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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 McCalla S, Reilly M, Thomas R, McSpedon- Rai D, McMahon LA, Palumbo M. An automated hand hygiene compliance system is associated with decreased rates of healthcare-associated infections. Am J Infect Control. 2018 Dec;46(12):1381-1386. doi: 10.1016/j.ajic.2018.05.0 17. Epub 2018 Jul 6. PMID: 30509358.

Wałaszek, M., Kołpa, M., Wolak, Z., Różańska, A., & Wójkowska-Mach, J. (2018). Patient as a Partner in Healthcare-Associated Infection Prevention. International Journal of Environmental Research and Public Health, 15(4), 624. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ij erph15040624

Hong, T. S., Bush, E. C., Hauenstein, M. F., Lafontant, A., Li, C., Wanderer, J. P., & Ehrenfeld, J. M. (2015). A hand hygiene compliance check system: brief communication on a system to improve hand hygiene compliance in hospitals and reduce infection. Journal of medical systems, 39(6), 69.

Jenner EA, Watson PW, Miller L, Jones F, & Scott GM. (2002). Explaining hand hygiene practice: an extended application of the Theory of Planned Behaviour. Psychology, Health & Medicine, 7(3), 311– 326.

Mary Jane Heaney

Nilda, well presented critical appraisal of the four peer-reviewed articles and Evaluation Table within the Critical Appraisal Tool Worksheet Template. Relevant examples and well stated appraisal, with discussion and explanation of best practice based on the research you reviewed. Nice work overall. Check format for references. Include an introduction, purpose statement, and conclusion. https://academicguides.waldenu.edu/writingcenter/apa/references https://academicguides.waldenu.edu/writingcenter/undergraduate/guidelines/purpose https://academicguides.waldenu.edu/writingcenter/templates/general Check journal format, include complete journal title. Incluude doi for all research articles if available.

Mary Jane Heaney

Check caps in journal titles. The response should fully integrate at least two outside resources and two or three course-specific resources that fully support the responses provided.

Evidence Level * (I, II, or III)

This article is a level II This article is a level IV This article is a level I This article is a level V

Conceptual Framework

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

The aim of this nonrandomized, pre– post intervention analysis was to see whether introducing an automated HHCS across the hospital was linked to a lower incidence of HAIs. Hand hygiene (HH) activities may help prevent health-care- associated infections (HAIs). Hand hygiene enforcement systems (HHCSs) have been seen to properly evaluate HH enforcement, there is little proof on their success in preventing HAI rates.

The study's aim was to learn about Polish patients' and healthcare workers' awareness and attitudes about hand hygiene. Partnership between HCWs and patients is one of the goals of HAI prophylaxis, as is cultivating successful hand hygiene practices in patients, which can be a significant link in achieving this purpose.

The experiment is based on a prototype framework that includes enforcement rate monitoring, real-time sanitization notifications, and a data repository for future research.

The Health Belief Model, the Theory of Reasoned Action , and the Theory of Planned Behavior (TPB) are among the theoretical models built to describe the influence of beliefs on individuals' behavior.

The importance of using the TPB as a foundation for modeling hand hygiene practice has been demonstrated in this report.

Design/Method

Describe the design and how the study was carried out (In detail,

The design method used in this study was a nonrandomized, pre-post intervention study.

The design method used for this study was surveys and interviews.

The design method used in this study is experimental design.

The design method used in this study is cross-sectional survey .

including inclusion/exclusion criteria). Sample/Setting

The number and characteristics of patients, attrition rate, etc.

There were 14,297 and 36,890 patients in the pre-intervention and intervention years, accordingly. This was observed in two hospital units. The research included all patients who were in units that used the integrated HHCS system. The automated HHCS was needed for all unit caregivers who had direct patient interaction. Nurses, respiratory therapists, care assistants, doctors, dietary aides, transporters, registrars, physical therapists, housekeeping workers, and technicians were among those who were involved (radiology and cardiology).

