Research on MRSA Bath
Evidence Based Practice and Applied Nursing Research
A.
A3. Based on the analysis of the five key areas of the research, it is apparent that the authors were able to utilize the data obtained in supporting the conclusion. Part of the conclusion is the presentation of the findings that suggests the advantage and disadvantages of the two MSRA bathing method. The evidence obtained from the quasi-experimental method of study, on the other hand showed weakness in supporting one element of the conclusion, which is to establish the developed bathing protocol as a better alternative to the traditional bathing method. In addition, the findings also did not support the claim that the proposed bathing protocol can significantly eradicate the MSRA transmission both to the patients and the nurses. The positive side quality of the findings is that it was able to support the conclusion in terms of justifying the effectiveness of the use of CHG cloths in reducing the time spent in bathing and cost.
A4. In terms of ethical issues that may have occurred in the process, one the notable ethical risk is the possible exposure of the patients being observed to whom the proposed bathing method was performed. Since the method is still in the research phase, there is no guarantee that MSRA transmission is inhibited by the proposed bathing method, making the patients possibly more susceptible to Staphylococcus aureus infection. The possible ethical violation that may have occurred during the observational phase and the execution of the experiment is the risk of the subject being more at risk of infection. This is because researches should be carried to create more effective practices that will be beneficial to the patient and the nurses. It would have been safer if the testing phase of the study were first conducted in a laboratory setting. This is where the Staphylococcus aureus can be cultured in a controlled environment. The CHD cloth can be used to simulate the bathing method to determine if the process entails the same inhibiting properties as the CHD solution. Once it was proven that the CHD cloth is a probable contender to replace the traditional CHD solution, then it should be the time that the research was carried forward to the testing phase involving the patient and the nurses.
A5. The research type employed in the study is a quasi-experimental method where the independent variables were manipulated, but lacks the important control attributes to the study. This approach is likely to the result to biases, which constitutes lack of credibility to the study as a whole. It would have been appropriate to use an outright experimental method because it is imperative in determining the MSRA colonization rate between the two bathing method.
B.
B1. The evidences found from the listed literature suggest management problems such as determination of the right dose of CHD solution that will work effectively in eliminating MSRA transmission. In addition, another evidence of nursing management problem is the proper care protocols in current practices involving the use of bath basins in hospitals. In a study by Johnson, Lineweaver, and Maze (2009) it was found that hospital basins used for bathing is also a major reservoir for bacterial growth that leading to infection. In other studies, lack of more defined MSRA bathing protocol is likely to cause nasal recolonization. In cases of infection, treatment should also follow appropriate therapy management and as such the short-term application of mupirocin ointment as Milstone, Budd, and Perl (2010) suggests eradication of S.aureus. In general, the nursing challenges found in the identified research is the appropriate protocols integrated into practice that are likely to promote or inhibit MSRA transmission and infection. There is no apparent standardization of MSRA bath protocols that are proven to eliminate the possibilities of S.aureus transmission and infection.
B2 (see separate spreadsheet for the list of primary sources)
B3. Annotated Bibliography
Coyer, F. M., O'Sullivan, J., & Cadman, N. (2011). The provision of patient personal hygiene in the intensive care unit: A descriptive exploratory study of bed-bathing practice. Australian Critical Care, 24(3), 198–209.
The research evidence found in this source is adequate to advocate practices change because of the findings suggesting that a variation in the process and products being used in ICU patient hygiene are detrimental in ensuring MSRA transmission prevention. In this study, the authors tested products and variation of practices in the ICU. It indicates a lack of a standard protocol in patient hygiene performed in the most sensitive and critical area of the hospital considering the critical condition of the patients admitted in intensive care units. In terms of tools employed in the study, it used conventional methodologies and tools that are usually utilized in research employing descriptive analysis approach. On the other hand, employing a different set of tools in the research could have resulted to findings deviating from the objectives of the research.
Turabelidze, G., Lin, M., Wolkoff, B., Dodson, D., Gladbach, S., & Zhu, B. (2006). Personal hygiene and methicillin-resistant Staphylococcus aureus infection. Emerging Infectious Diseases, 12(3), 422-427. Retrieved from http://wwwnc.cdc.gov/eid/article/12/3/pdfs/05-0625.pdf
The research provides relevant evidence regarding the ancestry pattern of S.aureus colonization and transmission in a prison setting, in relation to hygiene issues. An important contribution of the findings in this study to nursing practice change is identifying the historical pattern that leads to the problem of MSRA transmission. Determining the resistant characteristics of S.aureus from methicillin is important in structuring new protocols that will combat the resisting attributes of the strain particularly during the MSRA bathing process. One the strengths of the study are the use of more advanced measurement tools and method such investigations in extracting the findings from the collected data. There would be no other tools more appropriate for the study other than what was mentioned otherwise it would defeat the purpose and objectives of the study.
