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A. Discuss the impact of a clinical practice problem on the patient(s) and the organization it affects. Infection in patients can lead to longer hospital stays, sepsis and potentially death. Hospital organization’s infection rates are scrupulously monitored and implementing the best safety practices could decrease the risk of infection. Using chlorhexidine as compared to no chlorhexidine can help to reduce the risk of hospital acquired infection. 1. Identify the following PICO components of the clinical practice problem: • patient/population/problem (P) – Patients • intervention (I) – Using chlorhexidine • comparison (C) – Using no chlorhexidine • outcome (O) – Reduce incidences of hospital acquired infection 2. Develop an evidence-based practice (EBP) question based on the clinical practice problem discussed in part A and the PICO components identified in part A1. For patients, does use of chlorhexidine as compared to no chlorhexidine reduce the risk of hospital acquired infection? B. Select a research-based article that answers your EBP question from part A2 to conduct an evidence appraisal. 1. Discuss the background or introduction (i.e., the purpose) of the research article. The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis analyzes the effects of chlorhexidine bathing to reduce to risk of hospital acquired infection. This research was conducted in 2019, making it current to best practices in healthcare settings. 2. Describe the research methodology. The research methodology used was systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies. The researchers analyzed data from twenty-six studies that were acquired from a database utilizing inclusion and exclusion criteria. 3. Identify the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model. Based on the JHNEBP model, this is a Level II study. 4. Summarize how the researcher analyzed the data in the article. The researchers used a database to locate, screen and review studies relating to chlorhexidine bathing versus non-chlorhexidine bathing. They analyzed data from twenty-six studies and evaluated data within subgroups; for example, intensive care units versus non-intensive care units and chlorhexidine impregnated wipes versus chlorhexidine solution. The tests used to analyze the data include random effects logistical regression, I-square test, Egger’s test, relative risk, and a forest plot.

5. Summarize the ethical consideration(s) of the research-based article. If none are present, explain why. This article is a review of published literature. Therefore, there was no ethics approval or consent to participate. 6. Identify the quality rating of the research-based article according to the JHNEBP model. This is a high quality qualitative study. It compares findings from multiple studies and interprets the data. 7. Analyze the results or conclusions of the research-based article and explain how the article helps answer your EBP question. This article concludes that chlorhexidine bathing reduces the risk of hospital acquired infection and discusses the reduced rate of infectious bacteria, such as gram positive or gram negative, and includes different types of infections, such as central line associated bloodstream infections versus other bloodstream infections. It answers my EBP question by confirming that chlorhexidine reduces the risk of hospital acquired infection (Musuuza et al, 2019). C. Select a non-research article from a peer-reviewed journal that helps to answer your EBP question from part A2 to conduct an evidence appraisal. 1. Discuss the background or introduction (i.e., the purpose) of the non-research article. Implementation of chlorhexidine gluconate bathing to reduce HAIs reports the results from a hospital that implemented chlorhexidine bathing to reduce its rate of hospital acquired infection. 2. Describe the type of evidence (e.g., case study, quality improvement project, clinical practice guideline). This is a quality improvement project at a hospital in Tennessee. 3. Identify the level of evidence using the JHNEBP model. Based on the JHNEBP model, this is Level V evidence. 4. Identify the quality rating of the non-research-based article according to the JHNEBP model. This is a high quality article. It was written in 2019 and was posted by a respected journalism entity. It outlines the step-by -step process that a hospital followed to assess knowledge regarding chlorhexidine, educate about and implement its use, and analyze the results over the course of six months (DePrez et al, 2019). 5. Discuss how the author’s recommendation(s) in the article helps to answer your EBP question. The author compares the infection rate prior to and following the implementation of chlorhexidine bathing. It ultimately determines a lower incidence of infection rates and helps answer my EBP question by confirming that chlorhexidine bathing reduces the risk of hospital acquired infection (DePrez et al, 2019).

D. Recommend a practice change that addresses your EBP question using both the research and non-research articles you selected for Part B and Part C. Both articles support the evidence that chlorhexidine bathing reduces the risk of hospital acquired infection. In the research article, results from multiple studies were compared and ultimately determined that there was a “statistically significant reduction” in hospital acquired infection (Musuuza et al, 2019). In the non-research article, baseline infection rates were reduced with the implementation of chlorhexidine bathing (DePrez et al, 2019). My recommended practice change to support my EBP is to utilize chlorhexidine for bathing. 1. Explain how you would involve three key stakeholders in supporting the practice change recommendation. Firstly, I would involve the chief nursing officer, who acts as the spokesperson for nursing staff at the organization. The role of the chief nursing officer will be to allow open discussion amongst multiple units to form an understanding of potential successes and barriers. Secondly, I would involve an infection control nurse whose role will be to track and report the facility’s infection rates. This nurse could assist in providing statistical documentation before and after implementing chlorhexidine bathing. Thirdly, I would involve a safety committee comprised of two to three nurses from each unit. The role of a smaller unit-specific committee would allow for assessment of a new protocol and offer education to fellow staff. The committee members could also follow up with staff during the process to identify improvements or hinderances. 2. Discuss one specific barrier you may encounter when implementing the practice change recommendation. One potential barrier is ensuring education is consistent amongst staff, especially if a unit has a high turnover ate. Revolving staff can lead to decreased knowledge of the organization’s policies, procedures and current best safety practices. 3. Identify one strategy that could be used to overcome the barrier discussed in part D2. One strategy would be to ensure that new hires receive specific training during their orientation phase. Education about the organization’s use of chlorhexidine for bathing early in the training process can allow for staff to continue with this practice once they are independently working at the bedside. 4. Identify one outcome (the O component in PICO) from your EBP question to measure the recommended practice change. To measure the recommended practice change, one outcome would be a statistically lower rate of hospital acquired infections after implementing chlorhexidine bathing.

References DePrez, B., Schreeder, C., Davidson, S. (2019). Implementation of chlorhexidine gluconate bathing to reduce HAIs: A nurse leader-led evidence-based practice change. Nursing Management, 50(11), 13-17. https://doi.org/10.1097/01.NUMA.0000602824.95678.0a Musuuza, J. S., Guru, P. K., O’Horo, J. C., Bongiorno, C. M., Korobkin, M. A., Gangon, R. E., & Safdar, N. (2019). The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC Infectious Diseases, 19(1), N.PAG. https://doi.org/10.1186/s12879-019-4002-7...