Appraisal of Quantitative Study on Chlorhexidine Bathing Efficacy

The purpose of this quantitative study is to evaluate whether daily bathing with chlorhexidine reduces hospital-acquired bloodstream infections (BSIs) compared to routine bathing among critically ill ICU patients. The samples were obtained using a priori protocol aligned with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, focusing on randomized controlled designs targeting adults above 18 years in ICU settings. Data collection involved extracting information from reviewed studies via standardized forms, with resources featuring published data being utilized. The meta-analysis confirms that daily chlorhexidine bathing significantly reduces hospital-acquired BSIs without major complications. Specifically, it is more effective against gram-positive bacteremia but does not completely eliminate the risk of hospital-related infections. The study's credibility is enhanced by its peer-reviewed publication and adherence to rigorous research methodologies, including random assignment and controlled variables. The clinical significance of these findings lies in their potential impact on infection control practices within hospitals, emphasizing the reduced BSI levels (RR = 0.69; CI: 0.55–0.85; P < 0.001) observed with chlorhexidine use. This study provides robust evidence supporting the efficacy of chlorhexidine bathing as a preventive measure for BSIs in ICU settings, suggesting its integration into standard care protocols to improve patient outcomes.

Appraisal Guide:
Findings of a Quantitative Study
APA Formatted Citation: (4 pts.)
Choi, E. Y., Park, D. A., Kim, H. J., & Park, J. (2015). Efficacy of chlorhexidine bathing for
reducing healthcare associated bloodstream infections: a meta-analysis. Annals of intensive
care, 5(1), 31.
Synopsis (16 pts.)
1. What was the purpose of the study
- The purpose of this study was to determine whether daily bathing of critically ill
patients was able to decreases hospital-acquired BSIs compared to patients who
received routine bathing using chlorhexidine.
2. How was the sample obtained?
- The samples were obtained using specified priori protocol using the Preferred
Reporting Items for Systematic Review and Meta Analysis.
3. What inclusion or exclusion criteria were used?
- Studies which were eligible included parameters such as study design which is
randomized controlled designs, population above age 18 years, intervention
comparison of daily bathing with chlorhexidine and control and outcomes
4. Who from the sample actually participated or contributed data (demographic or clinical
profile and dropout rate)?
- Adults above age 18 years who were critical ill in the ICU ward.
5. What methods were used to collect data ?
- Data was extracted from the reviews using standardized form , resources with
published data were used.
6. Was an intervention tested?
Yes
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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A. How was the sample size determined?
- Sample articles were sampled using Mantel Haenszel method.
B. Were patients randomly assigned to treatment groups?
- Random effects model was applied for variation across studies applied.
7. What are the main findings of the study? (10 pts.)
- This study concluded that daily bathing with chlorhexidine is associated with
reduction of hospital acquired BSI, without any major complications. Further results
indicated that daily bathing with chlorhexidine is more associated with lower levels of
gram positive bacteremia, however the use of chlorhexidine could be entirely linked
to hospital related infections.
Credibility (14 pts.) Yes No Not
Clear
Is the study published in a source that required peer review? No
*Did the data obtained and the analysis conducted answer the
research question? Yes
Were the measuring instruments reliable and valid? Yes
*Were important extraneous variables and bias controlled? Yes
*If an intervention was tested, answer the following five
questions:
Were participants randomly assigned to groups and were
the two groups similar at the start (before the
intervention)?
Yes
Were the interventions well defined and consistently
delivered? Yes
Were the groups treated equally other than the difference
in interventions? Yes
If no difference was found, was the sample size large
enough to detect a difference if one existed? Yes
If a difference was found, are you confident it was due to
the intervention? Yes
Are the findings consistent with findings from other studies? Yes
All Some No
ARE THE FINDINGS CREDIBLE? Yes
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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Clinical Significance (6 pts.)
1. Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)
- Reduced level of hospital acquired BSI at 0.69 (95 % CI 0.55–0.85; P < 0.001; I2=
57.7 %). Gram-positive-induced (RR = 0.49, 95 % CI 0.41–0.58; P = 0.000; I2=
0.0%) compared to control
- There was significance in terms of the effects of use of chlorhexidine and reduction of
infections among ICU patients.
Yes No Not
Clear
*Is the target population clearly described? Yes
*Is the frequency, association, or treatment effect impressive
enough for you to be confident that the finding would make a
clinical difference if used as the basis for care?
Yes
All Some No
ARE THE FINDINGS CLINICALLY
SIGNIFICANT?
Yes
*= Important criteria
Comments
The level of evidence portrayed from this review showed that the 5 RCT meta analysis. The
overall incidence rate of BSI was lower among the chlorhexidine group compared to controls as
0.69 at 95% CI 0.55-0.85 p<0.001 and RR at 0.49, 95%CI .41-0.58. This signifies that daily
bathing has an effect in lowering hospital based acquired BSI.
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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