Central Line-Associated Bloodstream Infections

Central Line-associated Bloodstream Infections.
Walden University
Dr. Linda Johanson
Francis Mercado
1
Identification and description of the clinical issue.
The clinical issue or problem identified for my study is the
central line bloodstream infections (CLABSI)
Central line bloodstream infections(CLABSI) is a health
condition that affects many people.
It occurs when pathogens such as bacteria and other germs
invade the patients central line after which they get into the
bloodstream.
CLABSI related infections are often serious but they can be
successfully managed through appropriate treatment approaches.
Femoral central venous catheters and internal jugular along with
subclavian central lines have high risk of getting infected.
As per the survey conducted in 2019 about the central line
bloodstream infections, it was found that the infection ratio for
the said infections was 0.8 per 1000 central line days. This
means that over 250000 people across the world bloodstream
infections occur yearly and most of them are associated with
the presence of intravascular devices.
2
Identification and description of the clinical issue.

Cont.………
Risk factors for Central Line-associated Bloodstream Infections
(CLABSI)
presence of gastrostomy tube.
ICU placement of central venous catheter.
Immunosuppression.
Antibiotic therapy(Steffens et al., 2019,).
Poor nutrition;
Multiple invasive procedures.
nonoperative cardiovascular disease.
Central line bloodstream infection is associated with numerous
predisposing risk factors. From healthcare stats, it can be said
that central line catheters are the common causes of health
callings linked to CLABSI. However there are many other risk
factors that predispose patients to contracting or developing
central line bloodstream infections. Contamination may occur
within the central line and this may cause central line related
illness. Such contamination include; non interact dressing,
contaminated infusion, central venous access devices as well as
patient's skin flora.
3
How to develop PICOT question for CLABSI
By analyzing the major components of PICOT, that is P-
population, patients, or problem at hand, I-interventions
required to solve the issue, C- control or alternative
interventions to be compared, O-outcome or the objective to be
achieved and T-time framework required to achieve desired
outcome(Steffens et al., 2019).
This will help formulate questions such as;
Who and what is the issues that need to be addressed?
What is the proposed intervention and actions to remedy the
issue?
What is desired outcome?

How much time is required to realized anticipated results?
To come up with PICOT statement of question on the clinical
issues that I had chosen I had to analyze all the components of
PICOT to identify their meanings so as to develop a questions
that meets PICOT guidelines. The analysis of the PICOT
components will help develop questions about the what are
kind of population or patients affected with central line
bloodstream infection in Belgian home care setting.
4
Research questions used to refine the search outcome.
Numerous questions may be developed which are associated
with the issue of compliance with EBP healthcare guidelines
that can be used to reduce incidences of patients contracting
central line associated bloodstream infections.
What are main causes of CLABSI in Belgian home care setting?
From the result generated, it can be said that many patients are
suffering from the CLABSI health challenges as a result of
incorrect insertion of a central line by healthcare professionals.
Another questions for refining the EBP on the said issues was
about the most applicable approaches or medical interventions
that could be used to reduce increased chances of developing
CLABSI
CLABSI has been identified as one of the health challenge that
whose causes have been associated contaminated infusion,
patient’s skin flora and contamination on insertion. Such risk
may be reduce if nurses and other healthcare professional get
extensive understanding on the major causes and risk factors
leading to occurrence of CLABSI among patients.
5
PICOT Question on CLABSI

will treatment of adults patients with CLABSI (P) be effective
when using intravenous antibiotics therapy (I) as opposed to use
of supportive approaches such as oxygen therapy along with
maintenance of hand hygiene (C) to reduce the incidence of
CLABSI (O) among the adults within a period of eight
months(T)?
antibiotics such as ampicillin should be used as the first line
of antibiotic therapy to treat adult patients with CLABSI.
Also Vancomycin, Linezolid or daptomycin may be used in
serious cases where the CLABSI pathogens seem to be resistant
to ampicillin.
Antibiotics are type of medication that are used to treat
infections caused by wide rage of pathogens. Normally the type
of antibiotics given to patients largely depend on the kind of
bacterial found in the blood stream of the patient. For serious
infections, both antifungal and antibiotic medicine may be given
via PICC line to reduce the rate of infection.
6
Four Research Databases Used To Conduct Search
I used wide range of research databases to conduct search for
the clinical issues of my interest. These included;
Scopus: it’s the world's largest abstract and citation database.
MedlinePlus: this contains chapters and whole articles that use
@MCPHS option to locate whole test for incomplete chapters.
Cochrane Library (De Miranda Costa et al., 2020).
PubMed: provides medicine and science based publications.
By the help of the above mentioned research databases it was
much easy to collected numerous articles have been enriched
with content on the adult CLABSI along with its causes,
predisposing factors, diagnosis and treatment measures to be
used to effectively control such conditions. PubMed, Cochrane

Library, Scopus and Scopus are all better equipped in terms of
articles and chapters whose content provide more insights about
medicine and other healthcare related problems together with
possible remedies to such issues.
7
Levels Of Evidence In Each Of The Four Peer-reviewed Articles
Article #1: there was evidence acquired from a thorough
examination and evaluation of how compliance are healthcare
facilities based in the nursing practice that promote well -being
of patients suffering from central line bloodstream infections.
(level2)
Artcle#2: through various trails, the article determined the best
EBP approaches that could be utilized for quality improvement
to reduce CLABSI cases among children. (Level 3)
8
Levels Of Evidence In Each Of The Four Peer-reviewed Articles
Cont.….
Article#3: via randomized trials and systematic review of the
existing approaches, the article provided that EBP treatment
approaches need to deployed within a comprehensive
ambulatory cancer to promote better strategies that standardize
neurology practices for central line infections(level 1).
Article #4. systematic review and evaluation of the impacts of
existing national systems that promote patient health, well-
being and safety. (Level 4)
Strengths of using systematic review for clinical research is that
it provides scientists and other research with opportunity to

