Johns Hopkins Nursing Evidence-Based Practice Appendix G: Individual Evidence Summary Tool Johns Hopkins Nursing Evidence-Based Practice Appendix G: Individual Evidence Summary Tool EBP Question: What are the barriers and importance of adherence to performing aseptic technique to decrease hospital acquired infections (HAIs) for medical-surgical nurses in an ER setting? Article # Author & Date Evidence Type Sample, Sample Size & Setting Study findings that help answer the EBP question Limitations Evidence Level & Quality 1 Concha-Rogazy, 2016 Systematic review 12 scientific articles □ N/A -low risk of infection (<5%) when aseptic technique used for derm procedures -iodine for broad spectrum of action against bacteria -rise in costs when infections occur and antibiotics needed to prevent infection Selection bias of articles used Level one, B 2 Tambe, 2019 Case Report 20 nurses in a Regional hospital in Cameroon □ N/A -patient financial barriers and inadequate supply of sterile equipment/dressings are barriers to adherence -using proper technique lowers risk of infection - nurses are knowledgeable in proper technique but a small few still do not follow it -Small sample size -No competing interests Level five, A 3 Lin, 2019 Qualitative 72 registered nurses in 28‐bed general surgical ward of a tertiary hospital in Australia □ N/A The facilitators of adherence to aseptic guidelines in a clinical setting: 1) awareness of the importance and effects of surgical site infections, 2) hospital online modules on aseptic technique, and 3) hospital-wide program on handwashing adherence The barriers of adherence to aseptic guidelines in a clinical setting: 1) nurses were unaware of the setting to use aseptic technique and 2) when to use clean vs. sterile gloves Social desirability bias in a single research with a limited sample size Level three, A 4 Towell, 2020 Qualitative 38 registered nurses in an emergency department (ED) in a tertiary hospital in Australia □ N/A The influences of engagement towards standardizing aseptic technique in a clinical setting found were: 1) motivation from self-autonomy, 2) relationships fueled by support and/or peer pressure, 3) education content & delivery, and 4) management directive which promoted direction Single research project with a small sample size Level three, A 5 Mohsen, 2020 Qualitative 450 registered nurses, Shebin ElKoom University Hospital □ N/A 1) The hospitals need to conduct education and training programs to enhance knowledge of SSI prevention to improve the quality of nursing care in this area. 2) Improve compliance with the surgical site infection prevention guidelines through comprehensively modified and updated nursing curriculum to include the prevention of surgical site infection. 3) Education and training program should be conducted to improve nurses’ knowledge and practice i ...

1. Johns Hopkins Nursing Evidence-Based Practice Appendix G:
Individual Evidence Summary Tool
Johns Hopkins Nursing Evidence-Based Practice Appendix G:
Individual Evidence Summary Tool
EBP Question: What are the barriers and importance of
adherence to performing aseptic technique to decrease hospital
acquired infections (HAIs) for medical-surgical nurses in an ER
setting?
Article #
Author & Date
Evidence
Type
Sample, Sample
Size & Setting
Study findings that help answer the EBP
question
Limitations
Evidence Level & Quality
1
Concha-Rogazy, 2016
Systematic
review
12 scientific articles

2. □ N/A
-low risk of infection (<5%) when aseptic technique used for
derm procedures
-iodine for broad spectrum of action against bacteria
-rise in costs when infections occur and antibiotics needed
to prevent infection
Selection bias
of articles used
Level one, B
2
Tambe, 2019
Case Report
20 nurses in a
Regional hospital in
Cameroon
□ N/A
-patient financial barriers and inadequate supply of sterile
equipment/dressings are barriers to adherence
-using proper technique lowers risk of infection
- nurses are knowledgeable in proper technique but a small few
still do not follow it
-Small sample size
-No competing
interests
Level five, A
3
Lin, 2019

