Evidence-Based Project, Part 4: Critical Appraisal of Research

Full citation of selected article

Article #1

Article #2

Article #3

Article #4

Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitising in infection control. British Journal of Nursing, 27(7), 382-388.

Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., ... & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. The Lancet Infectious Diseases, 18(11), 1269-1277.

Loftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices. American Journal of Infection Control, 46(10), 1134-1141.

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs Handwashing. American Journal of Critical Care, 27(4), 334-337.

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)

This study acknowledges that healthcare related infections are public health issue for healthcare systems around the world. It identifies surgical, respiratory, as well as urinary tract infections as some of the common hospital acquired infections. Most importantly, the study advocates for implementation of better strategies such as education, knowledge reinforcement among healthcare providers and the public to control hospital acquired infections (Munoz-Figueroa & Ojo, 2018).

This study demonstrates negative impact of hospital acquired infections on patient safety, mortality and morbidity rates, hospital stays, and medical costs. It also acknowledges significance of hand hygiene among care providers in maintaining patient safety, particularly with relation to methicillin- resistant Staphylococcus aureus. Nonetheless, the researchers indicate that few national programs have been successfully integrated into Australia’s national health structure. The study’s findings indicate that hand hygiene minimizes the risk of hospital related infections.

This study explores how increase in awareness as well as epidemiology of pathogen transmission can play a significant role in enhancing compliance with infection control measures. The study specifically focused on the risk of Staphylococcus aureus transmission during operation because of high transmission rates, virulence, as well as antibiotic resistance. Staphylococcus aureus transmission was also associated with widespread of pathogens to healthy community dwellers within acute care settings. The study also discusses evidence based practices that can help improve patient safety.

Halm and Sandau refer to the hand hygiene guidelines by the Centers for Disease Control and Prevention and World Health Organization. These guidelines indicate that a person can spread Clostridium difficile pathogens by touching body fluids and fluid. The most appropriate method to managing and controlling infections is to wash hands with water and soap. Nonetheless, the researchers recommend routine hand hygiene with alcohol based sanitizers for clinical settings. This article resonates with my study about impact of hand hygiene on hospital acquired infections.

Brief description of the aims of the research of each peer-reviewed article

The study aimed at assessing impact of alcohol based gel hand sanitizer in preventing infections in clinical settings. It focused on renal nursing due to growth of evidence based practice.

The researchers aimed at assessing the outcomes of the national hand hygiene initiative including its impact on incidences of hand hygiene compliance as well as hospital related Staphylococcus aureus. Grayson et al. were also inspired by background information about importance of complying with hand hygiene for patient safety.

The study aimed at exploring the impact of antibiotic resistance on healthcare-acquired infections. Hence, the researchers urge healthcare providers to ensure compliance with prevention measures to control unnecessary administration of antibiotics and reduce infections. The study proposes prevention of Staphylococcus aureus infection during surgical operations through hand hygiene

The aim of this study was to explore the impact of alcohol based hand sanitizer and washing of hands on pathogen transmission. The researcher indicate that frequent hand washing may lead to dermatitis transmission, hence not preferred in clinical settings as a means for controlling infections. Alcohol based hand sanitizers, on the contrary, are effective in reducing bacteria and do not cause skin irritation. As a result, many healthcare providers use alcohol based hand gels to prevent hospital acquired infections.

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.

For this qualitative study, the researchers reviewed different literatures on evidence based practices for clinical decision making. In particular, they reviewed recently published findings related to effectiveness of alcohol based hand sanitizers in controlling hospital acquired infections.

This quantitative longitudinal study assessed outcomes of national hand hygiene initiative program 8 years after implementation. The evaluation included the level of compliance with hand hygiene guidelines, educational engagement, and costs associated with hospital acquired Staphylococcus aureus infections.

In this quantitative study, the researchers isolated and collected Staphylococcus aureus pathogens from three medical centers. These pathogens were subjected to biofilm absorbance, analytical profile indexing, and genome analysis. In total, the researchers randomly selected 274 pair of cases with the help of a computer generated list from the three medical centers. They also isolated 178 Staphylococcus aureus species, out of 173 species were associated with possibility of transmitting healthcare acquired infections. The researchers also carried out an evaluation on virulent, and hyper-transmissible and antibiotic resistant Staphylococcus aureus strains. T-test statistical analysis and Poisson regression were applied for statistical analysis.

This qualitative study was a systematic review of literature. The researchers explored different databases such as CINAHL and MEDLINE by using various key words, including alcohol based hand gels and contact dermatitis. The search was limited to journal articles published during the past 10 years and only relevant articles were used.

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.

This study utilizes evidence based practice steps and relevant articles to justify research findings.

The researchers used a wide population to examine clinical impact of national hand hygiene initiative. A t-test statistical analysis was done, with a p-value of 0.05 considered as statistically significant. This increased accuracy of the study. Moreover, the researchers examined hand hygiene as well as compliance data for errors and consistency. To do so, they used a standard review and validation process. For data accuracy and validity, Grayson et al used hospital samples as well as poorly performing sites.

The study used random sampling technique and large study population, which increases probability of using the study’s findings on a wide population. Moreover, randomization helped in determining a cause-effect relationship between independent and dependent variables. The use of conceptual framework helped in determining course of action for the concept.

The study used most recent articles published within the last 10 years. In this regard, the research findings apply in current clinical settings and practice. Moreover, the researchers used key words, ensuring that only relevant articles were used for the study.

General Notes/Comments

Proper and adequate use of alcohol based hand gel can lead to dissemination of pathogens. Hence, it is important to have hand sanitizers at ward entrances for use before, when, as well as after performing healthcare related activities.

Compliance with hand hygiene guidelines is vital to preventing hospital acquired infections.

Staphylococcus aureus strains are pathogenic and highly transmissible. It is important to maintain high hand hygiene standards and patient decolonization in order to prevent hospital acquired infections

Healthcare providers must not wash hands with soap before and after using alcohol based sanitizers to remove emollients as well as sebum layers as it increases risk of contacting dermatitis.