ASSIGMENT WEEK 5 Prepare this assignment as a 1,500-1,750-word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below. PICOT Statement Revise the PICOT statement you wrote in the Topic 1 assignment. The final PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study). Research Critiques In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions. The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement. Refer to "Research Critique Guidelines." Questions under each heading should be addressed as a narrative in the structure of a formal paper. Proposed Evidence-Based Practice Change Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Research Critique Guidelines To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment. Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Method of Study: • Were qualitative methods appropriate to answer the research questions? • Did the author identify a specific perspective from which the study was developed? If so, what was it? • Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? • Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. • Did the author evaluate or indicate the weaknesses of the available studies? • Did the literature review include adequate information to build a logical argument? • When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Results of Study • What were the study findings? • What are the implications to nursing? • Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Quantitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Methods of Study • Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? • Was informed consent obtained from the subjects or participants? • Did it seem that the subjects participated voluntarily in the study? • Was institutional review board approval obtained from the agency in which the study was conducted? • Are the major variables (independent and dependent variables) identified and defined? What were these variables? • How were data collected in this study? • What rationale did the author provide for using this data collection method? • Identify the time period for data collection of the study. • Describe the sequence of data collection events for a participant. • Describe the data management and analysis methods used in the study. • Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis? • What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses? Results of Study • What is the researcher's interpretation of findings? • Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? • What limitations of the study were identified by researchers? • Was there a coherent logic to the presentation of findings? • What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing? • What suggestions are made for further studies? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Reference Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier. Running head: Clostridium difficile infection Article Review Clostridium difficile infection Article Review NRS – 433V Introduction to Nursing Research Institution Professor: Student name Date Clostridium difficile infection Article Review 2 Introduction Upon reading the article, “Infection Prevention and Control in Nursing Homes: A Qualitative Study of Decision-Making Regarding Isolation-Based Practices”, there was a close look at Clostridium Difficle and patients in nursing homes. “Clostridium difficile colitis results from disruption of normal healthy bacteria in the colon, often from antibiotics. C-difficile (Cdiff) can also be transmitted from person to person by spores. It can cause severe damage to the colon and even be fatal. As the bacteria overgrow, they release toxins that attack the lining of the intestines. C-diff is highly contangous; EBP proves there is a need to place these patients on isolation precaution” (Mayo, 2016). This ariticle looks at 10 different nursing homes with 73 different interviews (six to eight interviews per facility) lasting appx. 45 minutes long. This study showed that isolation-based practices differed from nursing homes (Cohen, 2015). Background of study “C-diff is one of the most common causes of infectious diarrhea in the United States” (Mayo, 2016). There is a difference from nursing homes and how they treat patients with infectuous diseases. “Interviewees discussed practice decisions in the context of organism transmission risk in specific situations and among individual residents. Most nursing home’s isolation practices incorporated the concept of organism ‘containment’, that is, low perceived transmission risk. This was a factor when staff decided the degree to which an infected resident would be limited in social and environmental contact. For example, anything that can be Clostridium difficile infection Article Review 3 contained, like MRSA (methicillin-resistant Staphylococcus aureus), or VRE (vancomycinresistant enterococcus) in a wound. Or if a patient has MRSA or VRE in the urine, it is contained within the bag. So, if it’s contained, they can be cohorted” (Cohen, 2015). The purpose is to explore decision-making in isolation based infection prevention