The survey study comprised 459 respondents who replied to the survey: 173 (37.6%) patients and 286 (62.3%)

A random sample of patients and staff was taken from the hospital's electronic database. Two samples of 300 subjects each were taken from the group of 629 patients and 846 HCWs.A standardized table of random numbers is used in the drawing. Every patient and HCW had an equal opportunity of being selected. In the case of a patient, the return sample population was 58 percent (173 questionnaires) and 95 percent in the case of HCWs (286 questionnaires). 127 (42%) of the patients did not answer the questions.

Using a new technological system A doorway sensor is used to keep track of who enters the room A BFlatback U-Ring, a system developed to house small IR beam detectors, was installed in the hospital's installed hand sanitizing stations.These are used to see whether the hand sanitizer was used because the beam under the nozzle was penetrated by a hand.The sensors are connected to an Arduino software, which. transmits the data to the hospital's wireless network allowing the data to be collected in one convenient system for review.

A total of 304 questionnaires were given to the infection control nurse and ward manager who agreed to distribute them to workers who were working in the hospital

34% of the 101 questionnaires were delivered to the internal infection control desk; there were 76 registered nurses, therapists, and doctors who participated in the sample (in addition to the other participants) (3 percent ). Four participants left the job untracked. the majority of respondents were female Only five participants identified themselves.

Major Variables Studied

List and define dependent and independent variables

Catheter-associated urinary tract infections and central line- associated bloodstream infections were observed. They were observed by hand hygiene compliance systems (HHCS) that include, human observers, The biovigil automated HHCS a wearable tool that prompts caregivers to perform. Training was provided on how to insert and maintain a Foley catheter, as well as how to insert and maintain a central line.

The diagnostic survey approach was used to conduct an observational and descriptive analysis in the Stukasz multi-profile provincial hospital, which has 713 beds and 22 departments (nine surgical, 12 non-surgical wards, and one intensive care unit). Structured interviews were performed using a specially designed survey questionnaire (Supplementary Materials).

Scenario 1: The customer can sanitize, activating the dispenser's infrared sensor, and then walk through the door in less than two seconds, activating the door's ultrasonic sensor. This is a good scenario.

Scenario 2: After going into the ultrasonic beam, the person uses the hand sanitizer in the patient's room for two seconds. Compliance is important as well. If the hand sanitizer doesn't work, the room is bypassed after two seconds.As soon as you enter the room, an alarm will go off Scenario 3: If all hands sanitizing mechanisms are active for two seconds, no entry is made.

A self-report questionnaire was developed to assess perceptions, subjective norms, perceived behavioral control, motive, behavior, personal responsibility, and barriers.

Measurement In order to test this study The questionnaire In a patient preoperative The questionnaire

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

hand hygiene compliance (HHC) was assessed at two different times: when entering and leaving patient areas. Each caregiver's computer registered hand hygiene (HH) occasions and instances, and data was created and saved on cloud computing-based databases. Routine hospital infection monitoring obtained data on the number of CAUTIs and CLABSIs.

questions that were asked include: List all “5 moments for hand hygiene.” Which are: (1) before touching a patient; (2) before clean/aseptic procedure; (3) after body fluids exposure risk; (4) after touching a patient; and (5) after touching patient surroundings.

Being at the hospital, were you aware that the medical staff were performing HH in the course of the activities associated with medical procedures?

Did you observe that HCWs performed HH before drawing your blood for testing?

When you were in primary and secondary school, were there towels and soap in the school bathrooms?

holding room.40 compliant and non- noncompliant testing were done in a single patient room ahead of time.

questions that were asked include:

‘Washing my hands before and after every patient contact is …’ (1 =‘not important’, 7 =‘very important’).

‘I feel under social pressure from other health care workers to wash my hands’ (1 = ‘strongly disagree’, 7 = strongly agree’)

‘If I wanted to, I could easily wash my hands before and after each patient contact’ (1 = unlikely’, 7 = ‘likely’).