identify and select research database whose content reduce the
incidence of biased projection or results. This increases the
accuracy of data collected and perhaps provide reliable content
that is trusted, credible and therefore can be adopted for
implementation in a clinical setup.
9
References
Conley, S. (2016). Central line–associated bloodstream
infection prevention: Standardizing practice focused on
evidence-based guidelines. Clinical Journal of Oncology
Nursing, 20(1), 23-26. https://doi.org/10.1188/16.cjon.23-26
De Miranda Costa, M., Santana, H., Saturno Hernandez, P.,
Carvalho, A., & Da Silva Gama, Z. (2020). Results of a national
system-wide quality improvement initiative for the
implementation of evidence-based infection prevention
practices in Brazilian hospitals. Journal of Hospital
Infection, 105(1), 24-
34. https://doi.org/10.1016/j.jhin.2020.03.005
Steffens, E., Spriet, I., Van Eldere, J., & Schuermans, A.
(2019). Compliance with evidence-based guidelines for the
prevention of central line–associated bloodstream infections in
a Belgian home care setting: An observational study. American
Journal of Infection Control, 47(6), 723-
725. https://doi.org/10.1016/j.ajic.2018.10.019
Ting, J. Y., Goh, V. S., & Osiovich, H. (2013). Reduction of
central line-associated bloodstream infection rates in a neonatal
intensive care unit after implementation of a multidisciplinary
evidence-based quality improvement collaborative: A four-year
surveillance. Canadian Journal of Infectious Diseases and
Medical Microbiology, 24(4), 185-
190. https://doi.org/10.1155/2013/781690
10

Name:
Sumesh Rajbahak
Date:
Submission Date:
· This SafeWork NSW White Card is a prerequisite qualification
for this course.
· This study assignment is designed to assist learners to qualify
for the following competency: UEENEEE141A Use of routine
equipment/plant/technologies in an energy sector environment.
· This study assignment must be completed and submitted to
your teacher by the submission date specified. Commence and
complete this assignment as soon as possible to allow for
marking and any corrections required.
· After completing this study assignment, return it to your
TAFE Teacher for marking.
Contents
1Introduction to SafeWork NSW.4
2Risk Management.5
3Personal Protective Equipment.8
4Construction Work.9
5The Safe Wok Method Statement.10
Construction Site Access.15
Element 1: Prepare to use routine equipment, plant and
technologies.17
1.1: Instructions in the use of routine equipment, plant or
technologies are communicated and confirmed to ensure clear
understanding.17
1.2 OHS policies and procedures are communicated and
confirmed to ensure they are understood as they apply in the
carrying out of the work.20

1.3 Tools, equipment and personnel protective equipment
necessary for the work are identified, scheduled and checked to
ensure they work correctly as intended and are safe to use in
accordance with established procedures.20
1.4 Appropriate personnel are consulted to ensure the work is
coordinated effectively with others involved.21
1.5 Resources and materials needed to do the work are
confirmed, scheduled and obtained in accordance with
established procedures.22
1.6 Schedule of work including practices for working safely are
confirmed in accordance with instructions and requirements.23
Element 2: Use routine equipment, plant and technologies.28
2.1 OHS policies and procedures and safe work practices are
followed to eliminate or minimise incidents.28
2.2 Routine equipment, plant or technologies are used in
accordance with schedule of work to ensure work is completed
in an agreed time, to a quality standard and with a minimum of
waste.29
2.3 Further instructions are sought from appropriate personnel
in the event of unplanned happenings or conditions.29
2.4 Ongoing checks of work quality are undertaken in
accordance with instructions and requirements.30
Element 3: Complete use of routine equipment, plant and
technologies.30
3.1 Final checks are made to ensure the use of routine
equipment, plant or technologies conforms with instructions and
to requirements.30
3.2 Appropriate personnel are notified of completion of the
work using routine equipment, plant or technologies.31
3.3 Tools, equipment and any surplus resources and materials
are, where appropriate, cleaned, checked and returned to storage
in accordance with established procedures.31
3.4 Work area is cleaned up and made safe and sustainable
energy practices are followed.32
3.5 Appropriate records are updated in accordance with
instructions and established procedures.34

Introduction to SafeWork NSW.
SafeWork NSW is the NSW government body that focuses on
workplace safety.
Go to this web page: https://www.safework.nsw.gov.au/about-
us. Find the information required to complete the following
sentence by adding the missing words:
The Work health and safety roadmap for NSW 2022 (Roadmap)
is aimed at everyone to enable the continued reduction in ____
fatalities ___ and ____ serious injury ___ and ____illness ___
in NSW. It sets out agreed priorities to keep safety simple while
focusing on the important risks that will reduce harm.
Go to this web page:
https://www.safework.nsw.gov.au/__data/assets/pdf_file/0006/ 9
9123/whs-roadmap-revised-aug-2018-SW08067.pdf. Find the
information required to complete the following sentence by
adding the missing words:
NSW has met and exceeded the targets of a ____20% decline in
worker fatalities and a _____30% decline in both serious
injuries, illnesses and musculoskeletal injury and illness.
Accordingly, the Government has set more ambitious targets.
By 2022 NSW aims to achieve the following results: ???
What results? From the same web page, list the three target
areas that SafeWork NSW is focusing on for 2022. Also list the
goals set by SafeWork NSW:
1: _____ fatalities
2: ______serious illness and injuries
3: ______serious musculoskeletal injuries and illness

