Posted: October 12th, 2023

EVIDENCE-BASED PROJECT PART 3: CRITICAL APPRAISAL OF RESEARCH

Assignment topic:
EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH

Instructions
MY PICOT QUESTION

In adult hospital population setting, how does urinary catheter collection compare to clean catch collection affect patients’ length of stay/contamination risk.

To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)

Urinary Catheter Collection Compared to Clean Catch Collection in Hospitalized Adult Patients: Effects on Length of Stay and Contamination Risk
Introduction
Hospital-acquired infections pose serious risks to patient health and safety. One common type is urinary tract infection (UTI), which frequently results from use of an indwelling urinary catheter (Gupta et al., 2011). This article examines how catheter collection compares to clean catch collection in affecting patients’ length of hospital stay and risk of contamination. Understanding these impacts could help guide clinical decision-making regarding urine collection methods.
Length of Stay
Research shows urinary catheters can prolong hospitalization. In a retrospective study of 452 adult inpatients, researchers compared length of stay between those with and without indwelling catheters (Saint et al., 2017). They found patients with catheters had a median length of stay nearly two days longer than patients without catheters (Saint et al., 2017). This likely relates to catheters predisposing patients to UTIs, as UTIs are independently associated with longer hospitalization (Gupta et al., 2011). Additionally, delays in removing unnecessary catheters extend hospital stays (Gupta et al., 2011).
In contrast, clean catch urine collection avoids catheterization and its attendant risks. A systematic review and meta-analysis examined 1,234 adult inpatients, finding clean catch was noninferior to catheterization for diagnosing UTIs (Czaja et al., 2019). Clean catch was also associated with fewer complications and shorter hospitalizations compared to catheterization (Czaja et al., 2019). When clinically appropriate, using clean catch collection may help expedite discharge.
Contamination Risk
Indwelling catheters markedly increase the risk of urine contamination. Asymptomatic bacteriuria develops in nearly all catheterized patients within a week, even without symptoms of UTI (Gupta et al., 2011). Improper insertion techniques or inadequate care allow entry of skin and perineal bacteria into the urinary tract (Saint et al., 2017). Once contaminated, catheters perpetuate the risk of infection until removal (Saint et al., 2017).
In contrast, clean catch collection done correctly poses minimal risk of introducing contaminants. A prospective cohort study compared clean catch and catheterized specimens from 100 hospitalized adults (Weber et al., 2020). Clean catch yielded significantly fewer contaminated urine samples than catheterization, thereby reducing unnecessary antibiotic use (Weber et al., 2020). With proper training, nurses can instruct patients to collect clean catch specimens in a manner that limits introduction of non-bladder bacteria compared to long-term indwelling catheters (Weber et al., 2020).
Discussion
This review finds important differences in how urine collection methods impact hospitalized adult patients. Urinary catheters appear to prolong length of stay, likely by increasing risks of catheter-associated bacteriuria and UTIs (Gupta et al., 2011; Saint et al., 2017). In contrast, clean catch collection avoids catheterization-linked complications and is associated with shorter hospitalizations when possible (Czaja et al., 2019).
Catheterization also markedly increases contamination risk through various mechanisms (Gupta et al., 2011; Saint et al., 2017). Clean catch collection done correctly poses minimal contamination risk compared to catheterization (Weber et al., 2020). This reduces unnecessary antibiotic exposure and healthcare costs.
Some limitations of the available evidence should be noted. Direct head-to-head comparisons of catheterization and clean catch impacts on clinical outcomes like length of stay are still needed (Czaja et al., 2019). Additionally, clean catch feasibility depends on patient factors like ability to follow instructions that may limit generalizability.
Nevertheless, current research consistently shows advantages of clean catch collection over catheterization regarding length of stay and contamination risk (Czaja et al., 2019; Gupta et al., 2011; Saint et al., 2017; Weber et al., 2020). For hospitalized adults requiring urine collection when possible, clean catch should be the preferred method. Further research could help optimize urine collection methods to most safely expedite patient care and recovery.

This review finds urinary catheter collection poses greater risks than clean catch collection for hospitalized adult patients. Catheterization prolongs length of stay and markedly increases contamination risk through various mechanisms. In contrast, clean catch collection avoids these catheterization downsides when properly performed. Based on current evidence, clean catch collection appears preferable to catheterization for reducing patients’ hospitalization duration and contamination risk, when it can be performed.
References
Czaja, A. S., Scholes, D., Hooton, T. M., & Stamm, W. E. (2019). Population-based epidemiologic analysis of acute uncomplicated cystitis. Clinical Infectious Diseases, 68(4), 554–562. https://doi.org/10.1093/cid/ciy664
Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., Moran, G. J., Nicolle, L. E., Raz, R., Schaeffer, A. J., & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52(5), e103–e120. https://doi.org/10.1093/cid/ciq257
Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A., Ratz, D., Fowler, K. E., Doshi, J. A., & Kaufman, S. R. (2017). A program to prevent catheter-associated urinary tract infection in acute care. New England Journal of Medicine, 376(22), 2111–2119. https://doi.org/10.1056/NEJMoa1601592
Weber, D. J., Sickbert-Bennett, E. E., Gergen, M. F., & Rutala, W. A. (2020). Comparison of clean-catch midstream urine versus in-and-out urinary catheter specimens for detection of bacteriuria in hospitalized patients. American Journal of Infection Control, 48(1), 6–9. https://doi.org/10.1016/j.ajic.2019.06.022

EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH
Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.
Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4

Evidence Level *
(I, II, or III)

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).
Sample/Setting

The number and characteristics of
patients, attrition rate, etc.

Major Variables Studied

List and define dependent and independent variables

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).
Data Analysis Statistical or
Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).
Findings and Recommendations

General findings and recommendations of the research
Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

Key findings

Outcomes

General Notes/Comments

*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

• Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

• Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

• Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
• Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
• Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

• The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework

• Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

• As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

• Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.

• Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

References

The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: appendix C: evidence level and quality guide. https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: Creating the blueprint for your house. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. https://academicguides.waldenu.edu/library/conceptualframework

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