‘I always intend to wash my hands before and after contact with each patient’ ( 1 = strongly disagree’, 7 =‘strongly agree’).

‘I always wash my hands before and after contact with each patient’ (1= ‘strongly disagree’, 7=‘strongly agree’).

Data Analysis Statistical or Qualitative findings

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

The rates of CAUTI and CLABSI were expressed as incidence rate ratios of 95% confidence intervals (CIs).

During the engagement phase, the automated HHCS reported the total number of HH opportunities per month. The number of HH opportunities increased from 60,167 in March 2015, when the automated HHCS was only in use in the ICU and ICU stepdown unit, and 779,824 in July 2016, when the system was completely introduced in the hospital.

The incidence of

192 (66.8%) of the 286 HCWs surveyed knew at least one of the "5 moments for HH," but 94 (33%) had no idea what they were. Medical professionals with less than six years of experience and those with more than twenty years of experience were more likely to correctly mention the "5 moments for HH."

The patients said that the staff disinfected their hands "always" and "sometimes" in about 40% of the cases, but that it occurred "rarely" in about 20% of the cases before direct physical contact or physical examination.

Majority of respondents

The method was accurate in detecting 97.5% of the test samples and 100% of the non-compliant samples, the total accuracy was 98.75%

The TPB predictors successfully developed a model explaining intention to practice hand hygiene, correctly classifying 70% of cases. Personal accountability contributed another 2% to the right classification, and obstacles contributed another 7%. Classification accuracy rates were 71% for 'medium' intenders and 84% for 'large' intenders. The overall correct classification rate was 79 percent, indicating that the model correctly predicted the majority of variance

CAUTIs was 2.20 per 1,000 catheter days prior to intervention. During the intervention phase, this rate dropped to 1.21 per 1,000 catheter days. During the pre intervention period, there were 1.43 CLABSIs per 1,000 central line days; during the intervention period, there were 0.64 CLABSIs per 1,000 central line days.

(329)(71.2%) said their school did not have such supplies . Just 105 (22.7%) of respondents said their school had soap and towels, while 28 (6.1%) did not respond.

in hand hygiene behavior purpose. As a result, the model's total predictive validity was high.

Findings and Recommendations

General findings and recommendations of the research

During the 32-month HHCS intervention, the relative risk of CAUTIs was reduced by nearly 45 percent. During the HHCS intervention, researchers saw a nearly 55 percent reduction in the relative risk of CLABSIs.

There are limitations to treating patients to participate in hand hygiene, and health care workers failure to follow the "5 moments for hand hygiene" greatly decreases patient safety.

Recommendations for this study include: Education about hand hygiene should begin at a young age for the entire society: a lack of adequate supplies in school

Hand hygiene compliance improves as a result of the alarm system. The system produced an overall accuracy of 98.75%

Attitudes were found to be a major predictor of hand hygiene intention.

bathrooms impedes the production of healthy hand hygiene habits.

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?

This study was intended to decrease the incidence of CAUTI and CLABSI and it did just that. The strengths of this study is that it utilized preintervention and intervention periods The lack of randomization in this study's quasiexperimental nature is a disadvantage. The risks associated with this study is the invasion of privacy of healthcare workers and patients. This study is feasible to my practice because in the current research, where the use of the HHCS was expanded to all hospital units and the follow-up period for evaluating HAI rates was increased, substantial reductions in the rate of CAUTIs and CLABSIs were observed

This research practice was intended to determine if the partnership with patients and healthcare workers was feasible in accomplishing HAI. The strengths in this study is that they engage patients of different cultures, gender, and economical status, and participate in a worldwide struggle in healthcare. Limitations are that not all patients and HCWs were supportive in achieving the same goal and will fail to answer the questionnaires. also that this study has only been conducted in Poland. I do not think there are any risks in the implementation of this study. This study would be feasible in my practice because it would make patients aware of their importance in hand hygiene in regards to

This experiment was designed to promote the use of this Alarm system. The Strengths of this experiment is that Variables are under better control. It's easier to make a comment about cause and effect. Limitations ate the experiment was conducted in one hospital setting. The risks of this system is if it crashes and the data is not transmitted to the hospitals database causing failure to receive results of compliance. This experiment would be feasible in the use of my practice because it would allow for better recording the compliance of hand hygiene.