Go to this web page: https://www.safework.nsw.gov.au/legal-
obligations/legislation. Find the information required to
complete the following sentence by adding the missing words:
We administer, provide advice and monitor and enforce
______compliance____ with the Work Health and Safety ACT
act 2011____ and the Work Health and Safety
______2017____..
Risk Management.
https://legislation.nsw.gov.au/view/html/inforce/current/act-
2011-010#sec.47. What does the NSW WHS Act 2011 say
about the obligation of an employer (PCBU) to consult with
workers on WHS issues? Add the missing words to complete
the sentence:
The person conducting a business or undertaking must, so far as
is reasonably practicable, ____consult____, in accordance with
this Division and the regulations, with ____workers_____ who
carry out work for the business or undertaking who are, or are
likely to be, directly affected by a matter relating to work health
or safety.
https://www.safework.nsw.gov.au/__data/assets/pdf_file/0013/5
0071/Work-health-and-safety-consultation,-cooperation-and-
coordination-COP.pdf Refer to P.6 of this pdf to answer the
following question:
This duty to consult is based on the recognition that worker
input and participation improves _____decesion______-
_____making______ about health and safety matters and assists
in reducing work-related injuries and disease. The broad
definition of a ‘worker’ under the WHS Act means a PCBU

must consult with employees and anyone else who carries out
work for the business or undertaking. A PCBU must consult, so
far as is reasonably practicable, with ___contractors_____ and
____sub-contractors____ and their employees, on-hire workers,
outworkers, ___apprentices_______, ______trainees_____,
work experience __students_____, volunteers and other people
who are working for the PCBU and who are, or are likely to be,
directly affected by a health and safety matter.
Go to this web page: https://www.safework.nsw.gov.au/legal -
obligations/employer-business-obligations/managing-hazards-
and-risks. Study the info on this page then list the three steps
in Risk Management:
1: _________Identify hazards in the work
place_______________________________
2: _________Access the risk those hazards can
create__________________________
3: _________Eliminate or minimi ze those risk as much as
possible________________
46028/hierarchy-of-controls-SW09182.pdf. List the preferred
method to control hazards. Also list other methods if the
preferred method is not possible:
Hazard ___Control Measures_____ is the preferred method to
control hazards. If this preferred method is not possible, other
hazard control methods include:
1:
_______ADMINISTRATION_____________________________
____

2: _______ENGINEERING CONTROLS
___________________________
3: _______PERSONAL PROTECTIVE EQUIPMENTS
(PPE)_____________
If risks remain, the possible impact on people must be
controlled using ______PPE_____.
When engaging in Risk Management, it is wise to refer to the
Codes of Practice published by SafeWork NSW.
The RHS photo shows the cutting and chasing of a wall in
preparation for the installation of an electrical pipe and
electrical outlets.
Refer to the following web page and list all Codes of Practic e
that relate to this work activity:
https://www.safework.nsw.gov.au/resource-library/list-of-all-
codes-of-practice
1: ____Construction
work____________________________________
2: ____First aid in work
place_________________________________
3: ____Hazardous manual
task________________________________
4: ____Managing noise and preventing hearing
loss_______________
5: ____Managing electrical
risks_______________________________
6: ____How to manage work health and safety
risks_______________
7: ____Managing the risk of falls in housing
construction.___________
8: ____Managing then risk of plant in the work
place_______________
Download these Codes of Practice for future reference when

completing assignments.
This SafeWork NSW web page provides info on the Hierarchy
of Risk Control Measures:
46028/hierarchy-of-controls-SW09182.pdf.
Provide examples of the following:
Elimination:
Change working environment. Like instead of working at
heights we should move it to ground levels.
Engineering:
Using manhole lid seal breaker or using powered mechanism
instead of manual handling.
Substitution:
Using powered tools instead of manual tools.
Isolation:
Installing screens or barriers to hazardous area.
Administration:
Providing training. Team induction or toolbox meeting. Using
signages and warning signs.
PPE:
Mask, Hearing protection, safety boots, gloves and
Personal Protective Equipment.
The illustrations below represent some of the PPE items
commonly used by tradespeople including electricians.
In the table below, list the PPE items required to cut and chase

a wall as shown in previous illustrations. Also specify the
reason these PPE items are essential:
PPE ITEM:
REASON REQUIRED:
Gloves
Because of vibration
Hearing protection
Prevents for loud noise
Face shield
Prevents from bits and piece
Respiratory mask
Prevents from dust particles
Eye protection
Prevents from small bits
Construction Work.
Refer to this web page:
https://legislation.nsw.gov.au/view/html/inforce/current/sl-
2017-0404#ch.6. Use the info on this web page to fill in the
missing words:
Part 6.1 Preliminary: 289 Meaning of “construction work”.
(1) In this Chapter, construction work means any work carried
out in connection with the ___construction___,
_____alteration____, conversion, fitting-out, commissioning,
renovation, repair, maintenance, refurbishment, demolition,
decommissioning or dismantling of a _____structure___.

Go to this web page: https://www.safework.nsw.gov.au/your-
industry/construction/construction/general-requirements-
accordians/prepare-safe-work-method-statement. Use info on
this web page to fill in the missing words:
Take into account all relevant matters, including circumstances
that may affect the work and work health and safety
management plans that may be prepared in connection with a
construction project. If the SWMS is not followed, stop work
immediately and only recommence when the statement can be
followed. The SWMS must be understandable to those who use
it and should outline:
•the ____work_____ involved
•the _____hazards_________ and ______risk________
•the ___control___________ measures and how they will be
implemented, monitored and reviewed
Give a copy of the SWMS to the principal contractor before the
work commences. Keep a copy available for inspection and
readily accessible to workers until the work is completed, or for
at least two years if there is a notifiable incident. The SWMS
must be reviewed and, if necessary, revised when control
measures are changed after a notifiable incident.
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________

