Vianna P. G. Jr Dale C. R. Simmons S. Stibich M. & Licitra C. M. (2016). Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital. American Journal of Infection Control 44(3) 299-303. doi:10.1016/j.ajic.2015.10.009
Hospital associated infections are attributed to extended hospital stays or death. Patients are at increased risk of acquiring infections after being admitted to rooms with previously contaminated MDRO-positive patients (Vianna Jr Dale Simmons Stibich & Licitra 2016). Therefore environmental personnel play a pivotal role in decontaminating infected rooms. Problem arises when there are variation in cleaning methods. The study published by the American Journal of Infection Control reported that the use of xenon ultraviolet light technology in conjunction with standard cleaning measures greatly decreased hospital-wide and ICU infection rates. Based on the Rating System of the Hierarchy of Evidence this particular study is a Level III evidence obtained from well-designed controlled trail without randomization (Melnyk & Fineout-Overholt 2014). Unlike Level II there is a lack of randomization. Level III is befitting as the study has a well-controlled trail for instance: all ICU rooms have no touch cleaning before ultraviolet emission and non-ICU c. diff rooms were no touch cleaning before ultraviolet use. Although one should note that results differ from ICU rooms and non-ICU rooms because of lack of control in cleaning procedures hand washing compliance and antimicrobial stewardship.
Humphrey J. (2015). Primary cesarean delivery results in emergency hysterectomy due to placenta accreta: A case study. AANA Journal 83(1)28-34.
High risk pregnancy complication such as placenta accreta has become more common as the rate of c-section increase (Humphrey 2015). Placenta accreta is when the placenta remain attached to the uterine wall which can consequently result in severe bleeding and maternal morbidity and mortality. Humphrey (2015) described a scenario in which a 35 year old female with gravida 3 para 0 presented with ruptured membrane and breech presentation that required a primary c-section. Her hospitalization was complicated by postpartum hemorrhage hours after delivery which eventually led to the patient receiving a hysterectomy in order to control bleeding. Risk factors such as increase maternal age history of placenta previa and primary c-section can potentially increase postpartum hemorrhage. In summary Humphrey expressed the importance of quickly recognizing and identifying those at risk of postpartum hemorrhage as a result of placenta accreta in order to control bleeding. The article made it a point to express that these patient require close monitoring even if there vital signs are stable because continued bleeding might me undetectable. The author recommended initiating protocols that aides in identifying at risk mothers. Institution of such protocol will alert staff of these life threatening situations in order to provide the appropriate intervention. Upon review of this article it is a Level VI on the Rating System of the Hierarchy of Evidence. This article was presented in a case study format that identified patients with primary c-section which resulted in placenta accreta. The author exposed the topic of interest and provided recommendation for practice. In addition Level VI evidence is good for addressing questions related to harm and can provide circumstantial evidence and not provide definitive proof of the causes of a disease. It is slightly reliable but there is a potential for bias when recalling information (Ingham-Broomfield 2016).
The advanced practice nurse evaluate evidence through research by critical appraisal. This means assessing the validity and usefulness of evidence (Melnyk & Fineout-Overholt 2014). In addition determining the type of method of research such as quantitative or qualitative. The research methodology is also important for determining the appropriateness of the research such as the use of systematic reviews or clinical trials. Rigor or the validity of the result is also crucial of evaluation of evidence (Melnyk & Fineout-Overholt 2014). For instance this means determining if the research question is focused. Furthermore the results of the research determine if there were any significant findings or data. Lastly the advanced practice nurse must determine the relevancy of the research meaning how applicable is it for practice (Melnyk & Fineout-Overholt 2014).