The PICO(T) framework helps to answer questions of evidence-based practice in an organized manner. It stands for ‘Population, Intervention, Comparison, Outcome and Time’. This type of guiding medium is quite important in health care research as it guides on what needs to be done clearly and ensure the studies answer vital issues affecting clinicians and their clients in a systematic way. In PICO(T) framework breaking down a research question into these five components helps to identify the most relevant evidence and facilitate a focussed, comprehensive search for information. The approach ensures that patient care is based on scientific evidence that will enable improved quality and effectiveness when administering healthcare to a patient. Therefore, this paper investigates the problem concerning UTIs, creates a PICOT question to guide the research, and appraises the evidence that supports evidence-based interventions.
Practice Issue
The high rate of UTIs among the people is the most noticeable practice issue. Healthcare-associated infections (HAIs) are among the most prevalent and affect patient illness greatly besides consuming healthcare resources. According to the Centers for Disease Control and Prevention, over 30% of the HAIs that are reported by critical care hospitals in the U.S. are CAUTIs. It is estimated that approximately 15% of all hospitalized patients worldwide have a urinary catheter fitted during their hospital stay. Of these, approximately 20% will develop a CAUTI making it one of the commonest healthcare-associated infections in the world. One of the significant risk factors for developing CAUTI is the use of indwelling urinary catheter that is used persistently (Laan et al., 2020). This, therefore calls for critically looking into other strategies to prevent CAUTIs. There needs to be an evidence-based approach in such a way that effective interventions are identified and implemented in order to mitigate the risk of infection
hence giving better results to the patients and lessening the burden on the healthcare systems (Huang et al., 2022).
PICOT Question
Among adults with urinary catheters (P), the use of antimicrobial-impregnated catheters (I) as compared to standard catheters (C) does affect the incidence of catheter-associated urinary tract infections (O) over a period of six months (T)?
Population (P): Adults with urinary catheters
Intervention (I): Use of antimicrobial-impregnated catheters
Comparison (C): Standard catheters
Outcome (O): Incidence of catheter-associated urinary tract infections (UTIs)
Timeline (T): Six months
Benefits
The significant benefit of conducting research into UTI and CUTI issues through the PICO(T) framework is that it offers clarity and systematicity in the identification and appraisal of principal evidence. Therefore, health professionals can easily find studies needed to be analyzed for the quality and explain their applicability to the clinical environment. In such a way, the collection of evidence is notably more robust, safer, and more effective. PICO(T) defines the problem under question, such as patient populations with UTIs or CUTIs, the interventions being applied or considered such as antibiotic treatments, comparisons like comparing diagnostic methods, and outcomes that relates to the success of treatment and recurrence rates. The approach brings an issue to the best available evidence so that clinical decisions about UTI management are solved by research. It forms base for creating standardized protocols and interventions applied in healthcare and from this perspective, patients benefit from improved
quality of care and great clinical outcome while health care systems have reduced incidence and costs related to CAUTIs (Santos et al., 2022).
Sources of Evidence
The very first thing for answering a PICO(T) question about the use of antimicrobial-catheters to prevent CAUTI in adults involves the identification of credible sources of Evidence. For the systematic review regarding the prevention measures for CAUTI, one can refer to the “Lancet Infectious Diseases”, The paper provides a detailed understanding of what to do and avoid in order to minimize the occurrence of CAUTI (Wu et al., 2022). In general, clinical practice guidelines from reputable agencies like the American Medical Directors Association (AMDAS) and The National Library of Medicine play significant roles as exceptional sources (Ashraf et al., 2020). These guidelines are therefore derived from systematic reviews of the available evidence and the actual recommendations to healthcare providers. Current recommendations regarding the prevention of CAUTI include but are not limited to; catheter removal at the correct time, proper aseptic insertion procedure as well as the closed drainage system (Ashraf et al., 2020). Detailed description of the interventions and their outcomes were published in peer-reviewed medical journals, available in databases like PubMed and Cochrane library, primarily used for medical scientific papers. The implementation of catheter care studies in hospital are engaged in giving the broad picture of the intervention-practice in reducing the CAUTI rates. These types of articles are necessary for having an enduring understanding of intervention implementation intricacies and, hence about the challenges and facilitators in different health care frameworks.
