The project, which was dedicated to the use of chlorhexidine washcloths with the aim of preventing catheter-associated urinary tract infections (CAUTIs), has been completed. With only five patients, the conclusions that could be drawn from the data were limited. The number of staff members that were recruited was greater (26), and the conclusions that were related to their training were more solid, but they were not the focus of the project. Indeed, the project aimed to answer the question regarding the efficacy of chlorhexidine bathing in preventing CAUTI; the research-supported hypothesis was that it should be effective (Huang, Chen, Wang, & He, 2016; Noto & Wheeler, 2015). However, this project did not produce sufficient evidence in this regard, which is a partly expected conclusion that resulted from the limitations of the sample.
The data relating to the staff shows that the training effort succeeded in improving the participants’ knowledge that is related to CAUTIs. Indeed, with p=0.004 (Wilcoxon signed ranks test), it is apparent that the training was effective. The purpose of this action was to ensure that the participants were aware of the correct ways of applying the washcloths. Based on these data, the staff was sufficiently proficient in performing the task. In addition, the project demonstrated the efficacy of the training, which can be recommended for future similar interventions. CAUTIs are a major issue, and educating the staff that works with populations that are CAUTI-prone is important (Huang et al., 2016; Noto & Wheeler, 2015). Therefore, this conclusion is significant, and it is also in line with pre-training expectations, but it is not the focus of the project.
The data gathered for the five patients demonstrates that their state did not change throughout the project. It should also be noted that none of the patients tested negatively for leukocytes and nitrite before the intervention; all of them tested positive for leukocytes, and two also tested positive for nitrite. However, they did not demonstrate any CAUTI symptoms before or after the intervention. Chlorhexidine gluconate washcloths are meant to be a preventative measure (Abbas & Sastry, 2016; Noto & Wheeler, 2015), which is why it was originally intended to use them with patients with negative CAUTI tests. However, in the absence of other options, the five patients without CAUTI symptoms but with positive leukocyte or nitrite tests were treated as eligible. It is also noteworthy that one of the patients who had been recruited had to be transferred for reasons unrelated to the project, which left only four patients for the post-test assessment.
No changes in the patients’ state were recorded, which implies that it had not worsened or improved. It can be tentatively proposed that the findings support the idea that the washcloths prevent infections since no participant developed CAUTI symptoms. However, this conclusion is supported by the limited evidence derived from four patients’ data. Consequently, the project mostly functioned as an opportunity to improve the CAUTI prevention knowledge of the staff of the site, but it did not produce sufficient data for supporting or disproving the effectiveness of chlorhexidine in preventing CAUTI.
Expectations and Their Influence on the Project
The conclusions were not too different from what was originally anticipated and planned. The training conclusion had been anticipated; an intervention that was meant to improve CAUTI knowledge was expected to have at least some effect. Similarly, the fact that no patients developed CAUTI symptoms was expected due to some prior research (Huang et al., 2016; Noto & Wheeler, 2015). It should be noted that the data gathered for CAUTI prevention were rather scarce, and it is difficult to use these findings to make conclusions. Still, even this issue was not fully unexpected; a small sample was initially planned, although the final sample proved to be even smaller.
An unexpected limitation, which affected the conclusions, was that the patients tested positive for leukocytes and nitrite. The project’s methodology took into account the fact that the intervention was preventative; it was initially stipulated that only patients with negative tests for leukocytes and nitrite in urine would be recruited. The project, therefore, was guided by the assumption that the project’s site would have eligible patients. Before this assumption is deemed unreasonable, it should be noted that an initial investigation into the numbers of potentially eligible patients was performed. During it, it was determined that at least 17 patients could be available. However, some patients were transferred, and the treatment was changed for some other patients; also, not all patients or relatives wanted to participate. As a result, the sample only managed to include five patients, and leukocytes were found in their urinalyses.
This issue can be used to gain insights into the importance of assumptions for the development of a project. Indeed, future projects may avoid similar pitfalls by considering the topic of limited participant availability in detail. This project did not have access to alternative sites, but a project with more resources could be designed to recruit people from multiple institutions. In addition, the eligibility criteria for patients could be reconsidered, as well as the means of diagnosing their state and urinary tract health. In other words, assumptions about the conclusions and processes of a project affect its development and can help to shape it better.
The majority of the conclusions and limitations of the project had been anticipated. Still, this project shows that assumptions about conclusions and processes can affect the choices made during the planning stage. It also suggests taking into account the fact that resources and participants might be in short supply and preparing safeguards to improve the ability of similar projects to respond to their research questions.
Abbas, S., & Sastry, S. (2016). Chlorhexidine: Patient bathing and infection prevention. Current Infectious Disease Reports, 18(8), 25.
Huang, H., Chen, B., Wang, H., & He, M. (2016). The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units. The Korean Journal of Internal Medicine, 31(6), 1159-1170.
Noto, M., & Wheeler, A. (2015). Understanding chlorhexidine decolonization strategies. Intensive Care Medicine, 41(7), 1351-1354.