and control pracitices in nursing homes. The hypothesis is that isolation precautions are recommended in order to prevent spreading pathogens that are associated with high morbidity; for example, multidrug resistant organisms (MDRO) (Cohen, 2015). Methods of study This article is a qualitative method of study; “it is used to gain an understanding of underlying reasons, opinions, and motivations. Qualitative research is also used to uncover trends in thought and opinions, and dive deeper into the problem. Some common methods include focus groups (group discussions), individual interviews, and participation/observations” (Wyse, 2011). This method of study was conducted with staff, for example, staff nurses, infection prevention directors as well as directors of nursing “employed in purposefully sampled US nursing homes. Semistructured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim, and analysed using directed content analysis. The research team discussed emerging themes in weekly meetings to confirm consensus”(Cohen, 2015). There has been a research study with 10 different nursing homes and 73 different interviews (six to eight interviews per facility) lasting appx. 45 minutes long. This study included confining an MDRO infected patient within a private room during all activities to prevent organism transmission in order to prevent this organism from being tranmitted to patients that are Clostridium difficile infection Article Review 4 not affected. Standard precautions guidelines will be used when in contact with infected patients. For example, hand hygiene, use of gowns, gloves and other personal protective equipement depending on the anticipated exposure (Cohen, 2015). Results of study Within this study there was a variation in the nursing homes practices regarding which patients were isolated, at which point the isolation started, how the isolation was implemented, and these nursing homes setup the isolation for each patient. The patients that were interviewed clearly made decisions dependant upon the healthcare staff preceptions of acceptable transmission risk and patient’s quality of life. Some other influencing factors which influenced decision making was availability of private rooms, and how much time staff devoted to isolation based practices and communication tools. This study revealed a lack of knowledge of key infection prevention and control concepts (Cohen, 2015). Resources are more constrained in nuring homes, which can have an effect on infection prevention and control guidelines within the nursing home setting. There have been some studies that have established that placing a patient in isolation can have negative psychological effects if they are in semiprivate or private isolated rooms. “These adverse effects may be of greater concern in a nursing home facility since it is also a primary residence” (Cohen, 2015). Nursing home facilites have to balance the benefits verses the drawbacks of decreasing the spread of infectious diseases and patients experiencing negative psychological effects of being on isolation. There is a gap in literature when it comes to deciding when and how to implement isolation precautions for patients with infections diseases within the nursing home setting. Clostridium difficile infection Article Review 5 Ethical Considerations “Ethical considerations are the principles of respect for persons, beneficence, and justice relevant to the conduct of research” (Grove 503). The privacy of all subjects that participated within this study were protected. There were no identifying factors that would have lead to a Health Insurance Portability and Accountability Act (HIPAA) violation (Grove 99). The only ethical consideration within this study would be the fact that there are some unknown factors, for example, at which point the isolation started, how the isolation was implemented, and these nursing homes setup the isolation for each patient. This study has eithics approval by Columbia University Medical Center Institutional Review Board, University of Pittsburgh Institutional Review Board and RAND Corporation Institutional Review Board. Conclusion In conclusion, “current clinical guidelines are not specific enough to ensure consistant practice that meets care goals and resource constraints in nursing homes” (Cohen, 2015). Within nursing homes there is a wide variation in how and when isolation based infections preventions and control practices are implemented. It is clear that there is additional training and research that needs to be implemented within the staff providers in nursing homes, with emphesis on isolationbased infection prevention and control practices that are associated with the lowest infection risk among nursing home residents. These research studies would help clinicians’ decision making regarding transmission risk and appropriate practices for individual residents, especially in cases of colonisation, cohorting and other organism containment practices. “New Clostridium difficile infection Article Review evidence on these topics is required to ensure high-quality, consistent care for this vulnerable population” (Cohen, 2015). PICOT Statement In health care-acquired C. diff infected patients (P), what is the effect of limiting unnecessary antibiotic use (I) compared to unregulated antibiotic use (C) on decreasing the rate of C. diff infections (O) within the course of a year (T)? 