My clinical issue of interest is pressure ulcers/injuries (PU/PI) and how various support surfaces affect the development of or aid in prevention. As noted in Melnyk & Fineout-Overholt (2019), a focused clinical question will drive the subsequent steps of the EBP process. To focus on my clinical issue of interest, I formed a PICOT question based on adult patients (P), on specialty support surfaces (I) when compared with standard support surfaces (C), and how they affect the occurrence of pressure ulcers or injuries (O) during hospital admissions (T). Considering that Medicare no longer reimburses hospitals for treating preventable hospital-acquired injuries such as pressure ulcers, as noted in Melnyk et al. (2009), I assumed there would be a plethora of data to determine the best way to prevent such injuries.
Once I had determined my PICOT question, I began searching for related articles. I searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed, and Embase databases. An initial search using the boolean phrase pressure ulcer AND prevention yielded over 4,000 results in the CINAHL database. I knew pretty quickly that I would have to refine my results. I began searching using a mix of the following terms in various groupings: pressure injuries; pressure ulcers; prevention; adult patients; specialty mattress; standard surface. I limited my search parameters to within the last five years and only included peer-reviewed articles. The boolean phrase pressure ulcer AND prevention AND mattress with a five-year limit and only including peer-reviewed articles returned a more manageable 121 results.
Since no single database can provide a complete list of all the studies that meet search criteria, to increase the rigor and effectiveness of searches it may be beneficial to search multiple databases through a single search platform (Rethlefsen et al., 2021). Additionally, the use of boolean operators is an effective way to limit results, as are indexing terms and the use of synonyms (Ho et al., 2016). Furthermore, using the ‘related articles’ feature can also provide additional articles that may be of interest.
Central line infections are one of the common issues we face in the health care industry. In the facility I work, we had three cases this year. We are trying to decrease the infection rate by educating staff and patients. We currently use a Chlorhexidine (CHG) bath on all patients with central lines. Studies show that bathing with 2% CHG led to evident CLABSI reduction (Deigo et al., 2021). The decrease in HAIs was found to be greater than bathing with soap and water (Rubin et al.,2013). This led me to formulate my PICOT question.
In hospitalized patients with central lines(P), what is the effect of Chlorhexidine baths (I) on decreasing central line-associated bloodstream infection (CLABSI) (O) compared with regular baths with soap and water (C) while hospitalized (T)
CINAHL plus full text and Medline with full text
Search terms used
Central line-associated bloodstream infections, Central line infection prevention, Central line, AND associated bloodstream infection, Central line infections AND soap and water, Central line infections chlorhexidine baths.
CINAHL plus full text produced 133 results, while Medline with full text produced 190 results (Walden Library n.d.-a). These two databases produced original research and peer-reviewed articles. I restricted my search to produce articles within five years. Articles were geared toward my research question and related to chlorhexidine bath vs. soap and water to reduce central line infections. These are common occurrences for central line infection if proper infection control measures are not in place.
Addition of Boolean Operator
Adding Boolean operator to my search decreased my results greatly. Boolean operators and nesting help me search for combinations of words or phrases processed in a specified order. For greater precision, I use parentheses to group portions of complex Boolean expressions in the EXPERT option of Keyword Search. Terms inside parentheses are processed first (Library of Congress, n.d.).
Strategies to increase rigor and effectiveness of a database search
Some strategies used to increase the effectiveness of a database search include asking a Librarian and using parenthesis and Boolean operators. This will help me search for relevant documents that are more focused to my PICOT question. Another strategy I used was to limit my search to at least five years to get more updated materials.