For MN504's Unit 5 evidence table, nine chlorhexidine bathing studies are rated for Johns Hopkins level, quality and fit to one oncology unit, and every row carries commentary. Searches like "mn 504 unit 5 assignment example", "mn504 unit 5 sample" and "mn504 unit 5 example" land here.
Evidence Table: Chlorhexidine Bathing and Line-Related Bloodstream Infection, Ordered by Fit to an Adult Oncology Unit
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Purdue University Global
MN504: Evidence-Based Practice
Unit 5 Assignment
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[Date]
Row 1 is a composite internal report written for this model; every other row is a published source listed in the references.
Table
Columns: source; design; Johns Hopkins level; sample and setting; intervention and comparison; outcome and definition; main result; quality; fit; commentary. Levels and quality grades follow the Johns Hopkins model (Dang et al., 2022).
Row 1. Internal quality report, sister hematology-oncology unit in the same composite hospital system, 2024 to 2025 (unpublished). Design: before-and-after quality report. Level V. Setting: 28-bed adult hematology-oncology unit. Intervention: daily 2% chlorhexidine cloths versus soap-and-water bathing. Outcome: central line infections by surveillance definition. Result: 9 infections in 3,850 line days before (2.34 per 1,000) and 4 in 3,720 after (1.08 per 1,000); incidence rate ratio 0.46, 95% interval 0.14 to 1.49. Quality C. Fit high. Commentary: closest population to ours, but the interval crosses 1 and the design cannot separate bathing from other changes; useful for feasibility, weak for effect.
Row 2. Huang et al. (2019). Design: cluster-randomized trial across 53 hospitals. Level I. Setting: adult general medical and surgical units. Intervention: daily chlorhexidine bathing plus nasal decolonization for carriers versus routine bathing. Outcome: multidrug-resistant organism cultures and all-cause bloodstream infection. Result: no significant reduction overall; in a post hoc subgroup of patients with medical devices, including central lines, both outcomes fell. Quality A. Fit moderate to high. Commentary: the best non-ICU evidence; its overall result is null and its favorable finding comes from a subgroup, so it supports a targeted approach, not bathing for everyone.
Row 3. Caya et al. (2015). Design: systems engineering evaluation of hospital-wide implementation. Level III. Setting: one hospital, ICU and non-ICU units. Outcome: process and barriers to implementation. Quality B. Fit moderate. Commentary: useful for workflow and supply barriers on general units.
Row 4. Climo et al. (2013). Design: cluster-randomized crossover trial. Level I. Setting: 9 intensive care and bone marrow transplant units. Intervention: daily chlorhexidine cloths versus nonantimicrobial cloths. Outcome: acquisition of resistant organisms and hospital-acquired bloodstream infection. Result: both reduced during chlorhexidine periods. Quality A. Fit low to moderate. Commentary: strong design; mostly critically ill patients bathed by staff, though transplant units bring it closer to our population.
Row 5. Noto et al. (2015). Design: pragmatic cluster-randomized crossover trial. Level I. Setting: 5 adult intensive care units, one center. Result: the combined infection outcome did not fall significantly during chlorhexidine periods. Quality A. Fit low. Commentary: an important null ICU result that tempers row 4.
Row 6. Frost et al. (2018). Design: systematic review with trial sequential meta-analysis. Level I. Setting: adult intensive care. Result: chlorhexidine bathing associated with fewer health care-associated infections. Quality B. Fit low. Commentary: confirms the ICU effect; says nothing directly about oncology wards.
Row 7. Buetti et al. (2022). Design: expert practice recommendations. Level IV. Result: daily chlorhexidine bathing of ICU patients listed as an essential practice; guidance outside intensive care is weaker. Quality A. Fit moderate. Commentary: sets the professional standard for the ICU; does not settle our question.
Row 8. Musuuza et al. (2017). Design: qualitative interviews with ICU nurses. Level III. Result: time, product supply and patient refusal threaten sustainability. Quality B. Fit moderate. Commentary: directly relevant to patients on our unit who refuse cloth baths during nausea.
