GCU NUR550 PICOT Research Proposal

The purpose of this assignment is to write a review of the research articles you evaluated in your Topic 5 \”Evidence-Based Practice Project: Evaluation of Literature\” assignment. If you have been directed by your instructor to select different articles in order to meet the requirements for a literature review or to better support your evidence-based practice project proposal, complete this step prior to writing your review.

GCU NUR550 PICOT Research Proposal

A literature review provides a concise comparison of the literature for the reader and explains how the research demonstrates support for your PICOT.
You will use the literature review in this assignment in NUR-590, during which you will write a final paper detailing your evidence-based practice project proposal. GCU NUR550 PICOT Research Proposal

In a paper of 1,250-1,500, select eight of the ten articles you evaluated that demonstrate clear support for your evidence-based practice and complete the following for each article:

Introduction – Describe the clinical issue or problem you are addressing. Present your PICOT statement.

Search methods – Describe your search strategy and the criteria that you used in choosing and searching for your articles.

Synthesis of the literature – For each article, write a paragraph discussing the main components (subjects, methods, key findings) and provide rationale for how the article supports your PICOT.

Comparison of articles – Compare the articles (similarities and differences, themes, methods, conclusions, limitations, controversies). GCU NUR550 PICOT Research Proposal

Suggestions for future research: Based on your analysis of the literature, discuss identified gaps and which areas require further research. GCU NUR550 PICOT Research Proposal

Conclusion – Provide a summary statement of what you found in the literature.

Complete the \”APA Writing Checklist\” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing.
Include the completed checklist as an appendix at the end of your GCU NUR550 PICOT Research Proposal paper.

Refer to the \”Evidence-Based Practice Project Proposal – Assignment Overview\” document for an overview of the evidence-based practice project proposal GCU NUR550 PICOT Research Proposal assignments.

You are required to cite eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the 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.

You are required to submit this GCU NUR550 PICOT Research Proposal assignment to LopesWrite.

PICOT Research Proposal Example


Central line-associated bloodstream infections (CLABSI) are caused by bacteria that are introduced to the bloodstream through central lines. CLABSI is common in ICU patients majorly attributed to the severity of their conditions and the compromised immunity. The major causes of CLABSI are methicillin Resistant Staphylococcus aureus (MRSA). CLABSI is a health concern because it leads to increased mortality, morbidity, increased hospital stays, and increased cost of care. Different studies, among them that of Reynolds et al. (2021), have shown that health care workers have a great role in reducing rates of CLABSI by undertaking preventive measures such as the use of Chlorohexidine Gluconate. As such, this discussion forms the basis of the PICOT question, namely: In patients admitted in ICU with a central line catheter (P), how does the use of chlorhexidine (I) compared with flushing central line using normal saline (C) lead to the reduced central line-associated bloodstream infection (O) over six months (T)? GCU NUR550 PICOT Research Proposal

Search methods.

The information to support the PICOT was retrieved from scientific online sources that provided in-depth discussion to help achieve the objectives. The sources included PubMed, Google Scholar, CINANHL, ProQuest, and JOSTR. Keywords and phrases were searched systematically. The words included CLABSI prevention, Chlorohexidine roles in reducing CLABSI, and central lines in ICU patients. Additionally, Boolean Operators enabled the search of articles using AND, OR phrases. For example, Chlorohexidine and ClABSI, CLABSI prevention (chlorohexidine OR normal saline).  The resulting articles from the search were analyzed and information retrieved to support the discussion.

Synthesis of Literature.

Different papers provided different information that helped in discussing the PICOT question. The first study is a qualitative–clustered randomized study by Reynolds et al. (2021) done in 14 clinical units with a major aim of evaluating the impact of implementing the multifaceted program on compliance of nurses to the bathing process with chlorohexidine yielded some results. Nurses were educated through the demonstration on how to do the bathing process as champion nurses observed the other nurse while applying the knowledge. The study showed effective bathing process reduced CLABSI rate by 24% (Reynolds et al., 2021 GCU NUR550 PICOT Research Proposal). The information from the research supports the PICOT by encouraging nurses to adhere to the recommended bathing process to reduce the rate of CLABSI.