Evaluation Criteria
The ability of sources used to answer the PICO(T) question is evaluated by the CRAAP test, which stands for Currency, Relevance, Authority, Accuracy, Purpose, proves very useful in
checking the quality of the sources. According to this test, several key resources ensured to be credible and relevant to answer the question of use of antimicrobial-impregnated catheters to prevent CAUTIs in adults. Sources include, among others, PubMed, which is comprehensive and current with biomedical literature and the Cochrane Library, whose information is majorly systematic reviews and meta-analysis. Lancet Infectious Diseases and AMDAS Guidelines also offer evidence that is authoritative and rigorously reviewed. The National Library of Medicine made extensive, authoritative medical literature and guidelines available. On these sources, health professionals can ensure that the evidence to answer the PICO(T) question is the best, most current and most applicable to the clinical scenario in which they work. That increases the validity of interventions and, ultimately, better outcomes in patient care (Shaheen et al., 2023).
Findings of Evidence Based Studies
Evidence-based studies on the prevention of CAUTIs have showed several interventions to be successful. Systematic reviews and meta-analyses consistently indicated that catheter care like, clean insertion, timely removal, and maintenance of a closed drainage system significantly reduce the frequency of CAUTIs. The study by Au et al. (2020) indicates several useful tips in reducing the rate of infection in healthcare settings is suggested. For instance, evidence from recent studies suggests that CAUTI incidence can be reduced when guidelines for proper catheter use are put into place, studies reveal that reducing the period of catheterization to its minimum and using other available options other than indwelling catheter are very important. According to (Laan et al., 2020) protocols that encourage reviews of catheterization on a daily basis with removal as soon as there is no need have significantly worked in reducing the rate of CAUTI by avoiding the use of the catheter. Education and training for staff reduce the incidence of CAUTI. Training staff on best practices in catheterization and maintenance techniques, and enlightening
them about the importance of following the protocols for infection and prevention, enhances compliance with best practices and reduces the incidence rate of CAUTIs.
In a study by Patel et al. (2023) it reveals that interventions that focuses on staff knowledge during catheterization are very crucial in controlling UTIs. Studies show that it is possible to prevent infections through aspects like washing the hand before introducing catheter, wearing sterile gloves while placing catheter, and maintaining the catheter. Clarke et al. (2019) pointed out the role of the technology in reducing the cases of UTIs; for instance, antimicrobial-catheters are known to be less dangerous as compared to the standard catheters in the case of CAUTIs. These catheters antimicrobial agents which prevent the bacteria from growing enabling cases of infection to be minimized. Also, applying improvements in compliance with best practice with the help of electronic monitoring systems, tracking catheter utilization, and notifying the staff for a lower CAUTI rate.
Credibility of Sources
The CRAAP test is one of the most critical processes used in determining the validity of the source under consideration, particularly in the evaluation of research findings around CAUTIs. In the research studies by Au et al. (2020), and Patel et al. (2023), important information is provided on the best ways to prevent CAUTIs across medical institutions. These authored articles can be found in two of the peer-reviewed publications, Journal of Infection and Infection Control & Hospital Epidemiology. By using these two sources meet all the criteria’s of CRAAP, they are current published in recent dates, Relevant and concerned with CAUTI prevention, Authorship done by health care professionals, came from Academic sources peer-reviewed publications, and they are very much precise in the application of methodology and conclusion drawn. This all-inclusive evaluation ensures that the conduct of research is relevant to
provide credible guidance in implementing practices based on evidence to reduce CAUTI rates in hospitals.
Relevance of Findings
The three research articles by Au et al. (2020), Patel et al. (2023), and Clarke et al. (2019) had very relevant findings to the current efforts in reducing CAUTIs in healthcare settings. Au et al. (2020) indicated the effectiveness of a simple intervention for CAUTI prevention on a medical hospital unit, wherein a very simple and low-cost intervention brought an immense drop in the infection rate. This is especially relevant to hospitals seeking practical and easily implementable ways of reducing errors, improving patient safety, and raising the quality of health outcomes. Patel et al. (2023) have done an up-to-date review with updated guidelines based on state-of-the-art and evidence-based practices enshrined in infection control. Their work remains relevant because their findings are so greatly generalizable across different hospital and the framework is very detailed, allowing healthcare professionals to take practical action to prevent CAUTI. Clarke et al. (2019) contributed to the works on UTI and CAUTI prevention by discussing the role of technology and ways that could be applied to infection control, including electronic monitoring systems and new, advanced materials for urinary catheters. Technology not only supports the conventional methods of prevention but also opens up newer avenues in the prevention of infection and promotion of better patient outcomes. These studies contribute significantly to this field of knowledge because they discuss practical, strategic, and technological matters of CAUTI prevention.