Holder, C., & Zellinger, M. (2009). Daily bathing with chlorhexidine in the ICU to prevent central line–associated bloodstream infections. JCOM Turner White Communications, 16(11), 509-513.
The implication of the study to practice change is the processes performed during MSRA bathing that will prevent central-line bloodstream infection. There are several solutions being used to address S.aureus infection. However, the study aimed to test chlorhexidine as an effective agent in ensuring that bloodstream infection is avoided in the ICU. The study used a similar tool such as quasi-experimental method to determine the effectiveness of chlorhexidine in MSRA baths in reducing resistant organisms and BSI’s.
Johnson, D., Lineweaver, L., & Maze, L. M. (2009). Patients’ bath basins as potential sources of infection: A multicenter sampling study. American Journal of Critical Care, 18(1), 31-40. doi:10.4037/ajcc2009968
Researching on the subject of equipment used in MSRA bath such as basins as a potential source of infection changes the common nursing practices in terms of changing the tools usually used MSRA bathing. Basins that were not properly used such as not placing them upside down after use to let the liquid to drip off the basin is a simple practice, but when ignored is potentially a cause for bacterial infestation. The study was carried out similarly with other research including the use of methods such as standard biostatistical quantification. In this regard, the study encompasses an effective use of the research approach necessary in determining accurate findings. The structure of the research is appropriate to the chosen research tool because determining the rate of bacterial growth requires quantifying them, which can be done through biostatistical quantification.
Padula, C., Pashnik, B., Ritz, J., & Simmons, K. (2012). Effectiveness of 2 Methods of Chlorhexidine Bathing. Journal of Nursing Care Quality, 27(2), 171 - 175. Retrieved from http://www.nursingcenter.com/lnc/Static-Pages/Effectiveness-of-2-Methods-of-Chlorhexidine-Bathing
The study is imperative in changing nursing practices because of the findings that suggest the most effective method in MSRA bathing. Examining and comparing the two methods is likely to imply suggestive measures to change or standardize the bathing process in order to ensure that resistant organisms are eliminated during the bath. The study uses conventional research methodologies. However, the study could have rendered more substantial findings if it used experimental approach rather than quasi-experimental method.
Powers, J., Peed, J., Burns, L., & Ziemba-Davis, M. (2012). Chlorhexidine bathing and microbial contamination in patients’ bath basins. American Journal of Critical Care, 21(5), 338-342. doi:10.4037/ajcc2012242
The study provides relevant information in proving the effectiveness of CHG in eliminating bacterial growth in bath basins. Although, the findings constitutes weaker in terms of suggesting change in nursing practices, the findings are still substantial in determining the right antiseptic agent that will eliminate the possibilities of microbial contamination. In terms of tools employed in the research, the usual methods used, but the interpretation of the data employed a more structured approach such as a univariate test.
Sandri, A., Dalarosa, M. G., De Alcântara, L., Da Silva Elias, L., & Prehn Zavascki, A. (2006). Reduction in incidence of nosocomial methicillin‐resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: Role of treatment with mupirocin ointment and chlorhexidine baths for nasal carriers of MRSA. Chicago Journals, 27(2), 185- 187. Retrieved from http://www.jstor.org/stable/10.1086/500625
The study offers significant findings that will contribute to largely to conventional nursing practices. Reducing occurrences of nosocomial methicillin‐resistant Staphylococcus aureus infection in the ICU is an important step in preventing the spread of infection. Identifying the right antiseptic agent such as Chlorhexidine baths in combating resistant organisms is detrimental in nursing practice particularly in performing MSRA baths. The study encompasses similar tools used in other research such as standard biostatistical quantification in determining the effectiveness of Chlorhexidine bath solutions in combating methicillin‐resistant Staphylococcus aureus.
Sievert, D., Armola, R., & Halm , M. A. (2011). Infections? chlorhexidine gluconate bathing: Does it decrease hospital-acquired infections. American Journal of Critical Care, 20(2), 166-170. doi:10.4037/ajcc2011841
Similarly, the study also contributes change to nursing practices because it reinforces the findings in prior research about the use of chlorhexidine gluconate in MSRA bathing in reducing hospital-acquired infections. The methods and tools used in the study are similar to those the prior research, but the findings could have been more compelling if the study had performed an experimental methodology instead of just reviewing existing researches.
Mulvey, M. R., MacDougall, L., Cholin, B., Horsman, G., Fidyk, M., Woods, S., & Saskatchewan CA-MRSAStudy Group (2005). Community-associated Methicillin-resistant Staphylococcus aureus, Canada. Emerging Infectious Diseases, 11(6), 844-850. Retrieved from http://wwwnc.cdc.gov/eid/article/11/6/pdfs/04-1146.pdf
The contributing element of the study to nursing practice change is the findings suggesting the role that skin disease plays in the process of methicillin-resistant Staphylococcus aureus outbreak, in the community. The investigation offers significant details drawn from analyzing DNA restriction patterns, which further investigation of its correlation to S.aureus strain is likely to formulate a new approach in dealing with methicillin-resistant Staphylococcus aureus. The epidemiological study used conventional methodologies in drawing findings from the obtained data. Due to the complex structure of the study, it is only fitting that it used restriction epidemiological analysis to draw conclusion.
