In patients hospitalized in an urban facility, does the use of daily chlorhexidine gluconate (CHG) baths compared to soap and water baths, reduce the incidence of CVL infections?
Case Study 1 Due to a recent increase in central line-associated bloodstream infections (CLABSIs) in the inpatient care unit, the nurse begins to question the current care practice for patients with central venous lines (CVLs). The nurse wants to make an informed decision about changing the care practices on the unit. The nurse wishes to determine whether there is a more effective means to prevent CLABSIs than the practice currently uses. After reading about the topic and discussing concerns with other nurse leaders, the nurse has developed the following Population/Patient, Intervention/Indicator, Comparison/Control, Outcome, Time (PICOT) question: “In patients hospitalized in an urban facility, does the use of daily chlorhexidine gluconate (CHG) baths compared to soap and water baths, reduce the incidence of CVL infections?” Case Questions What is the difference between research methods and evidence-based practice? Will the nurse use evidence-based practice or nursing research methods to answer this question? Explain your choice. Five hierarchal levels of evidence are available to assist in answering the PICOT question. Which evidence is best used to answer the PICOT question? Explain. What additional source of information will help determine whether a practice change must be implemented? In this case, do you think findings will support the creation of new practice guidelines or practice standards? Explain your answer. Case Study 2 You are seeing a 45-year-old woman for her yearly health exam. It is January in the Midwest, and you have been monitoring influenza incidence, which is now at epidemic levels. The woman has not contracted the influenza virus during this year’s cycle. As part of the woman’s exam, you have recommended the influenza vaccine as well as a tetanus booster, as her last tetanus booster was 13 years ago. You also recommend a mammogram screening for cancer, as she has never had a mammogram, and her mother has a history of breast cancer. Case Questions What does an epidemic level of the influenza virus mean? Which source likely would have reported that influenza is at an epidemic level? What role will you play in the primary prevention of influenza for the patient? Why did you recommend a tetanus booster for the patient? What questions should you ask yourself before recommending that the patient get a mammogram screening for cancer?
