Appraise four pieces of evidence available for implementation in your area of interest - Essay Example

1048). The most common (30%) nosocomial infection is catheter-associated UTI, or CAUTI. The strongest factor in determining whether or not CAUTI will occur is the actual duration of catheterization. Other factors that can contribute to the development of CAUTI include age, diabetes mellitus, female sex, and elevated serum creatinine levels. Most patients with CAUTI do not show any symptoms, so treatment typically does not occur while the catheter is in place (Wazait, et.al., 2004). The recent surge in resistant antimicrobials has complicated the use of systemic antibiotics.

Typically, no rationale based on evidence is in existence to support the use of prophylactic antibiotics to reduce the occurrence of CAUTI after catheters have been removed. "A recent national multidisciplinary survey of healthcare professionals (by the present authors) showed a vast diversity in the practice (unpublished data). The aim of the present pilot randomized, double-blind, placebo-controlled trial was to assess if a short course of ciprofloxacin starting at the time of catheter removal reduced the UTI rate after removal (Wazait, et.al., 2004, pg. 1048). It took a total of four months to recruit enough patients to take part in the study.

These patients were taken from both medical and surgical wards in the authors' hospital. In order to qualify for the study, patients had to have been catheterized for 2-7 days. There were a number of exclusion criteria including the following: recent genitourinary surgery, the receipt of antibiotics within the preceding 48 hours, the inability to consent to the study, impaired renal function, pregnancy or breastfeeding, epilepsy, glucose-6-phosphate dehydrogenase deficiency, a history showing disorders of quinolone-related tendon disorders, or quinolone allergies (Wazait, et.al., 2004).

Age, sex, reason for catheterization, and comorbidity were among the background data collected from the patients participating in the study. Ethical committee approval on the local level was obtained for the study. Eligible patients provided written consent to take place in the study. "Patients were assigned randomly to receive a 48-h course of either ciprofloxacin (400 mg 12-hourly) or placebo tablets starting 2 h before catheter removal. Randomization was confirmed by a computer-generated list.

The ciprofloxacin and placebo were packaged into identical containers by an independent pharmacy, and all staff involved at any stage of the double-blind trial were unaware of the medication given to the patients" (Wazait, et.al., 2004, pg. 1049). Just before the start of the medication, a catheter specimen of urine (CSU) was taken from each patient. "At the follow-up 7 and 14 days after catheter removal, patients completed a questionnaire for UTI symptoms, and mid-stream urine (MSU samples were collected.

Patients who could not be seen in hospital were followed up by a home visit" (Wazait, et.al., 2004, pg. 1049). Standard collection and laboratory procedures to keep the samples pure and separate before, during, and after testing were followed in order to ensure accurate results (Wazait, et.al., 2004). Of the original 52 patients that were scheduled to take place in the trial, four had been excluded for one or more of the reasons listed above. 25 of the remaining 48 patients received ciprofloxacin, and 23 of them