PICOT statement paper

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SUMMARY OF CLINICAL ISSUE (200 – 250 words)

Hand Hygiene is one action that is most effective in reducing infections associated with healthcare such as Hospital Acquired Infections (HAIs). It is therefore a key activity for health care workers. Poor hand hygiene is detrimental to the health and safety of a patient and cause them to acquire more diseases to the detriment of their health, in addition to the one that brought them to the hospital. In fact, health workers have been revealed to be the chief carriers of hospital acquired infections. As revealed by many studies carried out to ascertain the adherence to hand hygiene and its effectiveness, a greater number of health workers fail to consistently adhere to hand hygiene practices. Apart from the international standard guidelines for hand hygiene, most health works fail to carry out common hand hygiene practices before and after contact with a patient. It has resulted in high morbidity and mortality cases caused by poor hand hygiene of health workers. There is need for more sensitization of health workers on the need for effective hand hygiene practices for quality healthcare. It is also important to know that the basic method used for hand hygiene like the entry and exit methods are insufficient. Healthcare institutions need to see it as their duty to introduce and foster various hand hygiene techniques for their hospitals for quality healthcare and patient safety, in addition to the guidelines of relevant international bodies such as World Health Organization.

PICOT Question: Does improvement in hand hygiene among healthcare workers lower the rate hospital-associated infections?

Criteria	Article 1	Article 2	Article 3
APA-Formatted Article Citation with Permalink	Lehotsky, A., Szilagyi, L. , Szeremy, P., Weber, G., Haidegger, T. (2017). Towards objective hand hygiene technique assessment: validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure. Journal of Hospital infection 97 (2017) 26-29 Permalink: https://www.ncbi.nlm.nih.gov/pubmed/28579470	Garus-Pakowska, A., Sobala, W., Szatko. F. (2013). Observance of hand washing procedures performed by the medical personnel before patient contact part 1 Retrieved from international journal of occupational medicine and environmental health 2013 Permalink: https://www.ncbi.nlm.nih.gov/pubmed/23715929	Sadule-Rios, N., Aguilera, G. (2017). Nurses’ perception of reasons for persistent low rates in hand hygiene compliance. Intensive and Critical Care Nursing 42 (2017) 17-21 Permalink: https://www.ncbi.nlm.nih.gov/pubmed/28366521
How Does the Article Relate to the PICOT Question?	The article validates hand hygiene quality assessment technique, which consequently improves the hand hygiene rates.	The study in this article was carried out to ascertain the effectiveness of health workers’ hand hygiene before they make contact with patient.	The article explains nurses’ view on the reasons for low hand hygiene compliance rates. This helps to improve hand hygiene compliance.
Quantitative, Qualitative (How do you know?)	Qualitative: The study validates the quality of a hand hygiene assessment technique	Quantitative: Health workers and hand hygiene data was collected and observed for the study.	Quantitative: The study quantified opinions of critical care nurses.
Purpose Statement	Microbiological validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure	Effectiveness of health workers’ hand hygiene before they make contact with patients	To explore nurses’ perceptions of reasons for persistent low rates in hand hygiene compliance in the Critical Care Unit and their recommendations for improvement
Research Question	How microbiologically effective is ultra-violet-dye-based hand-rubbing technique on hand hygiene quality assessment?	Does hand hygiene among health workers lower the rate of hospital acquired infections?	(1) What are nurses’ perceptions of the reasons for the persistent low rating in hand hygiene compliance in the critical care unit? (2) What are nurses’ suggestions to improve hand hygiene compliance in the critical care unit?
Outcome	Ultraviolet-dye-based hand-rubbing hand hygiene quality assessment technique is effective with 95.05% sensitivity and 98.01% specificity	Hand hygiene compliance level among health workers before patient contact appears to be greatly and shockingly below the expectations	51% chose high workload and under- stafﬁng as the main reason for scoring low-ranking in hand hygiene compliance, 47% chose difﬁculty donning gloves when hands are damp and difﬁculty accessing sink locations, 43% chose products placed in inconvenient locations (item # 4) as the third main reason for low-ranking in hand hygiene compliance among critical care nurses. 38% chose Skin irritation. Finally 36% selected lack of appropriate hand hygiene products available at the point of care
Setting (Where did the study take place?)	Institute of Medical Microbiology, Sem- melweis University (Budapest, Hungary)	Data collection and observation was carried out in three selected hospitals.	A 452 beds Magnet hospital
Sample	25 Artificial hand models	Health workers, including nurses, doctors and other medical staff of not less than 180.	47 critical care nurses
Method	Systematic qualitative research	Hand hygiene observed for over 1500 hours	Exploratory, descriptive survey design
Key Findings of the Study	UV-dye based hand hygiene assessment method is a true and reliable indicator of correctly disinfected and pathogen-free areas on the hand surface	Hand hygiene compliance level among health workers before patient contact appears to be greatly and shockingly below the expectations.	High workload and understafﬁng are the most important barriers to hand hygiene compliance
Recommendations of the Researcher	Infection prevention experts to continue assessing the performance of their staff the UV-dyed based method.	Following the WHO and CDC guidelines health workers should as a matter of obligation disinfect their hands before contact with each patient	Having the adequate nurse-patient ratios and consequently, more time, cleanser products available at the point of care, and easy accessible sink locations for hand hygiene.