In their sequential observation study, Urbancic et al. (2018) focused on an Australian tertiary ICU with the aim of assessing the effectiveness of CHG in an Australian setting. Nurses were observed while carrying out the bathing process and microbiology data were compared. The results revealed a minimal decrease in CLABSI and many reductions in MRSA. Nonetheless, the study stresses the importance of doing bathing appropriately. Unlike Urbancic et al. (2018 GCU NUR550 PICOT Research Proposal), Musuuza et al. (2017) conducted a qualitative study using semi-structured interviews. The study focused on a veterans administration hospital and aimed at identifying the facilitators and barriers to daily bathing with chlorhexidine. The process of bathing was demonstrated. The result revealed that increased workload, patient factors, and scheduling hindered the bathing process while soap availability, the existent policy of bathing, and reminders were facilitators for CHG bathing. The study was useful in identifying the barriers to CHG bathing and addressed how to overcome the barriers in ensuring adherence to daily bathing.

Zerr et al. (2020) through a randomized controlled trial involving 36 pediatric units aimed at assessing the efficacy of CHG in reducing infections in patients undergoing hematopoietic stem cell replacement (HCT). The researchers divided the patients into two groups: the control and the study group. The study revealed reduced rates of CABSI in the study group. The study was relevant in describing various instances when the use of CHG is recommended. Further, a prospective cohort study by Giri et al. (2021 GCU NUR550 PICOT Research Proposal) done at Duke University medical center sought to explain the impact of bathing adult patients undergoing allogeneic HCT with CHG. The result revealed a 15.6% decrease in CLABSI rates in patients who frequently used CHG. The study was essential in supporting the PICOT idea and that daily bathing is required for effective control of infection. GCU NUR550 PICOT Research Proposal

Lowe et al. (2017) conducted a prospective crossover study over 8 months in a Canadian academic hospital and assessed CHG and soap use within the setting. The researchers divided the participants into control and study group. Water and nonmedicated soap were used for controls while the study group received CHG. The results showed a decrease of 55% of CLABSI in the intervention group compared to only 36% incidence reduction in the control group. The result support that CHG is effective in preventing CHG as evident in PICOT. A study by Reagan et al., (2019), on the other hand, sought to determine the impact of reduced HAI on the cost of care. To achieve this, the authors performed a mathematical analysis of different studies. The results revealed that using CHG leads to reduced rates of HAI which in turn leads to an $815,301.75 reduction in the cost of care. The information is relevant to building the PICOT in the sense that prevention is better than cure.

The final study relevant to the current topic is that of Patel et al. (2019 GCU NUR550 PICOT Research Proposal), which is an observational study involving 462 facilities. The authors assessed the effects of multimodal intervention in reducing HAIs. Nurses were provided with knowledge through videos, tutors, and webinars and observation was done. There was a reduction in the rate of CLABSI throughout the intervention. The study is relevant to the current PICOT as it shows that continuous use is effective in reducing infection rates.

Articles Comparison.

While the studies reviewed differ significantly in terms of objectives, sample setting and intervention strategies, their outcomes do not differ much in as far as controlling CLABSI is concerned. For instance, the studies by Zerr et al. (2020 GCU NUR550 PICOT Research Proposal) and that of Giri et al. (2021) employ similar mechanisms in assessing the effectiveness of CHG use in the prevention of infections in patients undergoing allogeneic HCT. While the two studies focused on different age groups, their results revealed a reduced rate of CLABSI upon using CHG. Further, the methodologies were markedly different since Zerr et al. (2020) used a randomized controlled trial while Giri et al. (2021) used a prospective cohort study. The latter was done in 3 years and yielded conclusive results as compared with the former which was short-lived.

The study by Lowe et al. (2017) aimed at study the effectiveness of bathing to reduce MRSA, the result revealed reduced MRSA rates that lead to reduced hospital stay and cost. Thi study sharply contrasts with that of Reagan et al. (2019), especially in terms of the objectives. Specifically, Regan et al. (2019) compared different studies based on the reduction of CLABSI as presented in prior research works. Yet, the authors sought to establish the effects of reduced HAI on the cost of care, a goal similar to that of Lowe et al. (2017). The results from both studies revealed that health facilities can realize reduced cost of care with decreased CLABSI rates. However, different methodologies were used by the respective authors, with the former being a prospective crossover study while that of Reagan being mathematical analysis of research results from published sources. GCU NUR550 PICOT Research Proposal

Finally, studies by Patel et al. (2019) and Urbancic et al. (2018) leveraged observational study approach. The authors observed nurses performing the bathing process. However, while the study by Urbancic et al. (2018) focused on the effects of multifaceted program on compliance to bathing, that of Patel et al. (2019) assessed the effects of multimodal interventions in reducing HAIs. Nonetheless, both studies revealed that MRSA rates were reduced with an effective bathing process.

