Clostridium Difficile Prevention

10 Strategic Points Table

(Use this table to complete the 10 Strategic Points document for your project.)

The 10 Strategic PointsComments or Feedback
Broad Topic AreaBroad Topic Area: Effects of the use of probiotics in preventing Clostridium Difficile diarrhea in adult patients with abdominal and/or bowel surgeries.   
Literature ReviewLiterature Review: Background of the Problem/Gap: Clostridium difficile infection (CDI) causes over 337,000 infections in addition to 14,000 deaths annually (Canavan et al,. 2016). One of the prevention strategies against CDI is the use of probiotics. The availability of probiotics has increased their use in the prevention of Clostridium difficile infection (Chunhong et al., 2015). Hospitals have managed to prevent the infection through this intervention Armbruster et al., (2012). It is, however, important to know the effects of the use of probiotics in preventing Clostridium Difficile diarrhea in adult patients with abdominal and/or bowel surgeries. Theoretical Foundations (models and theories to be foundation for the project): Metchnikoff’s theory of longevity According to Metchnikoff’s theory of longevity, probiotics have beneficial effects on human health especially in lower gut flora and longevity (Azizpour, et al., 2009). Review of Literature Topics with Key Organizing Concepts or Topics for Each One Key Topic: Clostridium difficile infection (CDI) Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea both in the community and in hospitals (Goldstein et al., 2015). CDI is a global health concern associated with significant mortality and morbidity, and substantial health care costs. Key Topic:Prevention of CDI CDI occurs mostly in elderly patients taking antibiotics. Research identifies the use of antibiotics as a significant risk factor of the infection (Canavan et al., 2016). Several interventions have been proposed to prevent infection (Chunhong et al., 2015). These include early detection and isolation, proper hand hygiene, and the use of environment disinfectants. Key Topic: Use of probiotics as a prevention measure The limited success of the interventions of prevention CDI has led to the introduction of the use of probiotics (Canavan et al., 2016). Various studies have found the use of probiotics as effective in the reduction of the risk of developing CDI especially in patients taking antibiotics (Lau & Chamberlain, 2016: Chunhong et al., 2015). Settings: Hospital (Canavan et al., 2016) Medical center (Armbruster,& Goldkind, 2012) Computer-based ( Balsells et al., 2016) Certifications: National Committee for Quality Assurance (2020). Disease Management Accreditation/Certification. Retrieved from https://www.ncqa.org/programs/health-plans/disease-management-dm/ American Association of Critical-Care Nurses (n.d). AACN Certification Corporation. Retrieved from https://www.aacn.org/about-aacn/about-aacn-cert-corp Summary Gap/Problem: There is a need to investigate the effects of the use of probiotics in preventing Clostridium Difficile diarrhea in adult patients with abdominal and/or bowel surgeries. Prior studies: Prior studies show that the use of probiotics helps in reducing the risk of developing CDI especially in patients taking antibiotics. Quantitative application: There exist sources of data to collect numerical data on the effects of the use of probiotics in preventing Clostridium Difficile diarrhea in adult patients with abdominal and/or bowel surgeries.Significance: Knowing the effectiveness of probiotics in the prevention of CDI will help provide the most appropriate intervention for adult patients with abdominal and/or bowel surgeries. 
Problem StatementProblem Statement: Literature indicates that probiotics reduce the risk of developing Clostridium Difficile diarrhea. However, the effectiveness of the use of probiotics in preventing Clostridium Difficile diarrhea associated with antibiotic use during the postsurgical phase in adult patients with abdominal and/or bowel surgeries as compared to not consuming them is not known. The purpose of this study will be to determine how effective is the use of probiotics compared to not consuming them in preventing Clostridium Difficile diarrhea during the postsurgical phase within a 3-month time frame in adult patients with abdominal and/or bowel surgeries. 
Clinical/
PICOT Questions
Clinical/PICOT Questions: P- In adult patients with abdominal and/or bowel surgeries I- How effective is the use of probiotics   C- Compared to not consuming the probiotics O- In preventing Clostridium Difficile diarrhea associated with antibiotic use during the postsurgical phase T- During a 3-month time frame 
SampleSample (and Location): Location-   Target population- The study targets adult patients with abdominal and/or bowel surgeries in a hospital.   c. Sample size- an estimate of 20 participants in each group is needed. 
Define VariablesDefine Variables:Independent Variable: Probiotics Probiotics are medical interventions, live microorganisms, that counterbalances changes in gastrointestinal flora brought by the use of antibiotics (Banerjee & Adcock, 2018)   Dependent Variable: Prevention of Clostridium Difficile diarrhea Clostridium Difficile diarrhea is a bacterium causing diarrhea symptoms and colon inflammation (Lau & Chamberlan, 2016).     
Methodology and DesignMethodology and Design: The researcher will use a quantitative methodology with an experimental design to address the clinical question.   
Purpose StatementPurpose Statement: The purpose of this quantitative experimental project is to examine the effectiveness of the use of probiotics as compared to not using them in the prevention of Clostridium Difficile diarrhea for adult patients with abdominal and/or bowel surgeries.     
Data Collection ApproachData Collection Approach: The study will use routinely collected health data, as the primary instruments for collecting data in answering the clinical question. These instruments are useful in experimental studies (MC Cord et al., 2018).   
Data Analysis ApproachData Analysis Approach: The study will use a T-test in the analysis of the collected data. This means that the means of the independent groups will be compared (Lutabingwa & Auriacombe, 2007). The researcher will calculate the t-value through the use of the sample standard deviation and mean and then compare the calculated t-value against a tabulated value.   

