Literature Review Strategy for Evidence Based Practice (EBP)

Literature Review St arraygy for Evidence Based hold (EBP)IntroductionEvidence based practice (EBP) is an approach to health financial aid in which health professionals utilization the most appropriate information acquirable to make clinical decision for providing high quality patient contend (McKibbon, 1998). EBP has shifted the focus of health c be professionals from a traditional approach on authoritative opinions to a stress on facts extracted from previous investigate and studies (Sackett et al, 1997). It has been suggested by that treat practice based on licence enhances patient care, as compared to traditional practices (Majid et al, 2011). In addition, as nurses are increasingly more entangled in clinical decision making, it is becoming essential for them to make use of the best bear witness in purchase set up to make effective and justifiable decisions (Majid et al, 2011).To discuss the evidence for a clinical skill, this essay volition examine the antiseptic zeals for working(a) rank antisepsis. The rationale for selection of this topic is its deduction for the clinical nursing practice as nurses are frequently gnarly in the running(a) site preparation (Dizer et al, 2009). Surgical site transmission system (SSI) is a type of health care-associated contagion in which a wound transmittance occurs following an invasive (surgical) procedure. It has been suggested by National Institute of Health and safekeeping ( prissy, 2004) that surgical site infections account for almost 20% of all of healthcare-associated infections. It has been progress highlighted that n too soon 5% of patients undergoing a surgical procedure develop a surgical site infection antiseptic preparations. NICE (2008) has recommended that aqueous or alcohol based solution with chlorhexidine or iodine stick out be used for prevention of SSI. However, it does not favour or recommend wholeness solution over the other. This essay will explore the literature for e vidence about efficacy of these preparation in comparison to one another. It is cardinal for the nurses to be aware of the best available evidence regarding antiseptic preparations to denigrate the risk of surgical site infection. question Question and Literature assayThe research headspring for the current essay will be formulate on the PICO textile as suggested by Sackett et al (1997)P people or problemClean-contaminated surgical proceduresIInterventionChlorhexidine gluconateC likeness or comparatorPovidone-iodineOOutcomeSurgical site infectionThe question formulated for the current essay using PICO framework would therefore beIn surgical procedures, is chlorhexidine gluconate more effective in comparison to povidone-iodine in reducing surgical infections?To answer the question, literature search for the available evidence for was done. The author identified a list of key search equipment casualty and synonyms that can result in a large bite of hits and unite these with Bo olean terms AND/OR. Terms made up of of twain voice communication were looked for by making use of speech marks so that they were are not searched for separately, and truncation was used for terms identified to ready double endings. The key words used were surgical site infection anti-septic preparations iodine and chlorhexidine. In order to make sure that an in-depth search was done, which would elicit the largest weigh of studies more than one academic search engines were searched by the researcher.Cinahal Contains an index of nursing and allied health literature and is helpful for use in a thorough search (Glazsiou, 2001).Medline Suggested to be used in healthcare dictatorial reviews (Glazsiou, 2001).NHS Information Resources and NHS Evidence Is a widely used database resource containing evidence-based reviews and specialist research from reliable sources. NHS evidence was searched separately.Cochrane Library Provides a list of dogmatic reviews and RCTS that have been pr int or are in a branch of publishing (Glazsiou, 2010).Pubmed It is a commsolely used internet resource for healthcare professionals with a large international coverage.The results of the search get downd a large number of article however these had to be reduced in order to generate an appropriate research article which can answer the question formulated. Therefore, an cellular inclusion and excommunication criteria was set to narrow down the large number of articles generated.The guidelines from NICE (2008) in which twain preparation have been recommended in 2008 hence the research was done for studies published after that. Only disarrange controlled runnels (RCTs) have been include as they provide the best evidence. The articles which were not in English and published before 2009 were therefore excluded. Also, the studies in which preparations for a particular type of surgical procedure were studied were likewise excluded as the evidence for general surgical procedures was being looked for.Abstracts of the studies generated from the search of different data bases engines were thus read so that the articles which do not satisfy the inclusion criteria of this essay can be excluded. This resulted in selection of one article which satisfied the inclusion and exclusion criteria of the current work.The con by Darouiche et al (2010) is a RCT which compared the efficacy of two surgical preparations i.e. chlorhexidinealcohol with that of povidoneiodine for preventing surgical site infections. In order to achieve this, preoperative skin preparation was done for adults undergoing clean-contaminated surgery in six hospitals with either chlorhexidinealcohol scrape or povidoneiodine scrub and paint in a random focal point. The direct outcome was all surgical-site infection within 30 days after surgery. This train will be critically analysed to identify its effectualnesss and weaknesses. It has been suggested by Burls (2009) that critical appraisal is the wo rk of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context. The critical skills appraisal programme (CASP) tool (Appendix 1) for randomize controlled trials (RCTs) will be used as the selected arena is a randomised controlled trial.Screening questions1. Did the trial address a make itly focused way out?Yes, the theater of operations addressed a establishly focused issue with clear problem to be explored, comparison groups and outcomes being investigated using a PICO framework to formulate the research question thereby increasing the rigour of the look at (Huang et al, 2006).2. Was the assignment of patients to treatments randomised?Yes, the assignment