6 Clostridium difficile infection Article Review References: Cohen, C. C., Pogorzelska-Maziarz, M., Herzig, C. T. A., Carter, E. J., Bjarnadottir, R., Semeraro, P., . . . Stone, P. W. (2015). Infection prevention and control in nursing homes: A qualitative study of decision-making regarding isolation-based practices. BMJ Quality & Safety, 24(10), 630. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1136/bmjqs2015-003952 Grove, Susan, Jennifer Gray, Nancy Burns. Understanding Nursing Research, 6th Edition. Saunders, 092014. VitalBook file. Mayo Clinic Staff. (2016). C. difficile infection. Retrieved August 06, 2016, from http://www.mayoclinic.org/diseases-conditions/c-difficile/home/ovc-20202264 Wyse, S, E., Difference between Qualitative Researches vs. Quantitative Research. (2011). Retrieved August 06, 2016, from http://www.snapsurveys.com/blog/what-is-theDifference-between-qualitative-research-and-quantitative-research/ 7 Clostridium difficile infection Article Review 8 Peer reviewed research articles 1.- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805733/ 2.- http://ccn.aacnjournals.org/content/34/4/24.abstract 3.- https://www.americanjournalofsurgery.com/article 4.- http://jlpm.amegroups.com/article/view/ 5.- https://www.hindawi.com/journals/bmri/2018/8414257/ 6.- https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6109a3.htm 1.- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805733/ Clostridium difficile (C. difficile) infection (CDI) is the most common cause of healthcareassociated infections in US hospitals. The epidemic strain NAP1/BI/ribotype 027 accounts for outbreaks worldwide, with increasing mortality and severity. CDI is acquired from an endogenous source or from spores in the environment, most easily acquired during the hospital stay. The use of antimicrobials disrupts the intestinal microflora enabling C. difficile to proliferate in the colon and produce toxins. Clinical diagnosis in symptomatic patients requires toxin detection from stool specimens and rarely in combination with stool culture to increase sensitivity. However, stool culture is essential for epidemiological studies. Oral metronidazole is the recommended therapy for milder cases of CDI and oral vancomycin or fidaxomicin for more Clostridium difficile infection Article Review 9 severe cases. Treatment of first recurrence involves the use of the same therapy used in the initial CDI. In the event of a second recurrence oral vancomycin often given in a tapered dose or intermittently, or fidaxomicin may be used. Fecal transplantation is playing an immense role in therapy of recurrent CDI with remarkable results. Fulminant colitis and toxic megacolon warrant surgical intervention. Novel approaches including new antibiotics and immunotherapy against CDI or its toxins appear to be of potential value. 2.- http://ccn.aacnjournals.org/content/34/4/24.abstract Clostridium difficile has become the leading cause of nosocomial diarrhea in adults. A substantial increase has occurred in morbidity and mortality associated with disease caused by C difficile and in the identification of new hypervirulent strains, warranting a high clinical index of suspicion for infections due to this organism. Prevention of infection requires a multidisciplinary approach, including early recognition of disease, effective contact isolation precautions, adherence to disinfectant policies, and judicious use of antibiotics. Current treatment approaches are based on the severity of illness. As hypervirulent strains evolve, unsuccessful treatments are more common. Complicated colitis caused by C difficile may benefit from surgical intervention. Subtotal colectomy and end ileostomy have been the procedures of choice but are associated with a high mortality rate because of late surgical consultation and use of surgery as a salvage therapy. A promising surgical alternative is creation of a diverting loop ileostomy with colonic lavage. Clostridium difficile infection Article Review 10 3.- https://www.americanjournalofsurgery.com/article Background Clostridium difficile colitis is an important cause of morbidity and mortality in the surgical patient. In recent years, Clostridium difficile infections have shown marked increases in frequency, severity, and resistance to standard treatment. With urgent operative interventions and novel endoscopic approaches, pseudomembranous colitis is being seen more commonly in surgical practices. Data sources In this paper, we will review a number of papers from the literature. We will discuss the epidemiology, evaluation and treatment of Clostridium difficile infection. Fulminant colitis may require emergency operation. For the surgical endoscopes, fecal microbiota transplantation restores the gastrointestinal flora, and has been shown to be effective in more than 80% of patients. Conclusion Clostridium difficile infection is a major cause of healthcare-related diarrhea leading to increased morbidity and mortality in surgical patients. Increases in failure rates and resistance to current treatments are clinical and economic challenges in the healthcare situation. 