____________________________
_____________________________________________________
____________________________
The Safe Wok Method Statement.
A sample of the SafeWork NSW SWMS template appears below,
Note the Headings on each of the three columns:
All workers must read and sign Safe Work Method Statements.
This is a SafeWork NSW requirement:
Because work methods change (possibly with the introduction
of new technology) and because workers may wish to suggest
improved work or safety strategies, there is a need to review
SWMS’s. The above SafeWork NSW pdf emphasises this. Note
the extract below:
This SafeWork NSW pdf that introduces the SWMS also lists
the high risk construction work where the SWMS is mandatory.
Because the SWMS provides documented evidence of Risk
Management plans and the acknowledgement of all workers of
the steps required to work safely, many organisations mandate
the use of SWMS’s for other work activities not regarded as
high risk by SafeWork NSW. You therefore need to familiarise
yourself with SWMS’s and how to complete them.
SafeWork NSW penalties also encourage PCBU’s to implement
very effective safe systems of work and to document them. This
is another reason why PCBU’s may require workers to adhere to
SWMS’s. The current fine for a PCBU in breach of Sections 31
or 32 of the WHS Act extends to 3465 penalty units x $102.95
which equals $356,722. Fines against workers tent to be lower.
https://www.safework.nsw.gov.au/legal-
obligations/legislation/accordians/increases-to-penalty-
provisions-work-health-and-safety-amendment-review-act-2020-
schedule-2-consequential-amendments-to-the-whs-act

https://legislation.nsw.gov.au/view/html/inforce/current/act-
2011-010#sec.33
Scroll to Division 5 Offences and Penalties. Read Note 33 -
Category 3 Offences. Assume an individual worker (not a
PCBU) commits a Category 3 offence. How many Penalty Units
apply?
A person commits a Category 3 offence if:
(a) the person has a health and safety duty, and
(b) the person fails to comply with that duty.
Maximum penalty: (a) in the case of an offence committed by
an individual (other than as a person conducting a business or
undertaking or as an officer of a person conducting a business
or undertaking): _________ penalty units.
The 4 figure for a Penalty Unit was $100 but the NSW
Government has linked Penalty Units to the CPI and this will
cause an annual increase. Assume that a Penalty Unit is now
$$102.95. Multiply the number of Penalty Units by $$102.95 to
determine the fine for a Category 3 breach of the NSW WHS
Act.
____________________________________________________
The following page illustrates a SWMS designed to enable an
optical fibre cable to be safely terminated into a Fibre-
Breakout-Out-Tray (FOBOT). This worked example and the
MSDS info will help you to complete an SWMS exercise later
in this paper. It involves the use of cement. A few points when
preparing to write a SWMS:
· Start by noting the task steps in their correct sequence on a
separate sheet.
· Review docs such as Instruction Manuals, Codes of Practice
and MSDS Sheets etc to ensure you identify all possible
hazards.

· Before you complete the SWMS exercise (that involves the use
of cement) later in this paper, read this:
https://www.safework.nsw.gov.au/resource-library/hazardous-
chemicals/crystalline-silica/crystalline-silica-general-fact-sheet
A blank SWMS Sheet appears on the next page. To familiarise
yourself with the SWMS, complete this sheet to provide a Step-
by-Step process to enable fencing wire entangled around a
lawnmower cutting disk to be safely removed.
MSDS Sheets.
After an electrician fixes the electrical pipe and wall boxes into
the chased wall, your task is to mix mortar using sand and
cement to grout the cavity around the pipe. You must produce
an effective SWMS before commencing this activity. Before
using any substances, you must obtain the Material Safety Data
Sheet (MSDS) from its manufacturer for each substance that
you will use. To perform this activity, you will need to study
the MSDS for cement. This MSDS can be found here:
https://www.cementaustralia.com.au/sites/default/files/2018-
07/CASDS23%2BConcrete%2BMi x.pdf
https://www.ohsrep.org.au/silica_e6w4qije5l8wpqjctec0iw
Also consider the Hierarchy of Risk Controls. Refresh your
memory:
46028/hierarchy-of-controls-SW09182.pdf.
A number of sections in MSDS contain critical information that
needs to be included in our SWMS’s. Study this MSDS sheet
located at the web page above to complete the table below.
MSDS SHEET SECTION No:
SECTION HEADING.
1
Identification of the Material and Supplier.
2

3
4
5
6
7
8
9
10
11
Now list the Section No’s that contain critical info that needs to
be included in a SWMS to be used before grouting around the
pipe that you chased into the wall:
Keep all of this info for the future SWMS.

Construction Site Access.
Construction Projects must be controlled by a Principle
Contractor. Refer to this pdf to answer the following questions:
2151/Construction-work-COP.pdf
What is Construction work? Give a brief description:
____According to the WHS Regulation any work carried out in
connection with the construction, alteration, fitting out,
commissioning , renovation, repair, maintenance , and
refrubrishment, demolition, decommissioning or dismantli ng of
structure. It can be commercial, civil or housing
___
What is Construction Project? Give a brief description:
_____A construction project is the project that involves
construction work where the cost of construction works
$250,000 or more. A construction project covers the activities
in volved in the construction work over the point where the
construction project is handed over to the person who
commissioned it. The handover usually takes place at the
practical completion of the project, for example when the house
is considered habitable and the buyer or owner takes possession
______
When is a Principle Contractor required?
_______Each time when we get construction project Principle
Contractor is required. And there can be only one principle
contractor for each construction project.
_____________________________________________________
_____________________
The Principle Contractor has significant WHS obligations.
Refer to the Construction Work COP and find the relevant
paragraph to fill in the missing words:

Although a principal contractor or builder may not be present
on site, they must still ensure
the work is being carried out __safely____. The principal
contractor or builder should check the
subcontractor’s __work ____ _procedure___ and any
__SWMS____ (if relevant) to ensure risks associated with the
work are addressed and then __visit__ the site as necessary to
verify the work is being carried out __safely__. In every case,
individuals are expected to take reasonable _care__ for their
own __safety___ and that their acts do not adversely affect the
health and safety of others.
When a worker arrives at a Construction Site seeking access to
perform work, it is typical to be met by a person in charge of
site security who will direct the worker to the site
administration office where qualifications and accreditations
will be checked. Workers will require three different WHS
qualifications before they are granted access to the construction
site. One essential qualification required before enteri ng a
construction site is the White Card more correctly known as
General Construction Induction qualification. What are the
other two qualifications required? Refer to this web page pdf to
identify them and their purpose and complete the table below:
https://www.safeworkaustralia.gov.au/system/files/documents/1
703/information-sheet-work-induction-for-construction.pdf
Qualification
Related Knowledge and Skills.
White Card
White Card training provides workers with information relating
to general WHS issues. The need for WHS. Risk Management.
How to complete a SWMS. etc.

