Evidence-Based Practice in Nursing Health Care

DISCUSSION:  Using PICOT
Post a clinical question using the PICOT format that relates to your clinical practice. You may want to speak to your clinical manager or colleagues about a question
that is of interest. Describe why this question is important for your practice and the type of clinical question it is. In your replies to your classmates, help them perfect their question with constructive criticism. 

What is a PICOT question? A PICOT question, also known as a foreground question, is critical to finding evidence to answer that question. P refers to the population of interest, I is the intervention or area of interest, C is the comparison intervention or area of interest, and is generally the “usual standard of care” (the C does not mean “control” group). O is the outcome of interest, and T is the time it takes for the intervention or issue to achieve the outcome. Not all of the components may be appropriate for a clinical question; however, the essential components of a PICOT question include a P, I, and O.

•What is the purpose of a PICOT question? Once the PICOT question is formulated, the components of the question are the basis for the keywords used to search databases such as CINAHL and MEDLINE to find the evidence to answer the question.

•What are the kinds of PICOT questions? There are five types of PICOT questions: meaning, diagnosis, intervention, prediction/prognosis, and etiology. The PICOT question guides the systematic search to find the best evidence to answer the question. Remember that the PICOT question is NOT a research or QI question and it is NOT what will be done in an EBP project!

I work in icu so it must relate to this area ALSO PLS ADD URL OR DOI FOR A REFERENCES USED!!!

EXAMPLE OF A PICOT
Does hand washing by healthcare providers reduce transmission of hospital-acquired infections? The question first into PICO elements

P-Hospital-acquired infection

I-Hand washing

C-Alternative to hand washing such as wearing a mask or gloves

O-reducing infection

T 6 months

As an ICU nurse, my clinical issue of concern is that patients on mechanical ventilation in the ICU are at risk of acquiring Ventilator-Associated Pneumonia (VAP), which correlates to oropharynx colonization and dental plaque. The dental plaque serves as a reservoir for infectious microorganisms, which can cause pulmonary infections. VAP increases hospitalization length and is a significant cause of morbidity and death among critically ill patients. Therefore, my discussion addresses the following PICOT question, Among  critically ill adult patients under mechanical ventilation in the ICU (P) does oral hygiene with chlorhexidine gluconate (I) compared to no chlorhexidine gluconate (C)  prevent Ventilator-Associated Pneumonia (O) within six weeks? (T). Evidence-Based Practice in Nursing Health Care

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Use of Chlorhexidine Gluconate to Prevent VAP

Galhardo et al. (2020) describe that tooth brushing patients on mechanical ventilation with chlorhexidine shows a lower incidence of Ventilator-Associated Pneumonia. The mean time of critically ill patients on MV also decreases significantly with the use of chlorhexidine. Chlorhexidine gluconate is antimicrobial, decreasing bacteria colonization in the oral cavity hence reducing gum inflammation and bleeding. As such, critically ill patients stay free of infectious microorganisms when on chlorhexidine oral care and other systemic antibiotics. The relative risk of death among the control group was 41 percent, reinforcing the recommendation towards a better clinical outcome for patients on chlorhexidine gluconate for oral hygiene.

According to Veitz-Keenan et al. (2017), chlorhexidine (CHX) mouth rinse or gel as part of oral hygiene in the ICU reduces the incidence of VAP from 25 to 19 percent. Compared to placebo (tooth brushing without chlorhexidine), the risk of mortality and length of mechanical ventilation reduces markedly. Chlorhexidine offers selective digestive decontamination as well as selective oropharyngeal decontamination.  By clearing bacterial colonies from the mouth in the critically ill patient, CHX significantly prevents morbidity and mortality associated with nosocomial infections such as VAP. Evidence-Based Practice in Nursing Health Care

Conclusion

Good oral hygiene using technique and chlorhexidine gluconate has a positive effect in minimizing VAP development in critically ill patients on MV. Combining other infection prevention measures with the use of CHX is vital in preventing VAP no CHX gluconate. Oral hygiene is an essential factor to consider when preventing VAP.

References

Galhardo, L. F., Ruivo, G. F., Santos, F. O., Ferreira, T. T., Santos, J., Leão, M. V., & Pallos, D. (2020). Impact of oral care and antisepsis on the prevalence of ventilator-associated pneumonia. Oral Health Prev Dent, 18(2), 331-336. http://www.quintpub.com/journals/ohpd/fulltext.php?article_id=20757

Veitz-Keenan, A., & Ferraiolo, D. M. (2017). Oral care with chlorhexidine seems effective for reducing the incidence of ventilator-associated pneumonia. Evidence-based dentistry, 18(4), 113-114. https://www.nature.com/articles/6401272 

Evidence-Based Practice in Nursing Health Care