3. Qualitative
72 registered
nurses in 28‐ bed
general surgical
ward of a tertiary
hospital in Australia
□ N/A
The facilitators of adherence to aseptic guidelines in a clinical
setting:
1) awareness of the importance and effects of surgical site
infections, 2) hospital online modules on aseptic technique, and
3) hospital-wide program on handwashing adherence
The barriers of adherence to aseptic guidelines in a
clinical setting: 1) nurses were unaware of the setting to use
aseptic
technique and 2) when to use clean vs. sterile gloves
Social desirability bias in a single research with a limited
sample size
Level three, A
4
Towell, 2020
Qualitative
38 registered
nurses in an
emergency
department (ED) in
a tertiary hospital in
Australia
□ N/A
The influences of engagement towards standardizing aseptic
technique in a clinical setting found were: 1)

4. motivation from self-autonomy, 2) relationships fueled by
support and/or peer pressure, 3) education content & delivery,
and 4) management directive which promoted
direction
Single research project with a small sample size
Level three, A
5
Mohsen, 2020
Qualitative
450 registered nurses, Shebin ElKoom University
Hospital
□ N/A
1) The hospitals need to conduct education and training
programs to enhance knowledge of SSI prevention to improve
the quality of nursing care in this area.
2) Improve compliance with the surgical site infection
prevention guidelines through comprehensively modified
and updated nursing curriculum to include the prevention of
surgical site infection.
3) Education and training program should be conducted to
improve nurses’ knowledge and practice in some areas using
evidence-based practice.
Self-reported measures in a single research
Level four, A
6
Suvikas-Peltonen, 2017
Systematic
Review
26 PubMed

5. studies/articles
□ N/A
1) Incorrect practices led to increased contamination.
2) Aseptic skill level and environment hindered or encouraged
technique.
3) Lack of preparation and time lead to more infections.
A single search engine, a bias in selection
Level three, A
7
Clare, 2018
Mixed methods: Quantitative
And Qualitative
49 Registered Healthcare
Professionals in 2 hospital clinical settings
□ N/A
Barriers to following aseptic techniques:
-various and confusing definitions in literature leading to
practice variability, inadequate risk assessment, and
uncontrolled standards of practice
Establish adherence of aseptic technique through:
-improving staff understanding/competency (use of
common practice language and proper training)
-improve staff perceptions on their clinical practice

6. -use evidence based data to target education and training
areas
There was no randomization in the sample.
Level two, A
8
Johnson, 2018
Case Study
1 hospital in
Northern California
□ N/A
An interprofessional team decreased HAIs in a hospital by
focusing on cost-avoidance efforts, root causes, and sustainment
of improvement.
-evidenced based research is integrated into all policies
-each common HAI that occurs, is closely examined (cause and
effect), and then shared with all staff members
-team engages staff in idea sharing to improve
interventions for each case of infection, improves accountability
Importance of adherence: HAI cause patient safety,
ethical, regulatory, financial, and legal risk
It's possible that a single case study can't be applied to a
broader population.
Level five, A
References