4.- http://jlpm.amegroups.com/article/view/ Clostridium difficile infection (CDI) is a serious and sometimes life-threatening illness caused by toxin release from Clostridium difficile (CD), a gram-positive anaerobic bacterium. Infection with CD can cause clinical manifestations in a spectrum from asymptomatic carrier states to Clostridium difficile infection Article Review 11 pseudomembranous colitis and toxic megacolon. Accurate diagnosis of CDI depends on early recognition of clinical symptoms of diarrhea, fever, and cramps especially after antibiotic use. Bacterial culture can be performed for epidemiological and antibiogram purposes during outbreaks of CDI. Culture, enzyme immunoassays (EIA), and molecular assays are useful for diagnosis of CDI. Toxigenic culture is useful to determine the cytopathic effect of the bacteria. Current Infectious Disease Society of America (IDSA) and American College of Gastroenterology (ACG) guidelines recommend using nucleic acid amplification tests or glutamate dehydrogenase (GDH) antigen followed by EIA testing for CD toxin A and B. Future studies for CDI diagnosis are looking toward toxin identification and the use of metabolomic analysis. 5.- https://www.hindawi.com/journals/bmri/2018/8414257/ Clostridium difficile (C. difficile) is the most prevalent causative pathogen of healthcareassociated diarrhea. Notably, over the past 10 years, the number of Clostridium difficile outbreaks has increased with the rate of morbidity and mortality. The occurrence and spread of C. difficile strains that are resistant to multiple antimicrobial drugs complicate prevention as well as potential treatment options. Most C. difficile isolates are still susceptible to metronidazole and vancomycin. Incidences of C. difficile resistance to other antimicrobial drugs have also been reported. Most of the antibiotics correlated with C. difficile infection (CDI), such as ampicillin, amoxicillin, cephalosporins, clindamycin, and fluoroquinolones, continue to be associated with the highest risk for CDI. Still, the detailed mechanism of resistance to Clostridium difficile infection Article Review 12 metronidazole or vancomycin is not clear. Alternation in the target sites of the antibiotics is the main mechanism of erythromycin, fluoroquinolone, and rifamycin resistance in C. difficile. In this review, different antimicrobial agents are discussed, and C. difficile resistance patterns and their mechanism of survival are summarized. 6.- https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6109a3.htm Abstract Background: Clostridium difficile infection (CDI) is a common and sometimes fatal healthcare–associated infection; the incidence, deaths, and excess health-care costs resulting from CDIs in hospitalized patients are all at historic highs. Meanwhile, the contribution of nonhospital health-care exposures to the overall burden of CDI, and the ability of programs to prevent CDIs by implementing CDC recommendations across a range of hospitals, have not been demonstrated previously. Methods: Population-based data from the Emerging Infections Program were analyzed by location and antecedent health-care exposures. Present-on-admission and hospital-onset, laboratory-identified CDIs reported to the National Healthcare Safety Network (NHSN) were analyzed. Rates of hospital-onset CDIs were compared between two 8-month periods near the beginning and end of three CDI prevention programs that focused primarily on measures to prevent intra-hospital transmission of C. difficile in three states (Illinois, Massachusetts, and New York). Clostridium difficile infection Article Review Results: Among CDIs identified in Emerging Infections Program data in 2010, 94% were associated with receiving health care; of these, 75% had onset among persons not currently hospitalized, including recently discharged patients, outpatients, and nursing home residents. Among CDIs reported to NHSN in 2010, 52% were already present on hospital admission, although they were largely health-care related. The pooled CDI rate declined 20% among 71 hospitals participating in the CDI prevention programs. Conclusions: Nearly all CDIs are related to various health-care settings where predisposing antibiotics are prescribed, and C. difficile transmission occurs. Hospital-onset CDIs were prevented through an emphasis on infection control. 