Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

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Akuoko, C. P. (2019). Bacterial Reduction of Hand Contamination: Hand Rubbing with Alcohol-Based Solution or Hand Washing with Soap and Water. J. Health Med. Nurs, 67, 67-09.

Assefa, D., Melaku, T., Bayisa, B., & Alemu, S. (2020). COVID-19 Pandemic and its Implication on Hand Hygiene Status by Alcohol-based Hand Sanitizers Among Healthcare Workers in Jimma University Medical Center, Ethiopia .

DOI: https://doi.org/10.21203/rs.3.rs-51049/v1

Lagaya-Aranas, L. M. O. (2016). Randomized controlled trial comparing the efficacy of 70% isopropyl alcohol hand rub ver standard hand washing for hand hygiene healthcare workers. RCT .

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.

Evidence Level *

(I, II, or III)

1

111

1

1

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

Alcohol-based sanitizers destroy bacteria and a wide range of other pathogens, which makes it effective for disinfecting the hands.

The use of alcohol-based hand sanitizers (ABHS) is appropriate due to its wide coverage of microbial spectrum, handling convenience, and portability.

The use of soap and water is the standard hand sanitization method, alcohol solutions are safe and effective, and ought to be given more consideration in situations where hand washing is not possible due to work overload or lack of required hand washing resources.

Use of alcohol-based hand sanitizer gels can effectively kill bacterial cultures in the hands, which will in turn would reduce the spread of bacteria and other pathogens thereby reducing cases of urinary tract and other infections.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

The study utilized a meta-analysis of two relevant studies that showed statistically significant differences before and after the application of hand washing and alcohol-based sanitization. The inclusion criteria was based on sources’ conformity to the PICO question on comparison of the two hand-sanitization approaches.

The authors used a questionnaire-based descriptive cross-sectional design. The inclusion criteria were that the participants should be healthcare workers, and should have one or more years of experience.

The researcher used randomized controlled trials and categorized samples into two groups consisting of 38 participants each. The first group consisted of physicians and nurses who used antiseptic-free soap and water for hand disinfection. The second group used 70% isopropyl alcohol to disinfect their hands. Participants with hand dryness, irritation, and pruritus were excluded. The participants’ hands were tested for germs before and after disinfection with hand washing and alcohol-based disinfection accordingly. The results of the two groups were then compared to determine the content of bacteria.

The article is a systematic review of primary empirical studies that were conducted to study the effectiveness of the use of alcohol-based hand gels in sanitizing the hands.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

The inclusion criterion was based on studies that compared both hand-sanitization approaches, and bacterial reduction had to be a primary outcome.

A total of 96 participants were selected for the study. All were healthcare workers such as laboratory technicians, physicians, nurses, and midwives.

The study was conducted in clinical settings involving 76 participants consisting of doctors and nurses. The number of bacterial colony count was taken for each participant before and immediately after the disinfection exercise.

The inclusion criteria of the articles were based on studies on hand-based sanitizers. The studies should have been conducted in primary healthcare settings, and in renal nursing.

Major Variables Studied

List and define dependent and independent variables

Use of hand washing method of disinfection, and alcohol-based sanitization. The dependent variable was the number of bacterial colonies before and after sanitization.

The dependent variable was the use of ABHS while the independent variable was knowledge of ABHS. The use of ABHS was expected to vary according to healthcare workers’ knowledge of ABHS.

Dependent variables were the number of bacterial colonies present in the hands of the participants before and after the hand hygiene activities. The independent variables were the hand sanitization approaches, which were the use of 70% isopropyl alcohol, and use of soap and water. The number of bacteria is expected to reduce when the independent variables are manipulated.

The dependent variable in the study was the presence of bacteria on the hands of the healthcare workers, and independent variable was the use of alcohol-based hand sanitizer gels.

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

The author analyzed the mean and standard deviation of the collected data to find differences.

Measurements of p values were done using binary logistic regression to test healthcare workers’ knowledge of ABHS.

