methods followed here are mainly a laboratory method for testing and statistical
method for analysing. The data was collected from 60 women who are going through
gynaecology surgery and need catheterisation. 30women were cleaned by water and 30 by

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iodine solution. Urine cultures were obtained to check the growth of bacteria. Here, in the
article, the single-blinded randomised method is performed. The samples were cultured
overnight to observe the growth by serial dilution method which is reliable in any culture
technique. The results were analysed by the Chi-square method and Fisher’s tests. According
to the results are interpreted.
Result Summary
The result of the article established that 18.3% of the 60 women subjected to the
experiment were found to have pathogen bacteria when the catheter was removed. However,
the rates found were not statistically significant in the growth organisms in the water group as
well as the povidone-iodine group. No groups showed a result greater than 105 for the
development of Urinary Tract Infection (UTI). All showed the growth of gram-negative
bacteria in the culture groups.
Application of the study
The findings focused upon the use of water as alternatives for cleaning purposes of
catheters. It is a useful alternative for any antiseptics as no significant difference is found
among the groups of the subjects studied. Water is economically cheap and is available in any
hospital. No such protocols are to be followed by the nurses to use for cleaning purposes. The
nurses culturally diverse in their field of expertise and this study will help them in caring for
care for their patients prior or after any surgery. It will also help them to respond quickly to
any emergency and infections. However, there are many limitations in the article which need
further research.

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Conclusion
The application of catheters is worldwide, and it has immense impacts on health care
centres. Proper cleaning of the medical device is highly essential to get rid of infections. The
results of the article stated that in comparison to water, the use of epidermal antiseptics does
not effectively reduce the growth of pathogens and does not diminish the spreading of
chronic illness, which may delay the curing process. The paper also clinically appraises the
clinical experiment and assesses its validity, application and magnitude. The found in this
article has its immense demand in the field of medicines. However, there are some
restrictions in the research like the description must be manifest among all the staff as well as
the patients; the proper hygienic condition must be maintained in collecting the urine samples
and finally, the result is confined to a particular institution.

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References
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences.
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status,
adverse events and research agenda. Journal of medical engineering &
technology, 39(8), 459-470.
Kosambi, D. D. (2016). A bivariate extension of Fisher’s z-test. In DD Kosambi (pp. 87-91).
Springer, New Delhi.
McCoy, C. C., Englum, B. R., Keenan, J. E., Vaslef, S. N., Shapiro, M. L., & Scarborough, J.
E. (2015). Impact of specific postoperative complications on the outcomes of
emergency general surgery patients. Journal of Trauma and Acute Care
Surgery, 78(5), 912-919.
McDonnell, G. E. (2017). Antisepsis, disinfection, and sterilization: types, action, and
resistance. John Wiley & Sons.
McKenzie, S. (2014). Vital statistics-E-Book: An introduction to health science statistics.
Elsevier Health Sciences.
Meddings, J., Saint, S., Krein, S. L., Gaies, E., Reichert, H., Hickner, A., ... & Mody, L.
(2017). Systematic review of interventions to reduce urinary tract infection in nursing
home residents. Journal of hospital medicine, 12(5), 356.
Nasiriani, K., & oh re Kalani, Z. (2009). Comparison of the Effect of Water Vs. Povidone-
Iodine Solution for Periurethral Cleaning in Women Requiring an Indwelling Catheter
Prior to Gynecologic Surg e ry. Urologic Nursing, 29(2), 119.

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Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial resistance
and infection control, 3(1), 23.
Parvizi, D., Friedl, H., Wurzer, P., Kamolz, L. P., Lebo, P., Tuca, A., ... & Koch, H. (2015).
A multiple regression analysis of postoperative complications after body-contouring
surgery: a retrospective analysis of 205 patients. Obesity surgery, 25(8), 1482-1490.
Polit, D. F., & Beck, C. T. (2013). Study guide for essentials of nursing research: appraising
evidence for nursing practice. Lippincott Williams & Wilkins.
Tipton, E., Hedges, L., Vaden-Kiernan, M., Borman, G., Sullivan, K., & Caverly, S. (2014).
Sample selection in randomized experiments: A new method using propensity score
stratified sampling. Journal of Research on Educational Effectiveness, 7(1), 114-135.

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Appendix
The JBI checklists are as follows-
Questions Yes No Unclear NA
Was true randomization used for assignment of
participants to treatment groups?
✔
Was allocation to treatment groups concealed? ✔
Were treatment groups similar at the baseline? ✔
Were participants blind to treatment assignment? ✔
Were those delivering treatment blind to treatment
assignment?
☓
Were outcomes assessors blind to treatment assignment? ☓
Were treatment groups treated identically other than the
intervention of interest?
✔
Was follow up complete and if not, were differences
between groups in terms of their follow up adequately
described and analyzed?
✔
Were participants analyzed in the groups to which they
were randomized?
✔

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Were outcomes measured in the same way for
treatment groups?
✔
Were outcomes measured in a reliable way? ✔
Was appropriate statistical analysis used? ✔
Was the trial design appropriate, and any deviations
from the standard RCT design (individual
randomization, parallel groups) accounted for in the
conduct and analysis of the trial?
✔