Compare and contrast 4 peer-reviewed research articles using the PICOT question the student will be required to evaluate the evidence found in the articles, identifying similarities, differences and overall implications for clinical practice. Students will use the APUS library to search relevant databases to find at least 4 research articles from peer-reviewed sources, no older than 7 years, unless it is a landmark study. Two of these articles must be authored by at least one nurse. Students will then evaluate the evidence found in the articles, identifying similarities, differences, and overall implications for clinical practice. The paper will consist of the following sections: Introduction to the problem or issue -The PICOT question being asked, both in a sentence format and broken down into each element Population: Hemodialysis patients with fistulas, grafts and PICCs Intervention: the intervention is the use of the ethanol lock solution in the PICCs and use of daily 2% chlorhexidine wash. This is the change proposal that is aimed at reducing the rates of infections associated caused by the presence of the microbes on the fistula, graft, and PICC access sites. Comparison: the intervention is compared to the heparin lock solution and lack of use of 2% chlorhexidine wash. Outcome: Reduction in the rates of the infection in hemodialysis patients in the unit. -A brief discussion of the databases searched, including key words, limiters used, and total number of articles retrieved -A brief summary of each of the articles and the Level of Evidence rating for each, including the evidence rating scale used (i.e. Level I, Johns Hopkins Nursing Evidence Based Practice Scale) -In-depth discussion of major findings from the literature (EBP summary). This can be organized by article or major themes -Specific recommendations for clinical practice -Reference page The paper will be in APA format, written in third person, and should be 7-10 pages, not including the title and reference pages. An abstract is NOT required. Please use the following uploaded rubric to guide you. References to be reviewed 1. Fram, D., Taminato, M., Ponzio, V., Manfredi, S. R., Grothe, C., Batista, R. E., Belasco, A.,& Barbosa, D. (2014). Risk factors for morbidity and mortality of bloodstream infection in patients undergoing hemodialysis: a nested case-control study. BMC research notes, 7, 882. https://doi.org/10.1186/1756-0500-7-882 2. Hamid, H. A., Bouanane, H., Ibrahim, A., Ismail, S., El Sayed, A., Mahmoud, K. M., & Al Ali, F. (2019). Effective prevention bundle to eliminate catheter-related bloodstream infections in ambulatory hemodialysis patients. Canadian Journal of Infection Control, 34(1), 5457. 3. Kear, T., & Ulrich, B. (2015). Decreasing Infections in Nephrology Patient Populations: Back to Basics. Nephrology Nursing Journal?: Journal of the American Nephrology Nurses Association, 42(5), 43143; quiz 444. Retrieved from http://search.proquest.com/docview/1735902605/ 4. Macrae, J. et al (2016). Arteriovenous Access: Infection, Neuropathy, and Other Complications. Canadian Journal of Kidney Health and Disease, 3(1), 2054358116669127. https://doi.org/10.1177/2054358116669127 5. Zhang, J., Wang, B., Wang, J., Yang, Q., & Serra, R. (2019). Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials. PLoS ONE, 14(9), e0222408. https://doi.org/10.1371/journal.pone.0222408
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