References

Armbruster, S., Goldkind, L., Armbruster, S., & Goldkind, L. (2012). A 5-year retrospective        review of experience with Clostridium difficile-associated diarrhea. Military Medicine,          177(4), 456–459.

Azizpour, K., Bahrambeygi, S., Mahmoodpour, S., Azizpour, A., Mahmoodpour, S.,         Bahrambeygi, S. & Azizpour, K. (2009). History and Basic of Probiotics. Research       Journal of Biological Sciences, 4: 409-426.

Balsells, E., Filipescu, T., Kyaw, M. H., Wiuff, C., Campbell, H., & Nair, H. (2016). Infection      prevention and control of Clostridium difficile: a global review of guidelines, strategies,          and recommendations. Journal of global health, 6(2).

Banerjee, S. & Adcock, L. (2018). Probiotics for Antibiotic-Associated Diarrhea and Clostridium             difficile Infection: A Review of Guidelines. Canadian Agency for Drugs and         Technologies in Health.

Canavan, K. (2016). Prevention of Hospital-Onset C. diff Infection through a Multidisciplinary   Performance Improvement Approach. AJIC: American Journal of Infection Control, (6).

Chunhong, X., Jiajing, L., Kejia, W., Qinqin, L., & Daorong, C. (2015). Probiotics for the             prevention of antibiotic-associated diarrhoea in older patients: A systematic review.     Travel Medicine & Infectious Disease, 13(2), 128–134.

Ellie, G., Stuart, J., Pierre-Jean, M., Lynne, M., William, T., Linda, D., Mathieu, M., Hadi, M.,     Donald. E. (2015). Pathway to Prevention of Nosocomial Clostridium difficile Infection.        Clinical Infectious Diseases, 60(2), 148-158.

Lau, S. & Chamberlain, R. (2016). Probiotics are effective at preventing Clostridium difficile-      associated diarrhea: a systematic review and meta-analysis. International Journal of     General Medicine, 27-37.

Lutabingwa, J. & Auriacombe, C. (2007). Data Analysis in Quantitative Research.

MC Cord, K., Salman, R., Treweek, S., Gardner, H., Strech, W., Loannidis, J….Hemkens, L.       (2017). Routinely collected data for randomized trials: promises, barriers, and         implications. Trials, 1-9.

Spieth, P., Kubasch, A., Penzlin, A., Illigens, B., Barlinn, K. & Siepmann, T. (2016).         Randomized controlled trials – a matter of design. Neuropsychiatric Disease and            Treatment, 12, 1341–1349.

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