13 Running head: CLOSTRIDIUM DIFFICILE INFECTION ARTICLE Rough Draft Qualitative Research Critique and Ethical Considerations Clostridium difficile infection NRS – 433V Introduction to Nursing Research Professor: Student name Date 1 CLOSTRIDIUM DIFFICILE INFECTION ARTICLE 2 Introduction In an article dubbed “Clostridium difficile colitis: A clinical review,” Ong et al. (2017) present a qualitative study on Clostridium difficile infection (CDI) in which they discuss the epidemiology, diagnosis, clinical presentation, medical management, and surgical treatment. The authors review quite a number of literature papers, and they conclude that CDI is a leading cause of most healthcare-related diarrhoea. Further, they establish that it leads to increased mortality and morbidity in patients undergoing surgeries. According to the article, Clostridium difficile infection is "an etiology of diarrhoea from antibiotic use," and it has, over the years, increased in terms of severity and frequency. Also, the disease has increasingly shown resistance to the treatments currently available. Background of study The idea for the study came about due to the increasing concerns of CDIs. Specifically, there has been a general increase in the number of cases of the disease. The article observes that "in recent years, clostridium difficile infections (CDI) have shown marked increases in frequency, severity, and resistance to standard treatment." The frequency increased from 4.5 cases for every 1,000 clinical discharges to 8.2 (almost doubling) between 2001 and 2010. The mortality stands at 7%, and in one of the papers reviewed revealing close to half a million cases and 29,300 deaths in the U.S. between this period. CLOSTRIDIUM DIFFICILE INFECTION ARTICLE 3 The statistics are obviously worrying particularly given the nature of infections. Thus, understanding the underlying root causes of this sudden upsurge is urgent. There is a need to understand the clinical factors that lead to increased infections. Additionally, it is necessary to understand the infection in terms of the clinical signs, symptoms, and diagnosis so that it is easy to identify potential victims for isolation and early treatment. The significance of the study is based on the fact that CDI is a leading cause of diarrhoea related to healthcare, and which in turn increases the mortality and morbidity of patients undergoing surgical treatments. This, of course, has a huge impact on society. Other than simply increasing the medical cost and suffering in patients, it also reduces the chances of survival and recovery for surgical patients. Additionally, there has been an increase in failure to treatment. Resistance to standard treatment is yet another problem. These two taken together increase healthcare challenges in terms of the cost and personnel. The purpose of the study is not explicitly stated. However, from the information provided and the conclusions, it can be inferred that the purpose was to increase the knowledge of CDI in terms of the medical management, epidemiology, clinical presentation, diagnosis, and surgical treatment. The research questions, also not stated, would be inferred as follows: 1. What are the clinical presentations of CDI? 2. What are the best treatment and management practices of CDI? 3. What are the diagnostic features of CDI? In this instance, the research objectives would both relate to the problem of the study. Specifically, the research questions would serve as the basis for the research. For example, CLOSTRIDIUM DIFFICILE INFECTION ARTICLE 4 findings on the clinical presentation would relate with the purpose of understanding the clinical signs that are used to either decide for or against CDI during diagnosis. Method of study The study was based on the synthesis and analysis of papers in the literature. There could have been better methods to conduct the study but given the fact that a substantial amount of information already existed, there was no point in actually carrying out the primary study. That notwithstanding, the method was adequate in terms of addressing the research problem. The authors did not identify any specific point of view from which the study was conducted. However, based on the significant of the study, a quick guess can be made that the study was based on a social perspective. This is because the conclusions tie up the findings of the result to "clinical and economical challenges in the healthcare setting." Furthermore, the authors refer to the mortality and morbidity aspects of the infection, and these two are purely social concerns. The article utilizes journal papers as the basis of information. Every often, the authors borrow from leading studies as related to the research topic as well as other healthcare areas that are of importance to the current study. While the majority of the sources used are journal articles, there are a few instances in which medical reports and statistics by a respected organization like the World Health Organization are used. The currency of sources varies greatly. There are sources from as early as the 1970s as well as others more recent like 2016. The authors do not critic these articles. Instead, they use them to build their own case. They also compare them to show a trend or to simply reinforce an idea. Nonetheless, the literature review is adequate enough to answer the research questions. CLOSTRIDIUM DIFFICILE INFECTION ARTICLE 5 Results of the study and implications to nursing