Findings that Lead to Positive Outcomes
The findings from Au et al. (2020) and Patel et al. (2023) results the positive outcomes for the PICO(T) question, making the implication for CAUTI prevention vast. They promote the timely removal of catheters after their aseptic insertion and allow urine to flow freely by
maintaining a closed drainage system. Of all aspects of catheter care, these studies deal with almost every aspect, ensuring the best practice at every point during catheter use. Staff education and training is the other dimension of an effective CAUTI prevention strategy. It has been proved that with proper education and training for health providers on how to properly insert and maintain catheters, and along with the repeated stressing of significance for adherence to the protocols of infection prevention, will optimize compliance with best practices and reduce the rate of CAUTI.
Conclusion
In conclusion, the PICO(T) process is an important tool for addressing practice problems like UTIs prevention. Being clear and focused, finding out the research question and sources of evidence against the need identified, is only part of helping to guide interventions that are evidence-based in nature and design. It is this structured and methodic nature of the PICO(T) framework that guarantees clinical practice in accordance with the best approach, with an advanced and mature responsiveness to the realization of maximized safety and quality in patient care.
References
Ashraf, M. S., Gaur, S., Bushen, O. Y., Chopra, T., Chung, P., Clifford, K., Hames, E., Hertogh, C. M. P. M., Krishna, A., Mahajan, D., Mehr, D. R., Nalls, V., Rowe, T. A., Schweon, S. J., Sloane, P. D., Trivedi, K. K., Buul, L. W. van, & Jump, R. L. P. (2020). Diagnosis, Treatment, and Prevention of Urinary Tract Infections in Post-Acute and Long-Term Care Settings: A Consensus Statement from AMDA’s Infection Advisory Subcommittee. Journal of the American Medical Directors Association, 21(1), 12-24. e2. https://doi.org/10.1016/j.jamda.2019.11.004
Au, A. G., Shurraw, S., Hoang, H., Wang, S., & Wang, X. (2020). Effectiveness of a Simple Intervention for Prevention of catheter-associated Urinary Tract Infections on a Medical Hospital Unit. Journal of Infection Prevention, 21(6), 175717742093924.
https://doi.org/10.1177/1757177420939242
Clarke, K., Hall, C. L., Wiley, Z., Tejedor, S. C., Kim, J. S., Reif, L., Witt, L., & Jacob, J. T. (2019). Catheter-Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention. Journal of Hospital Medicine, 14(9).
https://doi.org/10.12788/jhm.3292
Huang, A., Hong, W., Zhao, B., Lin, J., Xi, R., & Wang, Y. (2022). Knowledge, attitudes and practices concerning catheter‐associated urinary tract infection amongst healthcare workers: A mixed methods systematic review. Nursing Open, 10(3).
https://doi.org/10.1002/nop2.1384
Laan, B. J., Maaskant, J. M., Spijkerman, I. J. B., Borgert, M. J., Godfried, M. H., Pasmooij, B. C., Opmeer, B. C., Vos, M. C., & Geerlings, S. E. (2020). De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): A multicenter, prospective, interrupted time-series and before and after study. The Lancet Infectious Diseases, 20(7), 864–872. https://doi.org/10.1016/S1473-3099(19)30709-1
Patel, P. K., Advani, S. D., Kofman, A. D., Lo, E., Maragakis, L. L., Pegues, D. A., Pettis, A. M., Saint, S., Trautner, B., Yokoe, D. S., & Meddings, J. (2023). Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 44(8), 1209–1231.
https://doi.org/10.1017/ice.2023.137
Santos, O. P. D., Melly, P., Hilfiker, R., Giacomino, K., Perruchoud, E., Verloo, H., & Pereira, F. (2022). Effectiveness of Educational Interventions to Increase Skills in Evidence-Based Practice among Nurses: The EDIT care Systematic Review. Healthcare (Basel, Switzerland), 10(11), 2204. https://doi.org/10.3390/healthcare10112204
Shaheen, N., Shaheen, A., Ramadan, A., Hefnawy, M. T., Ramadan, A., Ibrahim, I., Hassanein, M., Ashour, M. E., & Flouty, O. (2023). Appraising Systematic reviews: A Comprehensive Guide to Ensuring Validity and Reliability. Frontiers in Research Metrics and Analytics, 8(8). https://doi.org/10.3389/frma.2023.1268045
Wu, J., Li, H., Huang, Y., Tong, G., Tian, M., Wu, Y., Yu, C., Yang, J., Fan, R., Sun, T., Li, X., & Zhuang, J. (2022). Chinese contribution to NEJM, Lancet, JAMA, and BMJ from 2011 to 2020: A 10-year bibliometric study. Annals of Translational Medicine, 10(9), 505.
https://doi.org/10.21037/atm-21-6793
