Assignment: Appraisal of Systematic Review in Healthcare (Nursing)

This assignment presents an appraisal of a systematic review article by Noto et al. (2015) on the effectiveness of chlorhexidine bathing in reducing healthcare-associated infections in adult intensive care unit (ICU) patients. The analysis includes an examination of the review's methodology, including the identification of relevant studies, inclusion criteria, and the research designs used. The assignment critically evaluates the conclusions drawn from the meta-analysis, assessing their credibility, clinical significance, and applicability to clinical settings, particularly nursing practices. It considers the implications of the findings for patient outcomes and care, and proposes necessary steps for implementing evidence-based protocols, such as training nurses and providing teaching aids. The appraisal concludes with a recommendation to proceed with designing a protocol incorporating these conclusions, emphasizing the potential benefits of chlorhexidine bathing in minimizing infections within the ICU environment.

Article Appraisal
Conclusions of a Systematic Review with Narrative Synthesis
APA Formatted Citation:
Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler,
A. P. (2015). Chlorhexidine bathing and health care–associated infections: a randomized
clinical trial. Jama, 313(4), 369-378.
Synopsis
1. What organizations or persons produced the systematic review (SR)?
- Steven A. Frost, Mari-Cris Alogso , Lauren Metcalf , Joan M. Lync, Leanne Hunt,
Ritesh Sanghavi, Evan Alexandrou, and Kenneth M. Hillman from:
o Critical Care Research for Innovation & Evidence Translation (CCRICET)
Research Group, School of Nursing and Midwifery, Western Sydney University,
Sydney, New South Wales, Australia
o Simpson Centre for Health Services Research, South Western Sydney Clinical
School & Ingham Institute of Applied Medical Research, University of New
South Wales, Sydney, New South Wales, Australia Full list of author information
is available at the end of the article
2. How many persons were involved in conducting the review?
o Eight persons
3. What topic or question did the SR address?
o Systematic analysis undertaken to summarize the effectiveness of chlorhexide in
bathing use among adult intensive care patients towards reduction of ICU
infections.
4. How were potential research reports identified?
o The meta analysis was identified using a report template; preferred Reporting
Items for Systematic Reviews and Meta analysis tool guideline.
5. What determined if a study was included in the analysis?
o Trials which had the effectiveness of reducing infections among adult ICU
patients
6. How many studies were included in the review?
o Seventeen trials were incorporated in the study
7. What research designs were used in the studies?
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 cluster-randomized crossover design
o Randomized cluster designs
8. What were the consistent and important across-studies conclusions?
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?
o On catheter related blood stream infections, Daily bathing was estimated to have
reduced cases of BSI infections in the ICU at 56 % with RE-IRR = 0.44,95% CrI
0.26, 0.75.
o On ventilator associated with Pneumonia with ventilated daily bathing with CGH
was reduced in ICU by 18%, (Bayesian RE-IRR = 0.82,95% CrI 0.57, 1.25).
All Some No
ARE THE CONSLUSIONS CREDIBLE?
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? All
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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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
- Training nurses on practices of CHG bathing as evidences has shown that it reduces risks
to infections in ICU
- Teaching aids for teaching nurses on CHG bathing process and its benefits .
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
- Outcome of this activity is reduced levels of infections in high infectious ICU wards in
health care facility.
All Some No
ARE THESE CONCLUSIONS APPLICABLE TO OUR
SETTING? Yes
SHOULD WE PROCEED TO DESIGN A PROTOCO
INCORPORATING THESE CONCLUSIONS? Yes
Comments
- This meta analysis study has shown that there is sufficient evidences to show that CHG
bathing are effective in reducing infections among ICU patients. The immediate care
givers in the ICU are the nurses , whom they play critical role in ensuring that any
infections are minimized. This can be done using CHG bathing process.
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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