NUR5023 Module 5 Sample Paper

Daily Chlorhexidine Bathing to Prevent Central Line-Associated Bloodstream Infection in a 20-Bed Adult Medical ICU: An Appraisal of the Evidence

[Author Name]

Master of Science in Nursing Program, American College of Education

NUR5023 Advanced Nursing Research and Practice I

Module 5 Assignment

[Faculty Name]

August 11, 2026

Model document written for teaching. The intensive care setting, its rates and its staff are a composite; no real hospital, patient or clinician is described.

What this page is doingThe title names the intervention, the outcome, the setting and the genre in a single line, so a grader knows what kind of paper is coming before reading a word of it. Graduate research rubrics reward a question narrow enough to search, and a 20-bed adult medical ICU is narrow enough to search. Calling the paper an appraisal of the evidence sets the expectation that levels and quality judgments will follow, and the composite note at the foot of the page keeps every number that comes after it honest.

Practice Question and Search Strategy

The practice question for this appraisal comes from a composite 20-bed adult medical ICU inside a 300-bed community hospital. Over the 12 months ending in June, the ICU recorded 10 central line-associated bloodstream infections across 4,780 central line days, a rate of 2.09 per 1,000 central line days, against a National Healthcare Safety Network benchmark that placed comparable medical ICUs near 0.8 for the same period. Insertion practice was already strong: a full barrier bundle, chlorhexidine skin preparation at the site, and documented compliance above 95 percent on the insertion checklist across all four quarters. What the ICU had never standardized was daily care of the skin around catheters that were already in place, and that gap is where the search began.

The question was written in PICOT form. In adults with a central venous catheter in a medical ICU, does daily bathing with 2 percent chlorhexidine gluconate, compared with daily bathing using soap and water, reduce the rate of central line-associated bloodstream infection per 1,000 central line days over a six-month period? Searching ran in CINAHL Complete, PubMed and the Cochrane Library. The string combined controlled vocabulary with keywords: (chlorhexidine OR CHG bathing OR daily bathing) AND (central line-associated bloodstream infection OR CLABSI OR catheter-related bloodstream infection) AND (intensive care OR critical care). Limits were English language, adult populations, peer reviewed sources, and publication from 2013 forward. Guideline and agency literature was searched separately at the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality.

The search returned 312 records. Removing duplicates left 268 titles for screening, of which 41 went to full text review. Six sources were retained. A source was kept when it reported an infection outcome tied to a catheter day denominator in an adult critical care population, and set aside when the setting was pediatric or long term acute care, when chlorhexidine appeared only as an insertion site preparation, or when the report was a case series with no comparison group. Two large randomized trials, one professional practice compendium, two federal agency sources and one graduate text on evidence appraisal make up the retained set, and the two trials carry most of the weight of the answer.

What this page is doingThe rate appears with its denominator and its window before any source is named, which is what turns a complaint about infections into a question that can be searched. The PICOT sentence then carries every element a reader needs to judge relevance, and the search string is printed rather than described, so the search can be repeated. Reporting 312 records down to six retained sources shows that screening actually happened. Research rubrics usually credit the strategy and the yield separately, and both are visible on this page.

Appraisal of the Retained Evidence

The strongest single source is the multicenter cluster randomized crossover trial reported by Climo et al. (2013). Nine intensive care and bone marrow transplant areas bathed patients daily with chlorhexidine impregnated cloths or with non-antimicrobial cloths, crossing over after six months, across 7,727 patients. The combined rate of hospital acquired bloodstream infection and acquisition of resistant organisms fell from 6.60 to 4.78 per 1,000 patient days, close to a 23 percent reduction. On the Melnyk and Fineout-Overholt (2023) hierarchy this is Level II evidence from a well designed randomized trial, and the quality is high: allocation was made at the site level, the crossover controlled for differences between sites, endpoints were laboratory confirmed, and analysis respected the randomized clusters. The limitation that matters here is the composite endpoint, which counts organism acquisition alongside bloodstream infection.

Huang et al. (2013) supplies the second trial. Forty three hospitals and 74 adult intensive care areas were randomized to screening with isolation, targeted decolonization of known carriers, or universal decolonization using daily chlorhexidine bathing with nasal mupirocin, covering more than 70,000 admissions. Universal decolonization produced the largest reduction in bloodstream infection from any pathogen, reported as a hazard ratio near 0.56 against the screening strategy. This is Level II evidence of high quality, and its pragmatic conduct in ordinary intensive care areas strengthens how well it transfers to a community hospital. Its limitation must be stated plainly: bathing travelled with nasal mupirocin inside one intervention, so the trial cannot separate the effect of the bath from the effect of decolonizing the nose, and no patient or nurse was blinded.

The remaining sources set the frame rather than test the intervention. Buetti et al. (2022) is the acute care compendium update, which places daily chlorhexidine bathing of intensive care patients who have central lines among its essential practices; because those recommendations rest on a systematic review of the trial literature, the compendium is treated here as Level I evidence. The Centers for Disease Control and Prevention (2024) protocol is what makes the outcome countable, since it defines the infection event and fixes central line days as the denominator, and the Agency for Healthcare Research and Quality (2022) toolkit supplies the implementation structure. Both are agency sources near the bottom of the hierarchy, and neither adds effect data. Taken together the body of evidence is consistent in direction, strong in design, and weakest exactly where this question is narrowest: no retained trial studied a 20-bed medical ICU alone, and none isolated bathing from the rest of a maintenance bundle.

What this page is doingEach source receives the same three moves in the same order: what the study did with its numbers, the level assigned from a named hierarchy, and one limitation stated plainly. That order is what keeps an appraisal from collapsing into a summary. Naming Melnyk and Fineout-Overholt before assigning Level II shows the level came from a published scheme rather than from the writer's impression. The closing sentence about what the evidence does not cover is the move that most often separates a strong appraisal from an average one.