_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
Element 1: Prepare to use routine equipment, plant and
technologies.
You are studying to obtain the competency relating to Code
UEENEEE141A. The title for this code is:
Use of routine equipment/plant/technologies in an energy sector
environment. When you researched the topic of Codes of

Practice above you would have discovered and downloaded the
following pdf:
2156/Managing-the-risks-of-plant-in-the-workplace-COP.pdf
Note that the word plant appears in both the title for the
UEENEEE141A competency and also in the Code of Practice.
What is meant by the word plant? Refer to p. 5 in the code.
You will see Clause 1.1. Here’s an extract:
Note that Power Tools are included as plant. Electricians use
many electrical tools on a daily basis. These tools are capable
of causing severe injuries if misused. Misuse includes the use
of tools contrary to Manufacture’s Instructions or contrary to
accepted safe practices within the industry. The removal of a
safety guard is certainly an unsafe practice. The failure to wear
the required Personal Protective Equipment (PPE) is also an
unsafe practice. Using a power saw or an angle grinder in a
single handed manner is also unsafe. These are a few examples
that must be considered when formulating the WHS policies to
be enforced in the workplace.
1.1: Instructions in the use of routine equipment, plant or
technologies are communicated and confirmed to ensure clear
understanding.
Assume that you are a Licensed Electrical Contractor and that
you have just employed an apprentice. In this instance,
SafeWork NSW will no doubt regard you as the PCBU. You are
about to issue a work task to your apprentice. But before you
do, you need to ensure that your apprentice has been fully
trained to the extent that this person is able to perform the work
safely and this means without causing any injury. The task to
be completed includes the use of a hammer drill to chisel out
concrete between two cuts in a concrete wall. Refer to the RHS
photo:

What checks will you make to ensure that this hammer drill is
safe to use?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
When you check power tools to ensure that they are safe to use,
don’t forget to check that they have been tested and tagged to
meet SafeWork NSW standards: Study this web page to answer
the following question:
https://www.safework.nsw.gov.au/hazards-a-z/electrical-and-
power/electrical-inspection-and-testing
Who is permitted by SafeWork NSW to test and tag electrical
equipment for use on work sites including construction sites?
_____________________________________________________
____________________________
_____________________________________________________
____________________________
The photo below shows the use of a hammer drill on a
construction site and this means that the tool must be tested and
tagged every month. After an electrical tool passes the required
safety test, it is tagged with a colour coded tag. The chart
below shows the tag colours used in NSW:
Where will you obtain instructions for the safe use of the
hammer drill illustrated in the photo?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________

How will you ensure that your apprentice is able to check that
this power tool is safe to use and has the ability to use this tool
safely?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
What PPE must be used when using this hammer drill to chisel
out concrete as illustrated?
Anti-vibration gloves, safety glasses/face shield, hearing
protection, head protection, respiratory mask, safety boots,
_____________________________________________________
_______________________
_____________________________________________________
_______________________
Study the Makita Demolition Hammer User Manual supplied.
List all of the safe work practices and methods that must be
used with this tool and that you will teach to your apprentice.
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
Visit the SafeWork NSW web site that lists Codes of Practice
and list the Codes of Practice that relate to this work activity.
_____________________________________________________
_______________________
_____________________________________________________
_______________________

_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________1.2 OHS policies and procedures
are communicated and confirmed to ensure they are understood
as they apply in the carrying out of the work.
How will you gather evidence of your apprentice’s ability to use
tools safely?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
After you have educated your apprentice, ensuring that they
have the skills required, how will you record the fact that they
have acquired the skills required to use a hammer drill safely?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
1.3 Tools, equipment and personnel protective equipment
necessary for the work are identified, scheduled and checked to
ensure they work correctly as intended and are safe to use in
accordance with established procedures.
What PPE will you issue to your apprentice to enable the work

to be performed safely?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
How will you ensure that your apprentice is caring for their PPE
and that it is in good working order? How will you record store
this data? Paper records? Video evidence? Other?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
How will you ensure that your apprentice is adhering to the
safety standards, policies and rules?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
The use of this hammer drill will produce noise. Neighbouring
offices house workers. How will this impact upon your
scheduling of this work task? Visit the EPA and LGA web sites
and document laws relating to noise pollution regulations:
_____________________________________________________
_______________________
_____________________________________________________
_______________________
Apart from the hammer drill and PPE, what other tools and
equipment might be required to complete this task? Include
tools required to finish off the work to an acceptable standard.
_____________________________________________________

_______________________
_____________________________________________________
_______________________
1.4 Appropriate personnel are consulted to ensure the work is
coordinated effectively with others involved.
Looking at the RHS photo and focusing on the type of tool in
use, what service needs to be available at this construction site
to enable the tool to be used?
______________________________________
This worker is a labourer. To ensure effective Project
Management, what trade will follow after this job is complete?
And what steps will you take to ensure timely progress?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________1.5 Resources and materials needed
to do the work are confirmed, scheduled and obtained in
accordance with established procedures.
Looking at the photo above that illustrates the cutting and
chasing of a wall, make a full list of tools, PPE and material
required by this worker to complete the task:
Tools.

