This paper will compare the use of

This paper will compare the use of polyhexanide, mupirocin, and no exit site dressings (I) with chloral-prep, gentamicin, and covering the site with a sterile gauze dressing (C) to reduce exit-site infections and peritonitis in people aged 18 to 90 who are getting Peritoneal dialysis (P). I need some help writing a literature review for the articles in the references please [HSA34] Literature review[HSA35] Several studies compared the use of polyhexanide, mupirocin, and no exit site dressings (I) to chloral-prep, gentamicin, and covering the site with a sterile gauze dressing (C) to prevent exit site infections and peritonitis in people between the ages of 18 and 90 who were getting Peritoneal dialysis (P). [HSA36] There were observational studies, case-control studies, and randomized controlled trials among the articles reviewed. In a unique case study conducted by GoÅ‚embiewska, E., & Ciechanowski, K[HSA37] . a patient with polycythemia vera on peritoneal dialysis developed ESI due to skin infection. Risk factors of ESI include poor competency of ES[HSA38] care, poor catheter immobilization, history of catheter-pulling injury and mechanical stress on ESI (citation) . This strengthens the importance of methods of exit site care as well as proper teaching and PD training. (GoÅ‚embiewska & Ciechanowski, 2021, p. 3)[HSA39] [HSA40] Use of polyhexanide for skin care rather than saline, iodine, or chlorhexidine [HSA41] [HSA42] After researching what causes infection to the exit site and catheter, it was realized that not only the dressing method may affect the site but also whether the patients used normal saline for site cleansing or povidone-iodine (citation). Additionally, it was then noted that itching and skin irritation on the exit site, which mostly leads to infection, happens way less to the patients treated with saline compared to those treated with iodine. A randomized, double-blind, controlled protocol study conducted by Nochaiwong et al.(2019) on the prevention of peritonitis reported that the daily application of chlorhexidine gluconate for exit-site care may induce local skin irritation, which could limit patient acceptability and long-term complianceNochaiwong et al., 2019, p. 2[HSA43] Polyhexanide is therefore considered more effective in this case as compared to the use of chloral-prep for disinfection of the exit site skin. Based on the results, it[HSA44] was discovered that using polyhexanide minimizes skin stimulation, reducing infection[HSA45] . Use Mupirocin as compared to gentamicin to reduce site infection and Peritonitis.[HSA46] Mupirocin[HSA47] t is an antibiotic that has excellent activity against gram-positive infections and also has little to no effect on gram-negative bacteria (citation). This antibiotic has been tested and proven to effectively prevent exit-site infection and peritonitis in patients undergoing peritoneal dialysis (Obata, 2020). The application of mupirocin has therefore been adopted by most healthcare centers and tagged a standard effective [HSA48] due to its positive impact on patients. In 2005, it was reported that the use of mupirocin was associated with a lower catheter infection and led to decreased peritonitis (citation). The superiority of this antibiotic over gentamicin was also demonstrated in subsequent studies; therefore, the mupirocin antibiotic was recommended for patients undergoing peritoneal dialysis (citation). In a multicenter, observational, international study of PD patients by Boudville N et al.,(2018)[HSA49] found that significant practice differences exist between countries. Differences were most notable in the domains of frequency and monitoring of PD-related infection rates, use of periprocedural, [HSA50] antibiotic prophylaxis, type of exit-site cleaning strategy, use and choice of exit-site antimicrobial prophylaxis strategies[HSA51] and the use of antifungal therapy during a course of antibiotic therapy (Boudville et al., 2018, p. 2122)[HSA52] Practicing absence of exit site dressing to the patients undergoing Peritoneal dialysis.