Row 9. Kampf (2016). Design: narrative review. Level V. Result: reports of reduced chlorhexidine susceptibility; calls for antiseptic stewardship. Quality B. Fit moderate. Commentary: a reason to monitor, not a reason to stop.
Notes on Grades
The intensive care trials earn the highest level and quality, but their fit is low because critically ill patients bathed daily by staff differ from oncology inpatients who often bathe themselves between treatments. Row 1 is rated Level V because it is an internal quality report, not a study, and quality C because it has no concurrent control, a small number of events and no account of other changes during the same period. It is placed first only because it describes patients most like ours. Its incidence rate ratio of 0.46 is quoted with its interval so that an apparent halving is not read as a proven one. Row 7 is a guideline and row 9 a narrative review; both are labeled for what they are and are not counted as primary studies.
References
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. https://doi.org/10.1017/ice.2022.87
Caya, T., Musuuza, J., Yanke, E., Schmitz, M., Anderson, B., Carayon, P., & Safdar, N. (2015). Using a systems engineering initiative for patient safety to evaluate a hospital-wide daily chlorhexidine bathing intervention. Journal of Nursing Care Quality, 30(4), 337-344. https://doi.org/10.1097/NCQ.0000000000000129
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
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E., Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the effectiveness of chlorhexidine bathing and health care-associated infections among adult intensive care patients: A trial sequential meta-analysis. BMC Infectious Diseases, 18(1), 679. https://doi.org/10.1186/s12879-018-3521-y
Huang, S. S., Septimus, E., Kleinman, K., Moody, J., Hickok, J., Heim, L., Gombosev, A., Avery, T. R., Haffenreffer, K., Shimelman, L., Hayden, M. K., Weinstein, R. A., Spencer-Smith, C., Kaganov, R. E., Murphy, M. V., Forehand, T., Lankiewicz, J., Coady, M. H., Portillo, L., ... Platt, R. (2019). Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): A cluster-randomised trial. The Lancet, 393(10177), 1205-1215. https://doi.org/10.1016/S0140-6736(18)32593-5
Kampf, G. (2016). Acquired resistance to chlorhexidine: Is it time to establish an "antiseptic stewardship" initiative? Journal of Hospital Infection, 94(3), 213-227. https://doi.org/10.1016/j.jhin.2016.08.018
Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences. BMC Infectious Diseases, 17(1), 75. https://doi.org/10.1186/s12879-017-2180-8
Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler, A. P. (2015). Chlorhexidine bathing and health care-associated infections: A randomized clinical trial. JAMA, 313(4), 369-378. https://doi.org/10.1001/jama.2014.18400
How this MN504 Unit 5 example is structured
Ordering by fit is the table's main argument: the evidence most applicable to thirty oncology beds comes before the strongest designs, and the notes explain choosing that over the usual hierarchy. Level and quality are never merged. The intensive care crossover trial earns Level I and an A for conduct, then a low fit rating, because critically ill patients bathed by ICU staff differ from oncology inpatients who often bathe themselves. The local before-and-after report gets the same candor; it is an internal quality report, which the Johns Hopkins scheme places at Level V, and the notes say so rather than dressing it up. Its incidence rate ratio of 0.46, with an interval from 0.14 to 1.49, is quoted so nobody mistakes an apparent halving for a proven one. Each commentary cell closes on a plain verdict about usefulness.
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MN504 Unit 5 questions, answered
What is the difference between evidence level and quality?
Level describes the design, placing systematic reviews of trials and randomized trials above observational studies and expert opinion. Quality describes how well a particular study was carried out and reported, whatever its design. The Johns Hopkins tools rate them separately, levels I to V and quality A to C, so a trial with serious flaws can be Level I and quality C at once.
Should a clinical practice guideline go in the evidence table?
Usually yes, labeled as a guideline rather than a study. Johns Hopkins places guidelines and consensus statements at Level IV, and they often matter a great deal to a practice proposal because organizations look to them. What they should not do is count toward the tally of research studies, which some prompts ask for separately.
How much commentary does each row need?
Two to four sentences is typical: one on the study's main strength, one on its main weakness, and one on how well it fits the question and setting. The last sentence should say whether the study will be used and how. Longer commentary tends to drift into summary; shorter commentary rarely manages a judgment at all.