Reason Required.
Broom
To remove debris, restoring work site to a clean state.
Demolition hammer
For cutting chase in a wall.
Shovel
To dig through through the rock- filled dirt.
Masonry trowel
To place cement mortar.
Chisel
To remove the settled mortar from the wall.
PPE.
Reason Required.
Safety Footwear.
To protect feet if tool is dropped our debris falls.
Anti-vibration gloves
To protect your hands for any vibration syndrome.
Face shield
To prevent the hammered objects struck back to your face.
Hearing protection.
To protect your ears from load and continuous noise.
Head protection.
To protect your head from falling objects.
In the table below, list all materials required to complete the job
illustrated in the photo. Also assume that this worker is
supervised by an electrician. After cutting and chasing the
wall, what are the next logical steps and what materials will be
required to complete them?
Materials.
Reason Required.
Orange conduit.
To house power cables.
wires

1.6 Schedule of work including practices for working safely are
confirmed in accordance with instructions and requirements.
Assume that you are the supervisor organising for this cutting
and chasing work to be completed. The work is at an industrial
complex to be constructed of precast concrete walls. Refer to
the following pdf and search for info on Cutting and Chasing
precast concrete walls.
https://www.ccaa.com.au/imis_prod/documents/Library%20Doc
uments/CCAA%20Technical%20Publications/CCAA%20Guides/
CCAAGUIDE2001-T54-CPH5-9-TBR.pdf
What does this pdf state relating to Cutting and Chasing precast
concrete walls?
_____________________________________________________
____________________________
_____________________________________________________
____________________________
Given that this pdf appears to have no name or date or claim to
authority, what document will you access to verify the CCAA
extract above and to ensure adherence to Australian Law? Fill
in the missing word to answer this question: The ___________
Code of Australia. Refer to the following:
https://www.sa.gov.au/topics/planning-and-property/land-and-
property-development/building-rules-regulations-and-
information/the-building-code-of-australia
Now answer the following questions:
Who will you need to liaise with to enable this work to
proceed?

_____________________________________________________
_______________________
_____________________________________________________
_______________________
What essential work activities must be completed before
arranging for the walls to be cut and chased for power pipe and
cabling?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
What tools and materials need to be gathered for issue to the
worker who completes this task?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
Assume you are undertaking the task and your electrician /
supervisor instructs you to complete the Risk Management
activity required for the task of rendering over the pipe after it
has been chased into the wall. L:ist the three Risk Management
steps:
1:
_____________________________________________________
_________________________
2:
_____________________________________________________
_________________________
3:
_____________________________________________________
_________________________
Before commencing the work, what action will you take if you

encounter unclear work tasks?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
What action will you take if you discover hazards that are
beyond your control? Eg: Assume that the channel extends up
a wall to a height of 3m. Address this and all other possible
hazards.
_____________________________________________________
_____________________________
_____________________________________________________
_____________________________
You previously studied an MSDS Sheet for cement power. You
have adhered to your electrician / supervisor’s instructions to
fix the AS/NZS3000 specified pipe into the wall to the correct
depth etc. You are now required to complete a SWMS that is
capable of keeping you safe as you mix mortar and grout around
the pipe fixed into the channel in the concrete wall.
Use the blank SWMS on the following page to complete this
exercise. There is a spare SWMS on Page 22 in case extra room
is required. Also feel free to construct you’re a replica SWMS
using a spreadsheet if you’d prefer to avoid hand writing.
Think carefully about this exercise to ensure that you are able to
perform the work safely. For example, omitting PPE mandated
on an MSDS Sheet would be difficult to explain if a supervisor
or an Inspector dropped unannounced and started asking
questions. Your SWMS must be capable of keeping all workers
safe. SafeWork NSW Inspectors might use an injured worker as
evidence of an unsatisfactory SWMS or Risk Management
activity or WHS Management Plan.
_____________________________________________________

____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
Think about the task of mixing concrete and working from
ground level to a height of 3m to grout around the pipe. Study
the information on this web page:
https://www.service.nsw.gov.au/transaction/apply-high-risk-
work-licence
Now describe how SafeWork NSW legislation will impact upon
the use of specialist equipment to complete this job:
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
What steps might the supervisor take to enable the worker to
complete this grouting work, taking into consideration the
specialised equipment that will be required to complete this
task, and the fact that staff may not possess the licence required
to operate this equipment? Also list possible options open to
the supervisor:
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________

____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
Having considered all of these issues, now produce a SWMS
that will enable staff to grout around a pipe into a channel
chased into a masonry wall from 1400mm above floor height to
the top of the wall at a height of 3m. Remember - use the extra
SWMS blank is if extra lines are required.
Element 2: Use routine equipment, plant and technologies.
2.1 OHS policies and procedures and safe work practices are
followed to eliminate or minimise incidents.
Assume that you are the experienced worker on this job site and
that you are supervising two workers with very little work
experience. They have their White Cards and they have been
trained in the required work procedures including the safe use
of tools to be used. Explain how you will monitor and
document compliance to WHS rules and your process to escalate

your intervention if workers fail to comply:
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
When the apprentice attempts the work task for the first time
(and maybe a time or two after that). what level of supervision
will you provide to ensure the work is performed in a safe
manner?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
Before the apprentice commences work, what safety document
must be studied and signed?
_____________________________________________________
_______________________
Your apprentice might encounter a situation not listed on the
SWMS. What policy will you insist upon in such a
circumstance?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
After your apprentice has demonstrated an acceptable
competency level, how will you ensure that they are adhering to
the SWMS and other safety policies?
_____________________________________________________
_______________________
_____________________________________________________

_______________________2.2 Routine equipment, plant or
technologies are used in accordance with schedule of work to
ensure work is completed in an agreed time, to a quality
standard and with a minimum of waste.
Assume that your job is small. The length of the cut and chase
is 1.5m. What common tools could be used? And what
consumables are required?
_____________________________________________________
____________________________
_____________________________________________________
____________________________
Now assume multiple cut and chase locations throughout a
factory complex. What specialist equipment might be used to
aid in the timely completion of the job and to meet Project
Management Milestones? This web page should help:
https://www.totaltools.com.au/136987-makita-2-piece-vacuum-
cleaner-dust-extractor-wall-chaser-kit-sg1251jvc30m
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
2.3 Further instructions are sought from appropriate personnel
in the event of unplanned happenings or conditions.
To assist workers on the job, make a list of possible unplanned
happenings and the appropriate personnel to be contacted for
each event. Some info is provided to assist. Complete the
table:

