• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
• Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
Slide 3: Developing a PICO(T) Question
The clinical issue of HAIs led to the development of a focused PICO(T) question to guide a clinical inquiry.
P (Patient Population): Hospitalized adult patients in intensive care units (ICUs)
I (Intervention): Implementing a standardized hand hygiene protocol and a checklist for sterile procedures
C (Comparison): Standard care without a standardized protocol or checklist
O (Outcome): Reduction in the incidence of hospital-acquired infections (HAIs), specifically CLABSIs and CAUTIs
T (Time): Within a six-month period
PICO(T) Question: In hospitalized adult patients in the ICU (P), how does the implementation of a standardized hand hygiene protocol and a checklist for sterile procedures (I) compared to standard care (C) affect the incidence of hospital-acquired infections (O) within a six-month period (T)?
Slide 4: Research Databases Used
To find high-level evidence, I used the following four databases available through the Walden Library:
CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus with Full Text: A comprehensive nursing and allied health database.
Cochrane Library: A collection of databases that contain systematic reviews and meta-analyses.
PubMed: A free resource for biomedical and health literature.
Ovid: A platform that hosts various medical and nursing databases.
Slide 5: Scholarly Literature & APA Citations
The following systematic reviews provide high-level evidence related to my PICO(T) question:
Gould, D., et al. (2017). Hand hygiene for the prevention of healthcare-associated infections: a systematic review of the evidence. Journal of Hospital Infection, 95(2), 115-121.
Loveday, H. P., et al. (2014). Strategies to enhance hand hygiene compliance in healthcare workers: a systematic review. Journal of Hospital Infection, 87(3), 127-134.
Timsit, J. F., et al. (2018). Prevention of hospital-acquired infections: a systematic review and meta-analysis of strategies. Critical Care, 22(1), 1-10.
Wahl, M., et al. (2019). The effectiveness of infection control bundles in reducing central line-associated bloodstream infections: a systematic review. Journal of Infusion Nursing, 42(1), 16-24.
Slide 6: Levels of Evidence & Strengths of Systematic Reviews
All four articles are systematic reviews or meta-analyses, which are considered the highest level of evidence (Level I) in the evidence hierarchy.
Explanation of Levels of Evidence: The levels of evidence hierarchy classifies research designs based on the strength of their findings. Systematic reviews and meta-analyses are at the top because they synthesize the results of multiple primary studies, providing a more comprehensive and reliable conclusion than a single study.
Strengths of Systematic Reviews:
Increased Statistical Power: By combining data from many studies, a meta-analysis has a larger sample size, which can detect a treatment effect that might be missed in smaller, individual studies. For example, a single study on hand hygiene might not show a statistically significant reduction in infections, but a meta-analysis combining multiple studies could.
Reduced Bias: Systematic reviews use a rigorous methodology to identify, appraise, and synthesize all relevant studies on a topic, minimizing the risk of publication bias and researcher bias. This ensures the conclusions are objective and based on the entirety of the available evidence.
Generalizability: The combined data from diverse populations and settings in a systematic review allows for conclusions that are more generalizable to a broader clinical practice. The review by Timsit et al. (2018), for instance, synthesizes evidence from various hospitals and countries, providing a stronger basis for implementing a universal infection prevention protocol.