Future Research Suggestion

 The topic of prevention of CLABSI is paramount in health, not only in the U.S. context, but globally. Future studies should focus on advanced research that would lead to the prevention of CLABSI, especially over a long term for effective assessment of the reliability of the intervention processes available. Additionally, there is need for studies to focus on nurse training on how to bathe patients effectively as a means of reducing the rates of CLABSI in a hospital setting.


While CLABSI is a common occurrence in ICU patients, studies have shown that taking preventive measures can help reduce infection rates and improve the quality of life of the patients. Reliably, the resources reviewed in the paper, while focused on different circumstances to assess the effectiveness of chlorhexidine in reducing CLABSI rates, have shown consistent outcomes. Essentially, the studies reveal that performing appropriate bathing techniques, educating nurses, and coming up with policies that guide bathing will help in reducing the prevalence of CLABSI. Reduced infection rates lead to the reduced hospital stay, reduced cost of care, and improved quality of life. GCU NUR550 PICOT Research Proposal

GCU NUR550 PICOT Research Proposal References

  • Giri, V. K., Kegerreis, K. G., Ren, Y., Bohannon, L. M., Lobaugh-Jin, E., Messina, J. A., Matthews, A., Mowery, Y. M., Sito, E., Lassiter, M., Saullo, J. L., Jung, S.-H., Ma, L., Greenberg, M., Andermann, T. M., van den Brink, M. R. M., Peled, J. U., Gomes, A. L. C., Choi, T., … Sung, A. D. (2021). Chlorhexidine gluconate bathing reduces the incidence of bloodstream infections in adults undergoing inpatient hematopoietic cell transplantation. Transplantation and Cellular Therapy, 27(3), 262.e1-262.e11. https://doi.org/10.1016/j.jtct.2021.01.004
  • Lowe, C. F., Lloyd-Smith, E., Sidhu, B., Ritchie, G., Sharma, A., Jang, W., Wong, A., Bilawka, J., Richards, D., Kind, T., Puddicombe, D., Champagne, S., Leung, V., & Romney, M. G. (2017). Reduction in hospital-associated methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus with daily chlorhexidine gluconate bathing for medical inpatients. American Journal of Infection Control, 45(3), 255–259. https://doi.org/10.1016/j.ajic.2016.09.019
  • Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining nurses’ perspectives and experiences. BMC Infectious Diseases, 17(1), 75. https://doi.org/10.1186/s12879-017-2180-8
  • Patel, P. K., Greene, M. T., Jones, K., Rolle, A. J., Ratz, D., Snyder, A., Saint, S., & Chopra, V. (2019). Quantitative results of a national intervention to prevent central line-associated bloodstream infection: A pre-post observational study: A pre-post observational study. Annals of Internal Medicine, 171(7_Suppl), S23–S29. https://doi.org/10.7326/M18-3533
  • Reagan, K. A., Chan, D. M., Vanhoozer, G., Stevens, M. P., Doll, M., Godbout, E. J., Cooper, K., Pryor, R. J., Hemphill, R. R., & Bearman, G. (2019). You get back what you give: Decreased hospital infections with improvement in CHG bathing, a mathematical modeling, and cost analysis. American Journal of Infection Control, 47(12), 1471–1473. https://doi.org/10.1016/j.ajic.2019.07.003
  • Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial. Implementation Science: IS, 16(1), 45. https://doi.org/10.1186/s13012-021-01112-4
  • Urbancic, K. F., Mårtensson, J., Glassford, N., Eyeington, C., Robbins, R., Ward, P. B., Williams, D., Johnson, P. D., & Bellomo, R. (2018). Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition. Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine, 20(2), 109–116. https://pubmed.ncbi.nlm.nih.gov/29852849/
  • Zerr, D. M., Milstone, A. M., Dvorak, C. C., Adler, A. L., Chen, L., Villaluna, D., Dang, H., Qin, X., Addetia, A., Yu, L. C., Conway Keller, M., Esbenshade, A. J., August, K. J., Fisher, B. T., & Sung, L. (2020). Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children’s Oncology Group. Cancer, 127(1), 56–66. https://doi.org/10.1002/cncr.33271

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