Criteria	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	Chatfield, S. L., Nolan, R., Crawford, H. and Hallam, J. S., (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE Open Medicine Volume 4: 1 –9 Permalink: https://www.ncbi.nlm.nih.gov/pubmed/27803809	McLawsa, M. L., Farahangizb, S., Palenikc, C. Askariand, M., (2014). Iranian healthcare workers’ perspective on hand hygiene: A qualitative study. Journal of Infection and Public Health (2015) 8, 72—79 Permalink: https://www.ncbi.nlm.nih.gov/pubmed/24997855	Deochand, N., & Deochand, M. E. (2016). Brief Report on Hand-Hygiene Monitoring Systems: A Pilot Study of a Computer-Assisted Image Analysis Technique. Journal of environmental health, 78(10).
How Does the Article Relate to the PICOT Question?	This article explains the potential of improvement in hand hygiene among acute care nurses to reduce incidence of healthcare-associated infections	This article explains the view of health workers on various aspects of hand hygiene, and proposed improvement ways.	This article explains the results of Computer-Assisted Image Analysis Technique, for hand hygiene.
Quantitative, Qualitative (How do you know?)	Qualitative: It analyzed the quality of opinion of nurses using non-numerical data.	Qualitative: the study evaluated the different aspects of hand hygiene.	Qualitative: The study uses data collected from the image analysis
Purpose Statement	To identify the potential of improvement in hand hygiene among acute care nurses to reduce incidence of healthcare-associated infections	To assess various aspects of hand hygiene from the perspective of health workers in Iran.	To discover better and cost effective hand hygiene techniques that were more accurate and less intrusive.
Research Question	Does improvement in hand hygiene among acute care nurses have the potential to reduce incidence of healthcare-associated infections?	What are health workers opinion regarding various aspects of hand hygiene?	Does Image Analysis Techniques improve on hand hygiene
Outcome	Three themes practical hygiene, risky business, and hygiene on trial were developed and were supported by 50% of participants.	Three themes emerged from the thematic analysis including: ‘‘the relationship between personal factors and HH compliance,’’ ‘‘the relationship between environmental factors and HH compliance’’ and ‘‘the impact of the health system on HH adherence	Computer Assisted Image analysis is more effective than observation and some other traditional techniques.
Setting (Where did the study take place?)	Unite States	A public teaching hospital and 1 private hospital in Shiraz, Iran	Western Michigan University, Michigan.
Sample	Eight nurses who were employed in various patient-care roles	80 Health Care Workers; 16 intensive care unit (ICU) nurses, 14 surgical ward nurses, 24 support staff, 6 attending physicians, 20 medical students (interns working in ICUs and surgical wards) and 6 nursing students.	2 samples
Method	Qualitative interview review and interpretative phenomenological analysis	A purposive sampling method driven by the objectives of the study.	Quantitative research method
Key Findings of the Study	Three super-ordinate themes; practical hygiene, risky business, and hygiene on trial developed using quality control recommendations associated with IPA were supported by 50% of the sample.	Several factors play signiﬁcant role in improving health workers’ hand hygiene compliance, such as the regular adherence to health system tenets. Hand hygiene compliance may also be improved through application of realistic policies and better supervision. In addition, appropriate education may positively affect hand hygiene behavior and attitudes.	Glow germs could be effectively removed in 5 seconds. Less glow germs were still found in subject who used soap in hand washing
Recommendations of the Researcher	Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions.	Moe realistic hand hygiene policies should be put in place and appropriate education should be ensured to improve hand hygiene compliance	Hand image analysis can be used to improve on hand hygiene techniques as it provides effective feedback on hand hygiene.

References

Garus-Pakowska, A., Sobala, W., Szatko. F. (2013). Observance of hand washing procedures performed by the medical personnel before patient contact part 1.International journal of occupational medicine and environmental health 2013

Chatfield, S. L., Nolan, R., Crawford, H. and Hallam, J. S., (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE Open Medicine Volume 4: 1 –9

Deochand, N., & Deochand, M. E. (2016). Brief Report on Hand-Hygiene Monitoring Systems: A Pilot Study of a Computer-Assisted Image Analysis Technique. Journal of environmental health, 78(10). Journal of Hospital infection 97 (2017) 26-29

Lehotsky, A., Szilagyi, L. , Szeremy, P., Weber, G., Haidegger, T. (2017). Towards objective hand hygiene technique assessment: validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure.

McLawsa, M. L., Farahangizb, S., Palenikc, C. Askariand, M., (2014). Iranian healthcare workers’ perspective on hand hygiene: A qualitative study. Journal of Infection and Public Health (2015) 8, 72—79

Sadule-Rios , N., Aguilera, G. (2017). Nurses’ perception of reasons for persistent low rates in hand hygiene compliance. Intensive and Critical Care Nursing 42 (2017) 17-21