The frequency of CDI more than doubled between 2001 and 2010. The mortality rate also increased, and currently stands at over 7%. CDI diagnosis is based on the presence of diarrhoea of at least 3 stools in a period of 24 hours, the presence of C. difficile toxin in the stool, and r radiographic proof of ileus. Clinical signs include self-limited diarrhoea, fever, abnormal WBC count, tachycardia, and abdominal pain. Medical treatment includes discontinuation of the causative antibiotic, avoidance of antiperistalsis agents, and resuscitation. Surgical treatment includes abdominal colectomy. This information is very useful to nursing. Among many reasons, it adds to the knowledge base of nurses thereby making them better equipped to handle the infections. Additionally, the epidemiology calls for nurses’ attention. It is high time that nurses begin considering CDI a serious problem which manifests mostly in clinical settings and thereby put mechanisms in place to control it. Ethical consideration There were no ethical considerations for the study. The study did not include human subjects, and there was no provision for seeking of approval from relevant bodies. Conclusion Clostridium difficile infection is increasing in terms of frequency, mortality, and resistance to standard treatment. However, enough information is available pertaining to CLOSTRIDIUM DIFFICILE INFECTION ARTICLE 6 epidemiology, diagnosis, clinical presentation, medical management, and surgical treatment. This should serve as the starting point for nurse practitioners so that they can come up with better ways of managing this disease. CLOSTRIDIUM DIFFICILE INFECTION ARTICLE 7 Reference Burns, N., & Grove, S. K. (2010). Understanding Nursing Research-eBook: Building an Evidence-Based Practice. Elsevier Health Sciences. Centers for Disease Control and Prevention (CDC. (2012). Vital signs: preventing Clostridium difficile infections. MMWR. Morbidity and mortality weekly report, 61(9), 157. Dubberke, E. R., Reske, K. A., Olsen, M. A., McDonald, L. C., & Fraser, V. J. (2008). Short-and long-term attributable costs of Clostridium difficile-associated disease in nonsurgical inpatients. Clinical Infectious Diseases, 46(4), 497-504. Ong, G. K., Reidy, T. J., Huk, M. D., & Lane, F. R. (2017). Clostridium difficile colitis: A clinical review. The American Journal of Surgery, 213(3), 565-571. Running head: CLOSTRIDIUM DIFFICILE INFECTION 1 Rough Draft Quantitative Research Critique and Ethical Considerations Clostridium difficile infection NRS – 433V Introduction to Nursing Research Institution Professor: Student name Date CLOSTRIDIUM DIFFICILE INFECTION 2 Introduction In “Vital signs: preventing Clostridium difficile infections,” CDC (2012) presents a quantitative study aimed at examining both hospital-based and non-hospital sources of exposure for Clostridium difficile infection (CDI). In the article, too, CDC examine the effectiveness of Emerging Infections Program on the infection of CDI and control. The article makes various recommendations that if implemented, can greatly reduce the rate of infection of C. difficile. Additionally, the article summarizes CDI from a public health perspective, and it does well to show how and why the disease is such a big problem to the country. A critical analysis of the disease is also given. For example, the article defines Clostridium difficile as a bacillus which respires anaerobically and forms spores. The bacillus is responsible for causing pseudomembranous colitis, a medical condition which often manifests as diarrhea. This condition can occur repeatedly, and if it is not detected and treated in time, it can persist and develop into serious conditions that can cause death. The spores are the infective properties, and they can survive on surfaces for a long time. According to the article, CDI often spread in healthcare settings as a result of the concentration of symptomatic patients and the prescription of antibiotics. Background of study The medical costs, incidence, and mortality rates of CDI have been increasing tremendously throughout the past few years. For example, in the 1999/2000 period, there were about 3,000 deaths attributed to CDI. In the 2006/7 period, the number stood at 14,000. This increase in the number of deaths is alarming particularly in light of the suffering that it causes. What is more 2 CLOSTRIDIUM DIFFICILE INFECTION 3 worrying is the fact that many of the people positively diagnosed with CDI report to have had contact with clinical settings at some point. Many of them, too, had their onset once they cut the contact with the clinical setting. This raises concerns about the role of clinical settings to play in the transmission of the infection. The cost of hospitalization for CDIs has more than tripled over the years. For every case, it is estimated that it costs somewhere between $5,042 and $7,179 to treat a patient. Every year, the nation spends between $897 million and $1.3 billion on CDI (Dubberke et al., 2008). Between 2000 and 2009, the number of patients hospitalized with CDI increased from 139,000 