7. Clare, S., & Rowley, S. (2018). Implementing the Aseptic Non
Touch Technique (ANTT®) clinical practice framework for
aseptic technique: A pragmatic evaluation using a mixed
methods approach in two London hospitals. Journal of Infection
Prevention, 19(1), 6–15. https://doi-
org.roseman.idm.oclc.org/10.1177/1757177417720996
Concha-Rogazy, Marcela, Andrighetti-Ferrada, Catalina, &
Curi-Tuma, Maximiliano. (2016). Aseptic techniques for minor
surgical procedures. Revista médica de Chile, 144(8), 1038-
1043. https://dx.doi.org/10.4067/S0034-98872016000800011
Johnson, S. (2018). A case study of organizational risk on
hospital-acquired infections. Nursing Economics, 36(3), 128–
135. Retrieved from
https://search.ebscohost.com/login.aspx?direct=true&db=aph&A
N=130397389&site=eds-live
Lin, F., Gillespie, B. M., Chaboyer, W., Li, Y., Whitelock, K.,
Morley, N., Marshall, A. P. (2019). Preventing surgical site
infections: Facilitators and barriers to nurses’ adherence to
clinical practice guidelines—A qualitative study. Journal of
Clinical Nursing, 28(9/10), 1643-1652. https://doi-
org.roseman.idm.oclc.org/10.1111/jocn.14766
Mohsen, M. , Riad, N. and Badawy, A. (2020). Compliance and
barriers facing nurses with surgical site infection prevention
guidelines. Open Journal of Nursing, 10, 15-33. doi:
10.4236/ojn.2020.101002
Suvikas-Peltonen, E., Hakoinen, S., Celikkayalar, E.,
Laaksonen, R., & Airaksinen, M. (2017). Incorrect aseptic
techniques in medicine preparation and recommendations for
safer practices: A systematic review. European Journal of
Hospital Pharmacy: Science & Practice, 24(3), 175–181.
https://doi-org.roseman.idm.oclc.org/10.1136/ejhpharm-2016-
001015
Tambe TA, Nkfusai NC, Nsai FS, Cumber SN. (2019).
Challenges faced by nurses in implementing aseptic techniques
at the surgical wards of the Bamenda Regional Hospital,
Cameroon. Pan Afr Med J. 2019;33:105. Published 2019 Jun 12.

8. doi:10.11604/pamj.2019.33.105.16851
Towell, B. A., Slatyer, S., Cadwallader, H., Harvey, M., &
Davis, S. (2020). The influence of adaptive challenge on
engagement of multidisciplinary staff in standardising aseptic
technique in an emergency department: A qualitative study.
Journal of Clinical Nursing, 29(3/4), 459–467. https://doi-
org.roseman.idm.oclc.org/10.1111/jocn.15109
Key Points:
· Evidence synthesis is best done through group discussion. All
team members share their perspectives, and the team uses
critical thinking to arrive at a judgment based on consensus
during the synthesis process. The synthesis process involves
both subjective and objective reasoning by the full EBP team.
Through reasoning, the team:
■ Reviews the quality appraisal of the individual pieces of
evidence
■ Assesses and assimilates consistencies in findings
■ Evaluates the meaning and relevance of the findings
■ Merges findings that may either enhance the team’s
knowledge or generate new insights, perspectives, and
understandings
■ Highlights inconsistencies in findings
■ Makes recommendations based on the synthesis process.
· When evidence includes multiple studies of Level I and Level
II evidence, there is a similar population or setting of interest,
and there is consistency across findings, EBP teams can have
greater confidence in recommending a practice change.
However, with a majority of Level II and Level III evidence, the
team should proceed cautiously in making practice changes. In
this instance, recommendation(s) typically include completing a
pilot before deciding to implement a full-scale change.
· Generally, practice changes are not made on Level IV or Level
V evidence alone. Nonetheless, teams have a variety of options

9. for actions that include, but are not limited to: creating
awareness campaigns, conducting informational and educational
updates, monitoring evidence sources for new information, and
designing research studies.
· The quality rating (see Appendix D) is used to appraise both
individual quality of evidence and overall quality of evidence.
EBP Question:
Category (Level Type)
Total Number of Sources/ Level
Overall Quality Rating
Synthesis of Findings
Evidence That Answers the EBP Question
Level I
■ Experimental study
■ Randomized controlled trial (RCT)
■ Systematic review of RCTs with or without meta-analysis
■ Explanatory mixed method design that includes only a Level I
quaNtitative study
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
■ Explanatory mixed method design that includes only a Level
II quaNtitative study
Level III
■ Nonexperimental study
■ Systematic review of a combination of RCTs, quasi-