The independent t-test was applied to make comparisons between the two groups. The Fishers Exact Test was also applied to check for significance in adverse effects across the groups.

The populations and groups that used alcohol-based hand sanitizer gels reported low infections than control groups that did not use the sanitizers.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

There was a reduction in bacterial colonies from 75 to 9 in the alcohol method compared to 82 and 42 for the hand washing method in the first study. In the second study, there were 271 and 39 colonies for the alcohol intervention, and 232 and 69 for the hand washing approach.

Descriptive statistical tests were conducted using SPSS software. The level of significance was placed at 5%. Healthcare workers who had been trained about COVID-19 had 3 times sanitization competencies than untrained ones (AOR 3.65; 95% CI 0.41-32.56; P= 0.246).

The mean number of bacterial colonies among the hand washing group were 27.43 and 3.58 before and after the sanitization exercise respectively. For the alcohol group, the mean baseline bacterial colony counts were 21.5 and 0.76 respectively before and after the sanitization exercise.

The analysis was descriptive of the data that the analyzed studies found. The studies findings suggest that the alcohol-based gels reduced bacterial infections by between 25%-60%.

Findings and Recommendations

General findings and recommendations of the research

Alcohol-based hand sanitization is more effective than using water and soap. Further research is needed on hospital acquired infection (HAI) with regard to the use of the two sanitization approaches.

Knowledge, education, and training were positively associated with greater competencies regarding the use of ABHS by healthcare workers. Experience, age, and sex had no impact on health workers competencies of using ABHS.

Both hand washing and with soap and water significantly reduced the numbers of bacterial colonies. However, the hand washing group recorded a higher bacterial colony count than the isopropyl alcohol group. The alcohol group had 65.79% bacterial elimination whereas the hand washing group had a 52.63% bacterial eradication. It is recommended to have a 70% alcohol solution at patients’ bedsides or carried by doctors at all times. Studies should be conducted on the identification of bacterial colonies; and the effectiveness of other sanitization approaches such as use of iodine or antibacterial soaps.

Alcohol-based hand sanitizers are effective in preventing and reducing infections in clinical settings.

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?

The article provides comprehensive analysis and presents information in an understandable way. The limitation is that its inclusion criteria did not include researches done within the context of HAI. It can be used as a reference material on the effectiveness of different hand washing approaches.

The study contains important information on the factors that influence healthcare workers’ competencies of using ABHS. However, the authors did not conduct a literature review to show the findings of other related studies. Nevertheless, the article contains useful information that can be applied to recommend training initiatives to increase healthcare workers’ hand-hygiene competencies.

The article is of high quality since there were no biases, and statistical analysis tools applied were effective and accurate. The findings reveal clear differences between the two hand sanitization approaches. The information can be applied to support studies on suitable and effective hand sanitization approaches.

This systematic analysis comprehensive information gathered from many sources on the proof of the efficiency of alcohol-based hand sanitizers in the prevention of infections. The limitation of the study is that it did not compare the gel-based and liquid or antiseptic-based sanitizers. The information can be used to show evidence of the effectiveness of alcohol-based sanitizer gels.

Key findings

Alcohol-based sanitization is more effective than hand washing with soap.

Knowledge and training is positively related to high hand hygiene competencies.

Both hand washing and use of 70% alcohol are effective ways of ridding the hands of bacteria and other pathogens.

Alcohol-based sanitizer gels are effective in the prevention of the spread of pathogens in clinical settings and at home.

Outcomes

Reduction of bacteria and other pathogens.

Hand hygiene is positively associated with low transferability of pathogens.

Hand hygiene reduces bacterial colonies, which in turn reduces transferability of infections.

Reduction in and prevention off the number of renal infections.

General Notes/Comments

Both approaches should be used, and selection should be based on the context and situation.

Frequent training of healthcare workers is necessary since their hand hygiene competencies are low despite their professional competencies.

Hand hygiene can be used to reduce cases of hospital acquired infections in hospitals.

Alcohol-based gels and liquids should be carried in portable containers that can be carried easily by healthcare workers.