to 336,600, and this can explain why the medical costs have been increasing. It, therefore, follows that this matter requires urgent attention in terms of understanding the underlying factors that cause the upsurge. The purpose of the study, therefore, is to develop an understanding of the relationship between the clinical settings and CDI infection which will assist in developing clinical-based interventions to control the spread of the infection in these settings. Possible research questions would include: 1. Is the healthcare setting designed to control the spread of CDI? 2. Is there a difference between infections in healthcare settings and those outside healthcare settings? Method of study The study employs quantitative techniques. The article uses three sources of data to: • Identify the exposures of CDIs in healthcare settings, • Establish the number of cases of CDI that occur outside healthcare settings, and to • Evaluate the effectiveness of interventions in reducing CDIs 3 CLOSTRIDIUM DIFFICILE INFECTION 4 Active surveillance based on populations was conducted by the Emerging Infections Program of CDC in eight different geographical areas. Catchment areas were defined, and program coordinators were supplied with lab reports on stools that tested positive for the bacillus. Cases to be included in the study were defined based on a person having a positive test at that time but did not test positive in the previous 8 weeks. The medical records of participants were looked into to confirm that they indeed exhibited symptoms of CDI. Also, there records revealed all the exposures participants had to healthcare settings in the past 12 weeks before the specimen was collected. Data was also collected from the National Healthcare Safety Network (NHSN), and data relating to patients who tested positive for CDI after exposure to healthcare setting was given priority. Specifically, the specimen was collected and tested for the bacillus within three days of admission to healthcare settings and also taken and tested again 4 weeks after being discharged. This is because it is during this period that hospitalization is likely to increase the risk of or explain DCI infection. The final source of data was based on three programs lead by Illinois, Massachusetts, and New York state governments to prevent the prevalence of hospitalexposure infections with a specific focus on CDI. There were a total of 71 hospitals that were included in these programs. Results of study According to CDC’s Emerging Infections Program, a total of 310 nursing homes and 111 acute care facilities were included in the surveillance. The number of CDI cases that were identified stood at 10,342. Of this number, 44% was made up of patients of 65 years and above. 94% of all these cases were related to some kind of exposure to healthcare facilities. Of all the 4 CLOSTRIDIUM DIFFICILE INFECTION 5 cases that were related to exposure to healthcare settings, 75% developed symptoms long after their discharge from these facilities. There were also cases that were related to exposure to nursing homes and acute healthcare facilities. According to NHSN data, there were 42,157 cases of CDI and 52% of them are people presently admitted in various hospitals. Ethical considerations Ethical considerations refer to attempts made to demonstrate respect for human subjects' dignity and their rights even as they assist in the research process (Burns & Grove, 2010). It involves issues like protecting the identities and privacy of research subjects, getting approval from relevant authorities to conduct the study, and obtaining the consent of the research subjects. In this study, there is no provision for such. This may be due to the fact that the study is conducted by a reputable organization which is involved in the healthcare system. Whatever the case, the study should have included information on such basic research ethics. Conclusion In conclusion, healthcare settings make up part of the risk factors for increased transmission and infection of CDI. Specifically, the concentration of people with symptoms in these settings and the uncontrolled administration of antibiotics contribute to the spread of the disease. There is a need, therefore, to strengthen the monitoring of antibiotics in these settings as well as strict diagnosis of every patient before admission. There should be systems in place to quickly detect and isolate patients with symptoms. 5 CLOSTRIDIUM DIFFICILE INFECTION 6 References Burns, N., & Grove, S. K. (2010). Understanding Nursing Research-eBook: Building an Evidence-Based Practice. Elsevier Health Sciences. Centers for Disease Control and Prevention (CDC. (2012). Vital signs: preventing Clostridium difficile infections. MMWR. Morbidity and mortality weekly report, 61(9), 157. Dubberke, E. R., Reske, K. A., Olsen, M. A., McDonald, L. C., & Fraser, V. J. (2008). Short-and long-term attributable costs of Clostridium difficile-associated disease in nonsurgical inpatients. Clinical Infectious Diseases, 46(4), 497-504. 6
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