[HSA53] In[HSA54] a study conducted by Bieber & Mehrotra., (2019) [HSA55] 72 patients who underwent peritoneal dialysis to determine the various infections associated with peritoneal dialysis mentioned that the literature has not shown consistently that the routine placement of a dressing at the PD catheter exit site daily is necessary to prevent exit site infection and there is some suggestion that it may actually, increase the rates of infection (Bieber & Mehrotra, 2019, p. 24) [HSA56] Dressing of the exit site with the use of sterile gauze dressing is one of the previously used methods for patients undergoing peritoneal dialysis. However, continuous study and research have continued to prove that covering the site may be of little benefit when it comes to the incidence of ESI or PD- related infections (citation). It has been stated that the most convenient and efficient technique is the non-dressing technique with only prophylactic topical mupirocin cream application (citation). This method has been stated to be more cost-effective and has fewer disposables[HSA57] , providing the correct environment for the exit site to react normally (citation). The studies also show that a covered dressing may be a pathway for the organisms to access the exit site (citation). This is because a covered dressing does not inhibit the micro-organisms in but rather provides[HSA58] an acceleration for bacterial growth. This has further proven r that the absence of an exit site dressing should be practiced in the PD programs to reduce site infection and peritonitis[HSA59] . [HSA60] References[HSA61] Bieber, S., & Mehrotra, R. (2019). Peritoneal dialysis access associated infections. Advances in Chronic Kidney Disease, 26(1), 23-29. Retrieved February 13, 2023, from https://doi.org/10.1053/j.ackd.2018.09.002 Boudville, N., Johnson, D. W., Zhao, J., Bieber, B. A., Pisoni, R. L., Piraino, B., Bernardini, J., Nessim, S. J., Ito, Y., Woodrow, G., Brown, F., Collins, J., Kanjanabuch, T., Szeto, C.-C., & Perl, J. (2018). Regional variation in the treatment and prevention of peritoneal dialysis-related infections in the peritoneal dialysis outcomes and practice patterns study. Nephrology Dialysis Transplantation, 34(12), 2118-2126. Retrieved February 13, 2023, from https://doi.org/10.1093/ndt/gfy204 Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H., & Wagner, M. (2022). Iowa implementation for sustainability framework. Implementation Science, 17(1). Retrieved February 13, 2023, from https://doi.org/10.1186/s13012-021-01157-5 GoÅ‚embiewska, E., & Ciechanowski, K. (2021). Repeat exit site infection in peritoneal dialysis patient with polycythemia vera – a case report. BMC Infectious Diseases, 21(1). Retrieved February 13, 2023, from https://doi.org/10.1186/s12879-021-06342-x Nochaiwong, S., Ruengorn, C., Noppakun, K., Panyathong, S., Dandecha, P., Sood, M. M., Saenjum, C., Awiphan, R., Sirilun, S., Mongkhon, P., Chongruksut, W., & Thavorn, K. (2019). Comparative effectiveness of local application of chlorhexidine gluconate, mupirocin ointment, and normal saline for the prevention of peritoneal dialysis-related infections (cosmo-pd trial): A multicenter randomized, double-blind, controlled protocol. Trials, 20(1). Retrieved February 13, 2023, from https://doi.org/10.1186/s13063-019-3953-8 Obata, Y., Murashima, M., Toda, N., Yamamoto, S., Tsujimoto, Y., Tsujimoto, Y., Tsujimoto, H., Yuasa, H., Ryuzaki, M., Ito, Y., Tomo, T., & Nakamoto, H. (2020). Topical application of mupirocin to exit sites in patients on peritoneal dialysis: A systematic review and meta-analysis of randomized controlled trials. Renal Replacement Therapy, 6(1). Retrieved February 13, 2023, from https://doi.org/10.1186/s41100-020-00261-4 Perl, J., Fuller, D. S., Bieber, B. A., Boudville, N., Kanjanabuch, T., Ito, Y., … & Johnson, D. W. (2020). Peritoneal dialysis-related infection rates and outcomes: results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). American Journal of Kidney Diseases, 76(1), 42-53. https://doi.org/10.1053/j.ajkd.2019.09.016 Piraino, B. M. (2019). Putting peritoneal dialysis catheter infections into perspective. American Journal of Kidney Diseases, 74(5), 705-707. Retrieved February 13, 2023, from https://doi.org/10.1053/j.ajkd.2019.07.004 Comments [HSA34]Review of Literature (30 pts) 6-8 peer reviewed, current journal articles (within 5 years) with substantive data for your problem – Studies relate directly to the PICO . Succinctly summarizes articles on how they support, or do not support, stated problem. Addresses strength of literature using an identified data stratification method (i.e. level of evidence). – level of evidence not addressed, no p-values given for validity of data, no mention of sample sizes Attaches a summary of the matrix outlining included works, study attributes, expert opinion, evidence level ranking, and significant findings – not completed Provides a brief synthesis of the matrix findings in the body of the paper that includes support and contradictory findings in the literature review related to the problem.- not discussed in the summary

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