Event
You must contact:
All Unplanned events:
Your Supervisor at Cut & Chase Co.
Medical Emergency:
2.4 Ongoing checks of work quality are undertaken in
accordance with instructions and requirements.
Assume that you are the supervisor. Construct a Check Sheet to
be used when you visit the workers to ensure the quality of their
work and that they are working safely.
Work
Activity
Quality
OK?
Safety
OK
Comments:
(Add info that indicates OK or not OK)

Element 3: Complete use of routine equipment, plant and
technologies.
3.1 Final checks are made to ensure the use of routine
equipment, plant or technologies conforms with instructions and
to requirements.
When apprentices complete jobs, how will they measure their
work to ensure it meets the requirements of Cut & Chase Co and
the customer?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
_____________________________________________________
_______________________3.2 Appropriate personnel are
notified of completion of the work using routine equipment,
plant or technologies.
When you inspect the completed work task, what will you check
to ensure that the work is fit for purpose? And what actions
need to be taken to finish the job to a professional standard?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
When the walls are cut and chased to customer requirements,
and pipes are fixed in the channels with the assistance of a
supervising electrician, what documentation needs to be
submitted?
_____________________________________________________
_______________________

_____________________________________________________
_______________________
_____________________________________________________
_______________________
3.3 Tools, equipment and any surplus resources and materials
are, where appropriate, cleaned, checked and returned to storage
in accordance with established procedures.
List the power tools used on this job and the basic service /
cleaning activity required before they are packed away in their
cases and returned to the Cut & Chase Co store:
Tool
Servicing Requirements:
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________3.4 Work area is cleaned up
and made safe and sustainable energy practices are followed.
List the equipment to be used to clean up the work site after
cutting and chasing activities.

_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
List all hazards associated with the clean-up activities.
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
List the PPE required to complete the clean-up activities.
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
Refer to the Hierarchy of Risk Control, listing alternatives from
this hierarchy to safely control hazards as you clean up the work
site.
_____________________________________________________
____________________________
_____________________________________________________
____________________________
_____________________________________________________
____________________________
Create a SWMS to identify the task steps involved in work area
clean-up, associated hazards and control measures required.
The SWMS sheet appears on the following page:

3.5 Appropriate records are updated in accordance with
instructions and established procedures.
The illustration below represents the location of the office desk
in the factory unit requiring two power outlets (one at each end
of the desk) and at a height of 900mm above the floor to
provide easy access. Given that these pipes will be totally
concealed after rendering, complete the diagram below to
accurately identify the location of pipes. Include ALL
measurements. Include the Factory Unit No and the direction
that the wall is facing (N, E, S or W).
There may be a need to access the concealed pipe in the future,
perhaps for the purpose of repair or to remove a blockage.
After completing the job, who will receive copies of this plan
from you?
_____________________________________________________
_______________________
_____________________________________________________
_______________________
2
Running Head: ESSENTIALS OF EVIDENCE-BASED
PRACTICE
1
ESSENTIALS OF EVIDENCE-BASED PRACTICE
2
Essentials of Evidence-Based Practice
Francis Mercado

Dr. Linda Johanson
Matrix Worksheet Template
Use this document to complete Part 2 of the Module 2
Assessment, Evidence-Based Project, Part 1: An Introduction to
Clinical Inquiry and Part 2: Research Methodologies
Full citation of the selected article
Article #1
Article #2
Article #3
Article #4
prevention of central line-associated bloodstream infections in a
Belgian home care setting: An observational study. American
190. https://doi.org/10.1155/2013/781690
Conley, S. (2016). Central line-associated bloodstream infection
prevention: Standardizing practice focused on evidence-based
guidelines. Clinical Journal of Oncology Nursing, 20(1), 23-
26. https://doi.org/10.1188/16.cjon.23-26

Why you chose this article and/or how it relates to the clinical
issue of interest (include a brief explanation of the ethics of
research related to your clinical issue of interest)
I chose this article because the study focused on assessing
compliance of healthcare organizations with an acceptable
practice that is recommended for the prevention of central line -
related bloodstream infection. The study was ethical and
perhaps much concerned about community health services
The article was chosen because its research was aimed at
collecting the data about the use of central venous catheters as a
lifesaving treatment approach and perhaps find better
approaches that could be deployed to reduce infections
associated with a central line-associated bloodstream illness
(Ting et al., 2013).
The selection of this article was based on its content that
addressed a case study whereby healthcare professionals were
observed during CVC care. It can be concluded that since its
primary content was based on the patient interviews (Conley,
2016).
I chose this article because its study aimed at analyzing the
impacts of national system-wide QI that was initiated to
promote HCAI prevention. The study was ethical and result-
oriented (Dumpa et al., 2019).
Brief description of the aims of the research of each peer -
reviewed article
The research majorly aimed to evaluate how compliance are
healthcare organizations with respect to care practice that helps
promote the well-being of patients suffering from central line
related blood illness (Steffens et al., 2019).
The article aimed at identifying EBP strategies that can be
implemented to for quality improvement to minimize the
incidence associated with neonatal CLABSI
The study aimed at determining EBP approaches that could be
implemented within a comprehensive ambulatory cancer to help
in standardization of neurology practices for central lines
The researchers of the article intended to assess the effects of

national systems that deploy to promote patient safety
Brief description of the research methodology used Be sure to
identify if the methodology used was qualitative, quantitative,
or a mixed-methods approach. Be specific.
The authors used interviews along with questionnaires to assess
the compliance of home care nurses with a good practice that
could help prevent central line-associated bloodstream diseases
and other infections (Steffens et al., 2019).
This was a qualitative approach
During the study, the researcher applied a retrospective
observational technique to enable be able to a comparison of
CLABSI in neonates that had been admitted to level three NICU
between 2007 and 2011. This was to facilitate the assessment of
the trend across the years selected. It was quantitative research.
The author deployed a wide range of research methodologies in
which case the nurses were given two types of tests that
included post and pre-tests (Conley, 2016). As for the patients
they were interviewed and this generated qualitative outcomes
after which the nurses were audited while undertaking CVC care
upon exposure to education.
The study utilized well-designed before and after Quasi-
experiments that targeted over 1869 hospitals. the study
employed a quantitative research technique. The result
indicated that utilization of system-wide interventions for the
patient had an appositive impact in promoting
A brief description of the strengths of each of the research
methodologies used, including reliability and validity of how
the methodology was applied in each of the peer-reviewed
articles you selected.
The approach used by the authors give their study strength of
conducting one-on-one interviews that facilitate effectiveness
and reliability of the data collected
The major strengths of this research are that it applied Do-

