Sample Paper on Reducing Catheter-Associated Urinary Tract Infection

Reducing Catheter-Associated Urinary Tract Infection: A Critical Appraisal

            Reduction of the use of urinary catheters or alternatively, the replacement of standard urinary catheters with silver-coated ones has been touted as a potential solution for the reduction of catheter- associated urinary tract infections (CAUTI). It is approximated that 75% of all urinary tract infections are in one way or another linked to urinary catheters. The research sought to identify whether the use of silver-coated urinary catheters is more effective as compared to the use of standard silicon Foley catheters.

Are the Study’s Results Valid?

The first step in answering the above question is determining whether the study asked a clearly focused clinical question (Emptage, Koster, Schottinger, & Petitti, 2007). This study can be seen to fulfill this requirement by asking the question, “Can CAUTI rates be reduced in patients hospitalized in a 16-bed cardiovascular intensive care unit (CVICU) with the use of silver-coated urinary catheters versus the standard Foley catheters?” The research paper also clearly and explicitly states the population of interest, that is, hospitalized patients in the CVICU requiring catheterization. The research also clearly indicates the intervention, namely to change practice from the use of standard Foley catheters to the use of antimicrobial impregnated Foley catheters, also commonly known as silver-coated urinary catheters.

Despite these positive points in the form of clear definitions, the study falls short when tasked with the definition of the standard of care. This may be assumed since it states that the patient population under review is the hospitalized patients requiring catheterization. However, the type of hospital under which these patients are hospitalized is not clear from the research and hence may be open to a variety of interpretations. Therefore, this opens the research up to claims of ambiguity and lack of a specific focus group.

In addition, the study population was not subject to a standardized protocol on recruitment for the study. The recruitment process is not clearly defined and so the eligibility of candidates is not clearly defined. The patients in each of the two distinct groups should also be subjected to the same conditions in order to reduce the probability of bias in the collection of data and eventually in the end results.

With regard to the design of the study in relation to the clinical question, this research was able to choose an appropriate design. The research implements the use of a control group to compare the effectiveness of the two different approaches. The comparison group is drawn from the same population and therefore it is possible to determine with some degree of accuracy whether the changes in the two groups are significantly different. However, the study does not state how the patients will be divided into the two groups, for example, using random selection or not. This should be made very clear to avoid ambiguity.

The final consideration with regard to the validity of the results is whether the research was conducted or is expected to be conducted using the proper methodology (Elwood, 2007). This is in regard to the biases that may be present in the research that are not part of how the research itself is designed. This study falls short because it does not explicitly define the method of selection of the patients and how they are to be split into two distinct groups. This point also considers the comparability of study groups, the degree of compliance of the patients with the research, and the probability of skewing the results significantly, for example, through some patients refusing to participate in the research. For this research, these are not verifiable because the research has not been conducted yet, and therefore these facts cannot be analyzed with relative ease.

 

What are the results?

The results include not only the final findings of the research but also the magnitude of the treatment effect and the precision of the treatment effect estimate. The average difference between the distinct sets of patients forms the treatment effect. For this study dealing with the relative changes between the patients who used the standard catheter and those who used the silver-coated catheter, these results are not readily available. This is because the research has not been conducted yet. However, according to the way the research is designed, these results should be available when the research is finally conducted. This is because of the suggested use of a control group who make it possible to measure the effect of the adoption of the two different approaches to the treatment of urinary tract infections.

How can I apply these results to patient care?

The response to how the results of research can be applied to patient care is threefold. The first is the consideration of whether the patients in the study display similar characteristics to one’s patients. This is simply the equivalent of asking oneself whether one’s patients would have fit the criteria that the patients in the study went through. Even though they would not have, it is also important to consider whether the treatment applied would be as effective if administered to one’s patients. In this particular research, the selection criteria may not be effectively presented and so this is hard to determine. However, on analysis of the research put forward, it may be possible to determine the applicability of this research to one’s own patients.

The second point to be considered is if all clinically relevant outcomes are considered in the research (Emptage et al., 2007). The importance of an outcome is determined by both the point of view of the physician and their patient. The analysis of the research topics considered to be Grade A should reveal this outcome to both the potential patients and the clinical practitioners. This research also ignored to mention some information that may be of relevance to both parties, for example, the ages of the patients in the research. This is an important factor that may influence the outcome, yet was not considered. Other factors that may play a part include the general health of the patients and more personal traits, such as allergies to some of the materials that may be used to make catheters. These are relevant to the research and should be included.

The final consideration is whether the suggested treatment for patients is worth the potential risks that are being taken to test it and making it available to them. Factors to be considered here include the fact that it is no use exposing patients to more harm for the sake of a hopeful cure in future. There is also the consideration of whether the costs involved are necessary since they are undertaken at the expense of provision of alternative services. These factors should be considered before even coming to the decision of finally conducting the research with the view of eventually bringing it to your own patients. In this research, these factors should be taken into consideration before committing to the research to ensure that it is being done for the right reasons.

Apart from the considerations mentioned above, a research of this type is prone to some unique constraints. One of these constraints that must be taken into consideration is the literature considered for inclusion and its grading (Center for Evidence Based Medicine, 2014). Some factors to take into account here include whether the literature search was done extensively enough. For example, did it consider both published and unpublished material for inclusion? Another consideration is whether the extent of materials sought was from English-speaking countries only or also non-English speaking ones. This is to ensure that the literature considered is as wide as possible in order to have the most impact on future research (Polit & Beck, 2008). For this specific research, it seems that only online publications were considered. This therefore has the impact that unpublished materials may not have found their way into the research considered. The extent of non-English content in this particular research is also wanting and it seems that none of non-English content was considered. A final consideration is whether the opinions of experts in the topic were taken into account. This has the effect of getting the most relevant information. This, it seems, was also not considered and experts were not contacted to advice on best sources.

Summary

The various aspects of a critical appraisal have been considered and the research provided has been evaluated based on this criteria. This process is necessary to ensure research released is of the highest quality standards and will meet the needs of both the patients and the clinical practitioners. It also ensures that the results of the research are most applicable to practice and future research (Sackett, Strauss & Richardson, 2000).

 

References

Center for Evidence Based Medicine (2014).Levels of Evidence. Retrieved April 5, 2014,                         from http://www.cebm.net/index.aspx?o=1025

Elwood, M. (2007). Critical appraisal of epidemiological studies and clinical trials. Oxford           University Press.

Emptage, N. P., Koster, M. A., Schottinger, J. E., & Petitti, D. B. (2007). Critical Appraisal of     Clinical Studies: An Example from Computed Tomography Screening for Lung        Cancer. The Permanente Journal11(2), 81.

Polit, D. F. & Beck, C. T. (2008). Generating and Assessing Evidence for Nursing Practice.          (8th ed) Philadelphia: Lippincott Williams & Wilkins

Sackett, D. Strauss, S., Richardson, W. (2000). Evidence-based medicine: How to Practice and                Teach. EBM. London: Churchill-Livingstone.