to treatment and placebo group was carried out willy-nilly in a ratio of 21. This will sum up the rigorousness of the strike. Literature suggests that random allocation of patients to study groups help to minimize both(prenominal) the selection b ias as well as the impact of each confounder present (Cormack, 2000). It has also been observed in the study that in order to match the two groups and deal with possible inter-hospital differences, randomization was stratified by hospital by using computer-generated randomization numbers without blocking. This is a metier of the study as stratified randomisation can help to impress maximum balance of significant characteristics without compromising the benefits of randomisation (Altman and Bland, 1999).3. Were all of the patients who entered the trial properly accounted for at its conclusion?Yes, the trial was not stopped early and the patients were analysed in the groups to which they were randomised. The study has done both intention-to-treat analysis for both groups as well as per protocol analysis. This accounts for the drop outs in the study an also been reported thus accounting for these drop-outs which may decrease the internal cogency of the study. According to the Cochr ane Collaboration (2014) intention-to-treat analysis minimised the presence of bias which may embody due to loss of participants, thus upsetting the baseline similarity deliver the goods by randomisation.Detailed QuestionsThe study by Darouiche et al (2010) does not explicitly mention whether the personnel involved in the study were blind to the treatment groups. However, it has been mentioned in the study that the operating surgeon became aware of which intervention had been depute only after the patient was brought to the operating room. In addition, both the patients and the site investigators who diagnosed surgical-site infection on the basis of standard criteria stayed unaware of the group assignments. This minimises the bias in the study and increases its validity as differential treatment or evaluation of participants can possibly introduce bias in the study at whatsoever phase of a trial (Karanicolas et al, 2010). Hence, it is a strength of the study.According to Berger ( 2006), in addition to randomisation, it is important to keep the baseline variables of the study groups similar at the commencement of the trial as it is essential for a RCT to compare groups that differ only with reference to the treatment they receive. The baseline characteristics of both groups have been reported in the study and did not show any significant difference amidst the two intervention groups reflected by their insignificant p values. It appears from the study that both chlorhexidine and iodine groups were treated the same way other then intervention.In order to determine the treatment effect, clear pre-defined primal end point has been addicted by Darouiche et al (2010). The primary outcome was defined on the basis of a standard criteria given by the CDC hence it increases the reliability of study.The results of the study found that the overall rate of surgical-site infection was importantly lower in the chlorhexidinealcohol group than in the povidoneiodine group (9.5% vs. 16.1% P = 0.004). In order to find the results, the study undertook multiple statistical considerations and trial runs. The study increased its statistical power by increasing the savour size in each group which gives the study 90% power to identify a significant difference in the frequency of surgical-site infection between the two groups, at a import level of 0.05 or slight. In addition, as mentioned above intention-to-treat and per protocol analyses were performed which promote increases study validity. The study also carried out a pre-specified BreslowDay test for homogeneity to find whether the results were consistent across the six participating hospitals. This was also a strength of the study as literature suggests that involvement of multi-centre patients can compromise the external validity of the RCTs (Rothwell, 2010). This is due to potential effect of differences between health-care systemswhich result in different treatment affects, values and confidence intervals have also been reported where required.Regarding the application of the results in the settings in UK, it has been highlighted by that the study by Darouiche et al (2010) was done in the US and used an aqueous solution of iodine. However, in the UK, the most widely used skin preparations are alcohol-based solutions of 0.5% chlorhexidine or 10% iodine ( chromatic, 2012). This is because aqueous-based solutions are thought to be less effective than alcohol-based solutions. Hence, to make the study applicable to the UK settings, 2% chlorhexidine in alcohol should have been compared with 0.5% chlorhexidine in alcohol or 10% povidone iodine in alcohol.The benefits of the study are definitely superior to the harms as SSI not only causes significant unwanted outcomes and distress for the patient but also results in increased costs for the patient, the healthcare and the wider economy (Tanner, 2012).Thus, a number of factors increase the external validity and internal validity of the study including stratified randomisation, conspicuous of study personnel, intention-to-treat analysis, keep the baseline variables of the study groups similar, sample size and a number of statistical tests. In addition, clear pre-defined primary end point increased the reliability of the study. The study thus has genuinely low risk of bias and can be therefore rated as 1++ according to NICE hierarchy of evience (NICE, 2004). Hence, alcoholic chlorhexidine solution is significantly more effective in reducing SSIs than povidone iodine. However, the results should be applied to UK settings with caution.ReferencesAltman, D.G. and Bland, J.M. (1999) How to randomise BMJ. 11319(7211), pp. 703-4.Berger VW. (2006) A review of methods for ensuring the comparability of comparison groups in randomise clinical trials. Rev Recent Clin Trials. 1(1), pp. 81-6.Burls, A. (2009) What is critical appraisal? London, Hayward Group.Cochrane Collaboration (2014) Glossary, Online on hand(predicate) from http//www.cochrane.org/glossary Accessed 29 January 2014Cormack, D. (2000) The research process in nursing, 4th ed., Wiley-Blackwell Oxford.Crookes, P.A. Davies, S. (1998) Research into Practice. London Balliere Tindall.Darouiche, R.O., Wall, M.J. Jr, Itani, K.M., Otterson, M.F., Webb, A.L., Carrick, M.M., Miller, H.J., Awad, S.S., Crosby, C.T., Mosier MC, Alsharif A, Berger DH. 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