Critical Appraisal Worksheet

CINHAL search- changed terms to alcohol impregnated cap- 1 search result returned which was relevant Article 1: Nursing research?: collaborative between nursing and medicine Article: isin!ection o! Needleless Catheter Connectors and Access "orts #ith Alcohol $a% Not "revent $icrobial &ntr%: 'he "romise o! a Novel Antiseptic-(arrier Cap) Authors- *teve +, $en%ha%) -N) (*N. ennis /, $a0i) $ ) Level o! evidence- level two) randomi1ed controlled trial Design/Method: 2uantitative randomi1ed controlled trial to measure the di!!erence in bacteria survival between wiping needleless ports with alcohol and using chlorhe3idine swab caps Sample: 145 needleless luer loc0 ports intentionall% implanted with Enterococcus faecalis bacteria Measurement: culture medium was run through the caps a!ter treatment then tested !or bacterial growth Data analysis: in the control group o! ports that received no antibacterial treatment the cutlure medium showed positive bacterial growth in 15615 or 1447 o! the ports) in the group o! ports treated with alcohol wipes the culture medium showed positive bacterial growth in 84694 or :;7 o! the ports) and in the group o! ports treated with chlorhe3idine swab caps the culture medium showed positive bacterial growth in 16:4 or 1,:7 o! the ports Findings/Results: wiping the ports with alchol did not show reliable reduction in bacteria) but using chlorhe3idine caps did show a signi!icant and reliable reduction Concerns/Limitations/Signi icance to nursing: 'he onl% concern I !ound with this stud% is that the% used a di!!erent number o! ports !or each variable group, I did not !ind an% limitations to the stud%, 'he signi!icance to nursing is that this stud% shows a wa% to signi!icantl% reduce the chance o! transmitting bacteria through luer loc0 ports, 'his can then signi!icantl% reduce the ris0 o! central line associated bacterial in!ection "<($& search- advanced search was used with the boolean search terms central line in!ection AN prevention AN cap- 84 articles returned with 9 that were relevant) 1 o! which was onl% available through interlibrar% loan Article 8: Nursing Research?: No Article! Impact o! alcohol-impregnated port protectors and needleless neutral pressure connectors on central line=associated bloodstream in!ections and contamination o! blood cultures in an inpatient oncolog% unit) Authors-$ichael A, *weet) "harm ) Aaron Cumpston) "harm ) >ran0 (riggs) "harm ) $"H) $ichael Craig) $ ) $ehdi Hamadani) $ ) Level o! evidence- level three) non-randomi1ed trial with the use o! historical data !or a control group Design/Method! A period o! seven months was chosen to appl% the intervention o! appl%ing alcohol impregnated swab caps to the needleless ports o! patients with central venous catheters, A period o! 18 months was chosen to use as the control b% reviewing central line in!ection data without the swab cap intervention Sample! the authors chose to use the data set o! central line da%s, 'he intervention group was 9)445 central line da%s) and the control group was :)?51 central line da%s Measurement! 'he amount o! central line da%s was divided b% the number o! CLA(*I@s during that time period, Data analysis! 'he control group saw 1: CLA(*I@s during the :)?51 central line da%s !or a rate o! 8,9 in!ections per 1)444 central line da%s, 'he intervention group saw 1 CLA(*I during the 9)445 central line da%s !or a rate o! 4,9 in!ections per 1)444 central line da%s, N<-* 954 >&--I* *'A'& <NIA&-*I'B ls,summer19

Findings/Results! 'he stud% showed a signi!icant drop in CLA(*I rates with the use o! alcohol impregnated swab caps Concerns/Limitations/Signicance to nursing! 'he biggest concern that I !ound with this stud% is that the control and intervention groups were not running at the same time) there!ore it would be di!!icult to sa% i! an% other practices or interventions in use b% hospital sta!! had an e!!ect on the data, 'his stud% is signi!icant to nursing because it shows promising data about how nursing practice ma% reduce the ris0 o! CLA(*I Article 9: Nursing Research?! collaborative between nursing and medicine Article!Continuous passive disin!ection o! catheter hubs prevents contamination and bloodstream in!ection Design/method! 1,5ml o! intraluminal !luid was withdrawn !rom the central line on consenting patients who had been hospitali1ed and had a central line !or at least 5 da%s, 'he !luid was drawn on da% 5):) or ; o! line insertion and then twice wee0l% while the patient remained in the hospital with their central line, 'he amount and !re2uenc% o! bacterial growth !rom the !luid samples was recorded !or a time period be!ore implementing the swab caps) and then !or a time period a!ter implementing the swab caps Sample! ;CC enrollees Measurement! 'his stud% loo0ed at the percentage o! patients in which organisms were recovered both in the control time !rame "1) during the intervention time !rame "8) and then once the% again returned to control practices "9 Data Analysis!Contamination was 18,;7 D986858E during "1. 5,57 D8469:FE in "8 D"G,448E) and 18,47 D8861?9. "G4,?? vs "1 and "G,41 vs "8E in "9 D"G,441 vs "8E CLA(*I rates declined !rom 1,F9 per 1)444 line-da%s D1:611)15FE to 4,:C D1961?)C;8E in "8 D"G,4FE and increased to 1,91 D;65)95FE in "9 Findings/Results! <sing the alcohol swab caps showed a signi!icant decline in the number or CLA(*I@s Concerns/Limitations/Signi icance to nursing! 'his stud% was ver% thorough and attempted to isolate !or other variables b% also including the rate o! urinar% catheter related in!ections which would indicate a change in nursing practices other than the use o! swab caps, 'he% also loo0ed at the time !rame both be!ore and a!ter the use o! the swab caps to also show that the di!!erence in CLA(*I rates were not due to other practice changes, 'his stud% is signi!icant to nursing because it shows that the use o! swab caps can ma0e a signi!ant di!!erence in the rates o! CLA(*I

N<-* 954 >&--I* *'A'& <NIA&-*I'B ls,summer19