Milstone, A. M., Budd, A., & Perl, T. M. (2010). Role of decolonization in a comprehensive strategy to reduce Methicillin-Resistant Staphylococcus aureus infections in the neonatal intensive care unit: An observational cohort. Infect Control Hosp Epidemiol, 31(5), 558-560. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881154/
The main contribution of the study to nursing practice change is the use of Mupirocin ointment to address Staphylococcus aureus infection with or without the bath. Deciding whether or not to give the patient an MSRA bath knowing that Mupirocin ointment could also be used as an alternative in eradicating Staphylococcus aureus nasal carriage. The results of the study provide alternative options for practice in neonatal intensive care units where circumstances prevent nurses from giving the patients an MSRA bath. The study used the same methods and tools such as observational cohort to measure the outcome of the study.
B4. To summarize the evidences found in the sources, it can be assumed that Staphylococcus aureus infection is imminent in the hospital environment if MSRA bathing method does not be properly done. This also includes the proper use of antiseptic agent that will not only inhibit S.aureus infection, but also assures the elimination of methicillin-resistant Staphylococcus aureus through the use of either chlorhexidine gluconate or CHD.
B5. Based on the findings from the research, it is recommended that nursing strategies should be standardized and develops particular strategies to be implemented in critical hospital areas such as the ICU due to the critical conditions of the patients being admitted in the ICU.
B6. It is important to use a theoretical model for nursing research because it establishes the relationship between the study and existing theories where the research is being guided in the process of formulating the questions, method design, analysis and interpretation of results.
References
Coyer, F. M., O'Sullivan, J., & Cadman, N. (2011). The provision of patient personal hygiene in the intensive care unit: A descriptive exploratory study of bed-bathing practice. Australian Critical Care, 24(3), 198–209.
Holder, C., & Zellinger, M. (2009). Daily bathing with chlorhexidine in the ICU to prevent central line–associated bloodstream infections. JCOM Turner White Communications, 16(11), 509-513.
Johnson, D., Lineweaver, L., & Maze, L. M. (2009). Patients’ bath basins as potential sources of infection: A multicenter sampling study. American Journal of Critical Care, 18(1), 31-40. doi:10.4037/ajcc2009968
Milstone, A. M., Budd, A., & Perl, T. M. (2010). Role of decolonization in a comprehensive strategy to reduce Methicillin-Resistant Staphylococcus aureus infections in the neonatal intensive care unit: An observational cohort. Infect Control Hosp Epidemiol, 31(5), 558-560. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881154/
Mulvey, M. R., MacDougall, L., Cholin, B., Horsman, G., Fidyk, M., Woods, S., & Saskatchewan CA-MRSAStudy Group (2005). Community-associated Methicillin-resistant Staphylococcus aureus, Canada. Emerging Infectious Diseases, 11(6), 844-850. Retrieved from http://wwwnc.cdc.gov/eid/article/11/6/pdfs/04-1146.pdf
Padula, C., Pashnik, B., Ritz, J., & Simmons, K. (2012). Effectiveness of 2 Methods of Chlorhexidine Bathing. Journal of Nursing Care Quality, 27(2), 171 - 175. Retrieved from http://www.nursingcenter.com/lnc/Static-Pages/Effectiveness-of-2-Methods-of-Chlorhexidine-Bathin
Powers, J., Peed, J., Burns, L., & Ziemba-Davis, M. (2012). Chlorhexidine bathing and microbial contamination in patients’ bath basins. American Journal of Critical Care, 21(5), 338-342. doi:10.4037/ajcc2012242
Sandri, A., Dalarosa, M. G., De Alcântara, L., Da Silva Elias, L., & Prehn Zavascki, A. (2006). Reduction in incidence of nosocomial methicillin‐resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: Role of treatment with mupirocin ointment and chlorhexidine baths for nasal carriers of MRSA. Chicago Journals, 27(2), 185- 187. Retrieved from http://www.jstor.org/stable/10.1086/500625
Sievert, D., Armola, R., & Halm , M. A. (2011). Infections? chlorhexidine gluconate bathing: Does it decrease hospital-acquired infections. American Journal of Critical Care, 20(2), 166-170. doi:10.4037/ajcc2011841
Turabelidze, G., Lin, M., Wolkoff, B., Dodson, D., Gladbach, S., & Zhu, B. (2006). Personal hygiene and methicillin-resistant Staphylococcus aureus infection. Emerging Infectious Diseases, 12(3), 422-427. Retrieved from http://wwwnc.cdc.gov/eid/article/12/3/pdfs/05-0625.pdf