Study-Act cycles (PDSA). This method of study often generates
desired and reliable outcomes (Ting et al., 2013).
Monthly peer-peer audits were one of the strengths of this
article. Unlike clinical nurses, special audits peer-to-peer audits
provide reliable results. The only weaknesses of the study are
that patients’ interviews were subjective and this could reduce
the study’s reliability.
The strength of this article can be attributed with its efforts to
reach out to more than 26 states during the research as this
increases the accuracy of the results obtained. The assessment
of HCAI prevents indicated a great improvement through the
strategies deployed nationally and in the states (Dumpa et al.,
2019).
General Notes/Comments
The need for home care is on-demand, it is, therefore, necessary
to assess how homecare nurses are prepared in terms of
standardized and recommended good practices that could help
reduce impacts of central line-associated bloodstream infections
(Steffens et al., 2019).
Findings indicated that multidisciplinary EBP and collaboration
often result in a significant reduction in CLABSI (Ting et al.,
2013).
Implementation of EBP policies that are standardized can help
improve patient outcomes (Conley, 2016).
The assessment and evaluation of HCAI prevention provided
insights on how maintenance of hand hygiene by the nurse and
other care providers could serve as the primary intervention.
References
Conley, S. (2016). Central line-associated bloodstream infection
prevention: Standardizing practice focused on evidence-based
guidelines. Clinical Journal of Oncology Nursing, 20(1), 23-
26. https://doi.org/10.1188/16.cjon.23-26

prevention of central line-associated bloodstream infections in a
Belgian home care setting: An observational study. American
190. https://doi.org/10.1155/2013/781690
© 2018 Laureate Education Inc.
2
Evaluation Table
Use this document to complete the evaluation table requirement
of the Module 4 Assessment,Evidence-Based Project, Part 4A:
Critical Appraisal of Research
Full APA formatted citation of selected article.
Article #1
Article #2
Article #3
Article #4

Evidence Level *
(I, II, or III)
Conceptual Framework
Describe the theoretical basis for the study (If there is not one
mentioned in the article, say that here).**
Design/Method
Describe the design and how the study was carried out (In
detail, including inclusion/exclusion criteria).
Sample/Setting
The number and characteristics of
patients, attrition rate, etc.
Major Variables Studied

List and define dependent and independent variables
Measurement
Identify primary statistics used to answer clinical questions
(You need to list the actual tests done).
Data Analysis Statistical or
Qualitative findings
(You need to enter the actual numbers determined by the
statistical tests or qualitative data).
Findings and Recommendations
General findings and recommendations of the research
Appraisal and Study Quality
Describe the general worth of this research to practice.
What are the strengths and limitations of study?
What are the risks associated with implementation of the
suggested practices or processes detailed in the research?
What is the feasibility of use in your practice?

Key findings
Outcomes
General Notes/Comments
*These levels are from the Johns Hopkins Nursing Evidence-
Based Practice: Evidence Level and Quality Guide
· Level I
Experimental, randomized controlled trial (RCT), systematic
review RTCs with or without meta-analysis
· Level II
Quasi-experimental studies, systematic review of a combination
of RCTs and quasi-experimental studies, or quasi-experimental
studies only, with or without meta-analysis
· Level III
Nonexperimental, systematic review of RCTs, quasi-
experimental with/without meta-analysis, qualitative,

qualitative systematic review with/without meta-synthesis
· Level IV
Respected authorities’ opinions, nationally recognized expert
committee/consensus panel reports based on scientific evidence
· Level V
Literature reviews, quality improvement, program evaluation,
financial evaluation, case reports, nationally recognized
expert(s) opinion based on experiential evidence
**Note on Conceptual Framework
· The following information is from Walden academic guides
which helps explain conceptual frameworks and the reasons
they are used in research. Here is the link
https://academicguides.waldenu.edu/library/conceptualframewor
k
· Researchers create theoretical and conceptual frameworks that
include a philosophical and methodological model to help
design their work. A formal theory provides context for the
outcome of the events conducted in the research. The data
collection and analysis are also based on the theoretical and
conceptual framework.
· As stated by Grant and Osanloo (2014), “Without a theoretical
framework, the structure and vision for a study is unclear, much
like a house that cannot be constructed without a blueprint. By
contrast, a research plan that contains a theoretical framework
allows the dissertation study to be strong and structured with an
organized flow from one chapter to the next.”
· Theoretical and conceptual frameworks provide evidence of
academic standards and procedure. They also offer an

explanation of why the study is pertinent and how the
researcher expects to fill the gap in the literature.
· Literature does not always clearly delineate between a
theoretical or conceptual framework. With that being said, there
are slight differences between the two.
References
The Johns Hopkins Hospital/Johns Hopkins University (n.d.).
Johns Hopkins nursing dvidence-based practice: appendix C:
evidence level and quality guide. Retrieved October 23, 2019
from https://www.hopkinsmedicine.org/evidence-based-
practice/_docs/appendix_c_evidence_level_quality_guide.pdf
Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and
Integrating a Theoretical Framework in Dissertation Research:
Creating the Blueprint for Your" House". Administrative Issues
Journal: Education, Practice, and Research, 4(2), 12-26.
Walden University Academic Guides (n.d.). Conceptual &
theoretical frameworks overview. Retrieved October 23, 2019
from
https://academicguides.waldenu.edu/library/conceptualframewor
k
Critical Appraisal Tool Worksheet Template
© 2018 Laureate Education Inc.
2

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