Effectiveness of Intraoral Chlorhexidine Protocols in The Prevention of Ventilator-Associated Pneumonia Essay

Appraising the Literature

Conducting a clinical inquiry requires the identification of a practice problem that needs to be addressed and then formulating a PICOT statement or question (Stannard, 2021; Twa, 2016). This is what then enables the researcher or innovator to come up with key terms and then use them to search electronic databases for evidence. The PICOT question for this project is: In critically-ill patients who have been mechanically ventilated for more than 48 hours (P), does the use of semi-recumbent position and daily chlorhexidine oral care (I) compared to the usual care (C) result in a reduction of VAP rates (O) within a time period of 6 months (T)? The purpose of this paper is to outline my strategy for conducting a systematic search of evidence in the form of scholarly peer-reviewed articles; as well as how I will critically appraise the literature to be selected to arrive at the best evidence possible. Effectiveness of Intraoral Chlorhexidine Protocols in The Prevention of Ventilator-Associated Pneumonia Essay

The Strategy for Conducting a Systematic Literature Search

With the PICOT question above, the first thing that will be done is to come up with key terms that represent the PICOT question (LHS, n.d.; Melnyk & Fineout-Overholt, 2019). In this case, the terms that can be used include “pneumonia,” “ventilator-associated,” “critically-ill,” “prevention,” “chlorhexidine,” and “semi-recumbent position.” It is these key words that will then be entered into the search engines of the electronic databases to see what articles will come up on the search. However, for the best results, the key terms will be linked by the Boolean operator “AND” before being entered into the database search engines.

The electronic databases that are to be used for this project are reputable ones. In this case these are CINAHL, PubMed, Cochrane, ProQuest, and Embase. It is expected that the first hit will bring out very many articles that say something about the PICOT question. Some of them will be full-text while others will definitely be abstracts. This state of affairs will call for further filtering of the results so that only those publications that specifically and closely address the PICOT question show up. This filtering will involve refining the search for articles that: Effectiveness of Intraoral Chlorhexidine Protocols in The Prevention of Ventilator-Associated Pneumonia Essay

Are five years old or less since publication (current evidence)
Are in the form of full-text as opposed to being abstracts
Are high up on the pyramid of evidence, preferably levels I and II (systematic reviews with or without meta-analysis, and randomized controlled trials)
Are published in the English language.

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After applying the filters, only those articles that specifically answer the PICOT questions will be selected for critical appraisal. These are usually around 10-20 articles.

Critical Appraisal of the Literature Retrieved to Determine the Best Evidence

The next step after searching and obtaining the most specific articles is to critically appraise the evidence found. This helps to recognize the evidence that best justifies the proposed intervention. In the case of this project, articles such as those by Ghezeljeh et al. (2017), Hassankhani et al. (2017), and Villar et al. (2016) are prime candidates for the best evidence in the prevention of ventilator-associated pneumonia or VAP. These are some of the articles that would be critically appraised as outlined below. The critical appraisal of the selected literature to come up with the best evidence will involve the following: Effectiveness of Intraoral Chlorhexidine Protocols in The Prevention of Ventilator-Associated Pneumonia Essay

First will be a consideration of the level of evidence or LoE. It will be determined whether the article is a level I or level II evidence article. Lower levels of evidence (III, IV, and V) are not strong enough to change practice. For instance, systematic reviews and meta-analyses or randomized controlled trials (RCTs) are the ones with the highest level of evidence at level I. They are more preferable to back practice change.
The other factor in the critical appraisal will be the study sample and inclusion/ exclusion criteria, the theoretical framework, and the statistical tests used (such as regression analysis, chi-square test, t-tests, and ANOVA amongst others).
The results of the statistical analysis will also be looked at and a determination made whether they were statistically significant. Generalizability of these results will point towards a possibility of them being also clinically significant (applicable in practice).
Study strengths and limitations will also be looked at and a possibility of these limitations influencing the outcomes will be looked at.
Lastly but not least, the findings and the authors’ recommendations as well as the contribution of the study to clinical evidence-based practice (EBP) will be considered. Effectiveness of Intraoral Chlorhexidine Protocols in The Prevention of Ventilator-Associated Pneumonia Essay

Conclusion

After formulating a PICOT question, the next step in clinical inquiry is to search for evidence in research databases. The strategy is to use key terms from the PICOT statement and connect the using a Boolean operator. The ensuing results are then filtered as desired to produce very specific results. It is these final specific results that are critically evaluated in terms of methodology and so on to remain with the best evidence possible supporting the proposed intervention.

Appraising the Literature

The Strategy for Conducting a Systematic Literature Search

Are five years old or less since publication (current evidence)
Are in the form of full-text as opposed to being abstracts
Are high up on the pyramid of evidence, preferably levels I and II (systematic reviews with or without meta-analysis, and randomized controlled trials)
Are published in the English language.

After applying the filters, only those articles that specifically answer the PICOT questions will be selected for critical appraisal. These are usually around 10-20 articles.

Critical Appraisal of the Literature Retrieved to Determine the Best Evidence

The next step after searching and obtaining the most specific articles is to critically appraise the evidence found. This helps to recognize the evidence that best justifies the proposed intervention. The first consideration will be the level of evidence or LoE. It will be determined whether the article is a level I or level II evidence article. If it is of a lower LoE, that will also be determined. This determination will be done by looking at the design of the study. For instance, systematic reviews and meta-analyses or randomized controlled trials (RCTs) are the ones with the highest level of evidence at level I. Effectiveness of Intraoral Chlorhexidine Protocols in The Prevention of Ventilator-Associated Pneumonia Essay

The other factors that will be looked into during the critical appraisal are the study variables, the study sample and inclusion/ exclusion criteria, the theoretical framework, the statistical tests used (such as regression analysis, chi-square test, t-tests, and ANOVA amongst others), the results of the statistical analysis, study strengths and limitations, findings and recommendations, and the contribution of the study to clinical evidence-based practice (EBP). In the case of this project, articles such as those by Ghezeljeh et al. (2017), Hassankhani et al. (2017), and Villar et al. (2016) are prime candidates for the best evidence in the prevention of ventilator-associated pneumonia or VAP. Effectiveness of Intraoral Chlorhexidine Protocols in The Prevention of Ventilator-Associated Pneumonia Essay

Conclusion

After formulating a PCOT question, the next step in clinical inquiry is to search for evidence in research databases. The strategy is to use key terms from the PICOT statement and connect the using a Boolean operator. The ensuing results are then filtered as desired to produce very specific results. It is these final specific results that are critically evaluated in terms of methodology and so on to remain with the best evidence possible supporting the proposed intervention. Effectiveness of Intraoral Chlorhexidine Protocols in The Prevention of Ventilator-Associated Pneumonia Essay