10. experimental and nonexperimental studies, or nonexperimental
studies only, with or without meta- analysis
■ QuaLitative study or meta- synthesis
■ Exploratory, convergent, or multiphasic mixed-methods
studies
■ Explanatory mixed method design that includes only a level
III QuaNtitative study
Category (Level Type)
Total Number of Sources/ Level
Overall Quality Rating
Synthesis of Findings
Evidence That Answers the EBP Question
Level IV
■ Opinions of respected authorities and/or reports of nationally
recognized expert committees or consensus panels based on
scientific evidence
Level V
■ Evidence obtained from literature or integrative reviews,
quality improvement, program evaluation, financial evaluation,
or case reports
■ Opinion of nationally recognized expert(s) based on
experiential evidence
Based on your synthesis, which of the following four pathways
to translation represents the overall strength of the evidence?

11. Johns Hopkins Nursing Evidence-Based Practice
Appendix H: Synthesis Process and Recommendations Tool
Johns Hopkins Nursing Evidence-Based Practice
Appendix H: Synthesis Process and Recommendations Tool
· Strong, compelling evidence, consistent results: Solid
indication for a practice change is indicated.
· Good and consistent evidence: Consider pilot of change or
further investigation.
· Good but conflicting evidence: No indication for practice
change; consider further investigation for new evidence or
develop a research study.
· Little or no evidence: No indication for practice change;
consider further investigation for new evidence, develop a
research study, or discontinue project.
If you selected either the first option or the second option,
continue. If not, STOP—translation is not indicated.
The Johns Hopkins Hospital/ The Johns Hopkins University
Recommendations based on evidence synthesis and selected
translation pathway
Consider the following as you examine fit:
Are the recommendations:
■■ Compatible with the unit/departmental/organizational
cultural values or norms?

12. ■■ Consistent with unit/departmental/organizational
assumptions, structures, attitudes, beliefs, and/or practices?
■■ Consistent with the unit/departmental/organizational
priorities?
Consider the following questions as you examine feasibility:
■■ Can we do what they did in our work environment?
■■ Are the following supports available?
· Resources
· Funding
· Approval from administration and clinical leaders
· Stakeholder support
■■ Is it likely that the recommendations can be implemented
within the unit/department/ organization?
Directions for Use of This FormPurpose of form
Use this form to compile the results of the individual evidence
appraisal to answer the EBP question. The pertinent findings for
each level of evidence are synthesized, and a quality rating is
assigned to each level.
Total number of sources per level
Record the number of sources of evidence for each level.
Overall quality rating
Summarize the overall quality of evidence for each level. Use
Appendix D to rate the quality of evidence.
Synthesis of findings: evidence that answers the EBP question
· Include only findings from evidence of A or B quality.
· Include only statements that directly answer the EBP question.
· Summarize findings within each level of evidence.
· Record article number(s) from individual evidence summary
in parentheses next to each statement so that the source of the
finding is easy to identify.
Develop recommendations based on evidence synthesis and the
selected translation pathway
Review the synthesis of findings and determine which of the
following four path- ways to translation represents the overall

13. strength of the evidence:
■ Strong, compelling evidence, consistent results: Solid
indication for a practice change is indicated.
■ Good and consistent evidence: Consider pilot of
change or further investigation.
■ Good but conflicting evidence: No indication for practice
change; con- sider further investigation for new evidence or
develop a research study.
■ Little or no evidence: No indication for practice change;
consider further investigation for new evidence, develop a
research study, or discontinue the project.
Fit and feasibility
Even when evidence is strong and of high quality, it may not be
appropriate to implement a change in practice. It is crucial to
examine feasibility that considers the resources available, the
readiness for change, and the balance between risk and benefit.
Fit refers to the compatibility of the proposed change with the
organization’s mission, goals, objectives, and priorities. A
change that does not fit within the organizational priorities will
be less likely to receive leadership and financial support,
making success difficult. Implementing processes with a low
likelihood of success wastes valuable time and resources on
efforts that produce negligible benefits.