This study was designed to illustrate how the attitudes of people were found to be a major predictor of hand hygiene intention. The strengths of this study is that Multiple outcomes by the series of questions were addressed. The limitations were that with this study you weren't able to actually see if the attitudes impacted hand hygiene it was solely based on answers. I do not see there being any risks associated with this study and this research is feasible because it allows for a wider view on how attitudes can impact whether hands will

reminding healthcare workers to wash their hands.

washed or not be washed

Key findings

Hand hygiene compliance systems can improve HAI

The partnership of patient and healthcare workers is encouraged however education is needed.

Utilizing alarm systems can promote hand hygiene compliance.

Attitude towards hand hygiene.

Outcomes

There is a decrease in CAUTIs and CLABSIs when HH is utilized

patients and healthcare workers working together emphasize the practice of hand hygiene and decrease HAIs

Decrease in HAIs Attitudes can have an impact on hand hygiene.

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/conceptualframework

● 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/conceptualframework

Part 3B of Evidence-Based Project.

It is estimated that approximately 30% of hospital infections could be avoided if medical staff followed the recommendations on

hand hygiene. (Jenner.EA et al., 2002) This sought to be true based on a system of things including participation of healthcare workers,

patients, utilizing a theoretical approach such as a hand hygiene compliance system. Hand hygiene is essentially the root of the cause of

many HAIs that can be prevented if all healthcare worker, and patients in the hospital wash their hands. Compliance with hand hygiene is

described as proper washing of hands before and after all patients or patient environments, using soap and water or the antiseptic agent.

(Hong, T. S. et al, 2015)

Evidence based practices demonstrate that utilizing hand hygiene systems to record the compliance of healthcare workers hand

hygiene decreases the rates of HAIs. In a study of hand hygiene compliance monitoring, the use of a prototype device that includes a

doorway sensor, two sanitizer dispenser sensors, a microprocessor, and an alarm is decreasing HAIs. It allows for hospitals to educate

staff based on the data retrieved from the device.(Hong, T. S. et al, 2015) In addition to other infection prevention steps, tracking hand

hygiene activities via an automated system such as Biovigil may be an efficient way to reduce HAIs. The Biovigil is an automated

machine that reminds health care professionals to apply hand hygiene.The device's light flashes yellow, then red, before hand hygiene is

completed, at which point the light flashes green, assuring patients and everyone at the bedside that HHC was completed.(McCalla S., et

al, 2018) Attitudes were found to be a major predictor of hand hygiene intention. (Jenner.EA et al., 2002) In order to implement the

importance of hand hygiene education about hand hygiene should begin at a young age for the entire society: a lack of adequate supplies in

school bathrooms impedes the production of healthy hand hygiene habits. (Wałaszek, M., 2018)

As we advance in this world many studies have proven the use of hand hygiene compliance in the reduction of hospital acquired

infections. Emphasizing the importance of hand hygiene can be implemented by everyone it is standard for the prevention of

transmission of bacteria.

References

Hong, T. S., Bush, E. C., Hauenstein, M. F., Lafontant, A., Li, C., Wanderer, J. P., & Ehrenfeld, J. M.(2015). A hand hygiene compliance check system: brief communication on a system to improve hand hygiene compliance in hospitals and reduce infection. Journal of medical systems, 39(6), 69.

McCalla S, Reilly M, Thomas R, McSpedon-Rai D, McMahon LA, Palumbo M. An automated hand hygiene compliance system is associated with decreased rates of healthcare-associated infections. Am J Infect Control. 2018 Dec;46(12):1381-1386. doi: 10.1016/j.ajic.2018.05.017. Epub 2018 Jul 6. PMID: 30509358