What the Evidence Would Change in Practice

What this evidence would change is narrow and specific. The ICU would move from a bathing choice made at the bedside to a standing daily bath with 2 percent chlorhexidine gluconate cloths for every adult carrying a central venous catheter, from the day of insertion until the line is removed, with soap and water reserved for documented chlorhexidine allergy or broken skin at the bathing site. The bath would become an ordered row on the daily flowsheet rather than a comfort measure buried in narrative charting, because an intervention that is not documented cannot be audited. Nothing in the insertion bundle changes. The evidence supports adding a maintenance practice to an insertion practice that is already performing, not replacing a checklist that already runs above 95 percent.

Measurement would reuse the definitions the appraisal relied on. The primary measure stays the infection rate per 1,000 central line days, reported monthly for six months against the 2.09 baseline, with a target at or below 1.0 and the standardized infection ratio tracked beside it for external comparison. A process measure would audit 20 records a month for a completed and documented bath, with a threshold of 90 percent, because a trial result cannot appear in a hospital that half performs the intervention. A balancing measure matters more here than in most projects: skin integrity reports and any drift in chlorhexidine susceptibility among isolates would be reviewed each quarter with the infection preventionist. Cloth cost runs a few dollars per patient day against an attributable cost per infection that federal sources place far higher.

Governance decides whether a practice change survives past its first month. The proposal would go to the nursing practice council with the infection prevention committee as co-sponsor, since a standing bath order crosses nursing practice, pharmacy stock and supply chain. A charge nurse and the ICU educator would own daily reinforcement for the first 60 days, and results would be posted where staff can watch the line move. The stop rule is written before the pilot starts: if the rate has not moved after six months of documented compliance above 90 percent, the practice returns to the council rather than continuing on habit. Stating that in advance is what separates an evidence based change from a preference that has been given a protocol number.

What this page is doingThe recommendation is written as something a department could start on Monday: who is bathed, with what, from when until when, and where it is documented. The measures reuse the definitions from the appraisal, so baseline and target can be compared without argument. A balancing measure appears because a graduate reader expects the writer to have asked what the change could break. The stop rule is the strongest move on the page, since it commits the writer to a decision point rather than an open ended pilot.

References

Agency for Healthcare Research and Quality. (2022). Toolkit for reducing central line-associated bloodstream infections. U.S. Department of Health and Human Services. https://www.ahrq.gov/hai/clabsi-tools/index.html

Buetti, N., Marschall, J., Drees, M., Fakih, M. G., Hadaway, L., Maragakis, L. L., Monsees, E., Novosad, S., O'Grady, N. P., Rupp, M. E., Wolf, J., Yokoe, D., & Mermel, L. A. (2022). Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infection Control and Hospital Epidemiology, 43(5), 553-569.

Centers for Disease Control and Prevention. (2024). Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection). National Healthcare Safety Network. https://www.cdc.gov/nhsn/psc/bsi/index.html

Climo, M. W., Yokoe, D. S., Warren, D. K., Perl, T. M., Bolon, M., Herwaldt, L. A., Weinstein, R. A., Sepkowitz, K. A., Jernigan, J. A., Sanogo, K., & Wong, E. S. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. New England Journal of Medicine, 368(6), 533-542. https://doi.org/10.1056/NEJMoa1113849

Huang, S. S., Septimus, E., Kleinman, K., Moody, J., Hickok, J., Avery, T. R., Lankiewicz, J., Gombosev, A., Terpstra, L., Hartford, F., Hayden, M. K., Jernigan, J. A., Weinstein, R. A., Fraser, V. J., Haffenreffer, K., Cui, E., Kaganov, R. E., Lolans, K., Perlin, J. B., & Platt, R. (2013). Targeted versus universal decolonization to prevent ICU infection. New England Journal of Medicine, 368(24), 2255-2265. https://doi.org/10.1056/NEJMoa1207290

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

How this NUR 5023 Module 5 example is structured

American College of Education does not publish a deliverable name for each module of NUR5023 Advanced Nursing Research and Practice I, so read this NUR5023 Module 5 example as a worked model of the genre rather than a copy of one section's instructions. In many sections a module at this point in the Master of Science in Nursing program asks for a searched and appraised body of evidence behind one practice question; your course instructions and rubric decide the exact form. The paper runs in the order a research course grades: the practice question and the full search strategy first, so a reader could repeat the search; the appraisal second, where every retained source carries a level and a quality judgment; and the practice change last, because a research paper earns its ending by saying what the evidence would actually alter.

NUR5023 Module 5 questions, answered

What does NUR5023 Module 5 usually ask for?

American College of Education does not publish a deliverable name for each module, so read your course instructions and rubric first. In many sections a module at this point in the research course asks for a searched and appraised body of evidence behind one practice question, ending in a proposed change. This example models that genre from the search string through to the stop rule.

How much of the paper should the search strategy take?

Enough that another reader could repeat it. Name the databases, print the actual search string with its Boolean operators, state the limits and the date range, then report the yield: records returned, duplicates removed, full text reviewed, sources retained. In this example that runs about a paragraph and a half, roughly one page of a graduate paper.

How do I assign a level of evidence without guessing?

Pick one published hierarchy, name it in the paper, and apply it to every source the same way. This example uses the Melnyk and Fineout-Overholt levels, so a randomized trial is Level II and a compendium built on a systematic review is treated as Level I. Add a quality judgment and one honest limitation for each source.

Write yours, or have the desk draft it

This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.

NUR5023 Module 5: sample paper, in real form