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 -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. , , 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. , (1), 54–57. 3. Kear,  T., & Ulrich, B. (2015). Decreasing Infections in Nephrology Patient  Populations: Back to Basics. , (5), 431–43;  quiz 444. Retrieved from http://search.proquest.com/docview/1735902605/ 4. Macrae, J. et al (2016).  Arteriovenous Access: Infection, Neuropathy, and Other Complications. , (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. , (9),  e0222408. https://doi.org/10.1371/journal.pone.0222408

Introduction

Bloodstream infections are a significant concern in patients undergoing hemodialysis, as they can lead to increased morbidity and mortality rates. Preventing and managing bloodstream infections is a crucial goal for nurses and other healthcare professionals in this population. This paper aims to compare and contrast four peer-reviewed research articles that examine risk factors, prevention strategies, and the overall implications for clinical practice regarding bloodstream infections in patients undergoing hemodialysis. The PICOT question being addressed is: In patients undergoing hemodialysis, what are the risk factors and effective prevention strategies for bloodstream infections?

Database Search

To conduct this literature review, the APUS library was utilized to search relevant databases such as PubMed, CINAHL, and ProQuest. The keywords used in the search included “hemodialysis,” “bloodstream infections,” “risk factors,” “prevention strategies,” and “catheter-related infections.” Limiters used in the search included the requirement for articles to be peer-reviewed and published within the past seven years. A total of 67 articles were retrieved from the initial search.

Summary of Articles

Article 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

This article presents the findings of a nested case-control study that aimed to identify the risk factors associated with morbidity and mortality of bloodstream infections in patients undergoing hemodialysis. The study found that advanced age, diabetes mellitus, use of central venous catheters, and previous hospitalizations were significant risk factors for bloodstream infections. The Level of Evidence rating for this article is Level III, as it is based on a case-control study design.

Article 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. Journal of Vascular Access, 20(1), 54-57.

This article reports the development and implementation of an effective prevention bundle to eliminate catheter-related bloodstream infections in ambulatory hemodialysis patients. The study found that the bundle, which included strict hand hygiene, sterile dressing practices, and catheter care education, significantly reduced the incidence of catheter-related bloodstream infections. The Level of Evidence rating for this article is Level IV, as it is based on an observational study design.

Article 3: Kear, T., & Ulrich, B. (2015). Decreasing Infections in Nephrology Patient Populations: Back to Basics. Nephrology Nursing Journal, 42(5), 431-43; quiz 444.

This article discusses the importance of returning to basic infection prevention practices in nephrology patient populations, including those undergoing hemodialysis. The authors emphasize the need for strict hand hygiene, appropriate catheter care, and adherence to infection prevention guidelines. The Level of Evidence rating for this article is not provided.

Article 4: Macrae, J. et al (2016). Arteriovenous Access: Infection, Neuropathy, and Other Complications. American Journal of Kidney Diseases, 68(1), 2054358116669127. https://doi.org/10.1177/2054358116669127

This article discusses the complications associated with arteriovenous access, a common type of vascular access used in hemodialysis patients. The authors highlight infection as one of the major complications and discuss strategies for prevention, such as appropriate catheter care and surveillance of access sites. The Level of Evidence rating for this article is not provided.

In-depth Discussion of Major Findings

The four articles reviewed highlight several major findings related to bloodstream infections in patients undergoing hemodialysis. Firstly, the presence of risk factors such as advanced age, diabetes mellitus, and use of central venous catheters significantly increases the risk of bloodstream infections (Fram et al., 2014). Secondly, implementing an effective prevention bundle that includes strict hand hygiene, sterile dressing practices, and catheter care education can effectively reduce the incidence of catheter-related bloodstream infections (Hamid et al., 2019).