The Clinical Issue
Ventilator-associated pneumonia (VAP) is a common type of hospital-acquired pneumonia. It affects patients using a ventilator for a long duration. VAP is common among critically ill patients in the ICU. It is responsible for almost half of all antibiotics that patients in ICUs receive. VAP is associated with various issues, such as extended hospital stays, high burden of care, and high mortality. Therefore, it is essential to search for evidence to propose an effective intervention to prevent VAP. One of the proposed solutions is the use of chlorhexidine.
The PICO(T) Question
The beginning step in searching for evidence from online databases is to develop the research question (The PICOT question). The PICOT is a focused question that guides database searches for evidence by identifying appropriate resources. Evidence-Based Practice (EBP) practitioners use the focused framework to create a query. PICOT stands for:
- Patient Problem, (or Population)
- Intervention,
- Comparison or Control, and
- Outcome
- Time-bound
The PICOT question in the treatment of CAP is: How effective is the use of Chlorhexidine (T) compared to Linezolid (C) in the prevention of ventilator-associated pneumonia (O) in Ventilatory Patients in the ICU (P) within one month of use (T)?
Effective Database Search
Keywords from the PICOT question were manipulated in various ways to support the database search. The process involves manipulating the keywords using the Boolean Operators (AND, OR, and NOT). I searched in four databases, including CINAHL & MEDLINE Combined Search, EBSCOhost, MEDLINE, and Nursing Reference Center Plus. The databases have hundreds of articles on the topic of The Effect of Chlorhexidine on Ventilatory Patient in ICU. Below are the four options I used to search for articles from the four databases:
- Chlorhexidine and Ventilator-Associated Pneumonia
- Chlorhexidine and Ventilator-Associated Pneumonia and Ventilatory Patients in the ICU
- Ventilator Associated Pneumonia prevention and Chlorhexidine
- Ventilator Associated Pneumonia prevention and Chlorhexidine and Ventilatory Patients in the ICU
Search Results
Using the different combination of the keywords, different databases generated several articles to select from. For example, using EBSCOhost, the list below shows the number of articles that were generated using different options.
- Chlorhexidine and Ventilator-Associated Pneumonia: 451 articles
- Chlorhexidine and Ventilator-Associated Pneumonia and Ventilatory Patients in the ICU: 45 articles
- Ventilator Associated Pneumonia prevention and Chlorhexidine: 383 articles
- Ventilator Associated Pneumonia prevention and Chlorhexidine and Ventilatory Patients in the ICU: 43 articles.
The list below shows the number of articles that were generated from CINAHL & MEDLINE Combined Search using the four options:
- Chlorhexidine and Ventilator-Associated Pneumonia: 172 articles
- Chlorhexidine and Ventilator-Associated Pneumonia and Ventilatory Patients in the ICU: 41 articles
- Ventilator Associated Pneumonia prevention and Chlorhexidine: 281 articles
- Ventilator Associated Pneumonia prevention and Chlorhexidine and Ventilatory Patients in the ICU: 39 articles
Considering the number of articles generated using the different search options from the databases, it is evident that the combination of keywords plays a vital role in the kind of indication that an evidence-based practitioner can acquire and use. For example, when the keywords were combined in a general manner, such as Chlorhexidine and Ventilator-Associated Pneumonia, hundreds of articles were generated. However, when the search strategy was further refined, the articles generated were fewer and manageable. Therefore, the strategy to improve the rigor and effectiveness in databases is to make the search as specific as possible, such as using all the variables in the PICOT question. The APA list below shows the articles selected from the search.