Nur342 Evidence Based Health Research Assessment Answers

Please read these assessment items in conjunction with the notes on formatting and presentation which follows the assessment detail.  Also provided are some tools to guide your thinking.

The purpose of this assessment is to define, describe and provide a rationale for your chosen topic.

• Provide a background to the clinical problem/practice (citing relevant literature written in the 3rd person)
• What is the importance and relevance of the clinical problem/practice to nursing? (citing relevant literature written in the 3rd person)
• Using the 5R framework, reflect on your choice – why is this important to you? (personal reflection written in the 1st person, citing relevant literature as necessary)

In Assessment 2a, you did some introductory work on your chosen topic.  The purpose of this assessment is to develop a search strategy and find the best evidence for the clinical problem/practice you wrote about in Assessment 2a.  This is important knowledge to learn in your role as a nursing consumer of research.

1.Introduce your chosen topic in the form of a problem statement and what you aim to achieve from your search of the literature. (written in the 3rd person, citing relevant literature)

2.Define your PICO/PICo.  On the template provided, complete either the quantitative PICO or the qualitative PICo (delete the one you have not used).

Answer:

Background

One of the greatest burdens on the health care sector for the present situations in the Australian demographics is the hospital acquired infections (HAI). As mentioned by White et al. (2015), the number of individuals acquiring hospital acquired infection is 165000 per year which adds a considerable burden on the total health care expenditure of the nation. Hence, it is crucial for the health care expenditure considerably. Hence, it is very important for the health care facilities to have a robust infection control protocol in place with persistent hand hygiene products to be able to reduce rates of HAI. This paper will attempt evidence based research on the most plausible and effective infection control measure that can be employed in health care.

Importance to Nursing

The importance of infection control protocol is not just crucial for the patients, infection control protocol is also an imperative requirement for the nursing workforce as well. It has to be mentioned that nurses are the first point of contact with the health care facility and the most of the hospital acquired infections are spread by the hands of the nurses or the contaminated equipment of supplies that the nurses have been using (Ory, Zingg, de Kraker, Soule & Pittet, 2018). As per Jamal, O'grady, Harnett, Dalton and Andresen, (2012), nurses perform a pivotal role in avoiding the hospital acquired infections with the help of different infection control measures and ensuring evidence based practice in all aspects of care. Along with that, as mentioned by authors, nurses are exposed to different infectious pathogens while caring for the patients and hence, the implementation of a curative infection control measure is also helpful to provide a defense mechanism for the nurses against infectious diseases (Birnbach et al., 2012). Hence, the importance of proper infection control can be considered huge in the nursing context.

Personal Reflection

Reporting Hospital acquired infection is a grave concern for the Australian health care system as there are approximately 165000 new cases of hospital acquired infections reported every year. The most common prevalent types of infections occurred through HIA includes UTI, MRSA, surgical site and respiratory infections (Who.int, 2018). I believe that the infection control measures are one of the greatest defense mechanisms for the health care workforce to be able to provide protection against HAI. Although, it has to be mentioned that Australian national health care authorities lack a national surveillance system on HAIs to collect and report them. Hence, we require extensive research to develop a standard protocol for infection control with a particular product such as alcohol based sanitizer that health care professionals can follow.

Responding Personally I believe the lack of proper infection control in the health care facilities is substantially influenced by the lack of any standard protocol for the infection protocol to follow in certain situations. An evidence based comparative research to decide on a particular infection control product that is going to be used across the nation will provide clarity and transparency to the aspect and will reduce the numbers of hospital acquired infections.          

Relating Research states that, with alcohol based sanitizers or rubs, the chances of spreading the infection is far lesser than when using normal soap and water (Birnbach et al., 2012). According to the WHO guidelines as well, modern alcohol based hand sanitizers have minimal side effects and when used appropriately it will not have immense drying effect on the hands as well (Who.int, 2018). Hence, the effectiveness of alcohol based sanitizers as compared to normal soap and water is much higher.

Reasoning Most of the nursing workforce attempts to use normal antimicrobial soap and water for infection control in the facility. However, the use of alcohol based sanitizers is much more effective in case of the infection control than the soap and water (Pires, Soule, Bellissimo-Rodrigues, Gayet-Ageron & Pittet, 2017). Hence, the nurses need to incorporate the use of alcohol based products in their hand hygiene in order to be able to reduce the rate of HAI

Reconstructing The lack of literacy and understanding regarding the effectiveness of alcohol based sanitizers contribute to the most of the resistance in the nursing workforce (Jamal, O'grady, Harnett, Dalton & Andresen, 2012). Hence, an evidence based research exploring the efficacy of hand hygiene involving alcohol based sanitizers weighing out the pros and cons will be very useful to improve practice.

Aim

Even with infection control and hand hygiene, the Australia has a total of 165000 HAIs reported ever year. WHO states the hand hygiene protocol using a proper antimicrobial product such as alcohol based sanitizer is optimally effective in reducing the infection spread; although most do not use it due to lack of knowledge about the alcohol based products (Who.int, 2018). This research study aims to discover the advantage of using alcohol based sanitizers as compared to normal soap and water in hand hygiene to avoid the risk of hospital acquired infections.

PICO (Quantitative)

Population  

Intervention

Control

Outcome

PICo (Qualitative)

Population Patients

Phenomenon of Interest Comparison of alcohol based sanitizers with normal soap and water

Context Will reduce number of HAIs reported

Research Question

Does the use of alcohol based sanitizers before and after patient care as compared to normal soap and water reduce the number of HAIs

Search Strategy

For this research study the database selected had been SCOPUS which is a specific database that provides access to only peer reviewed articles (Aghaei Chadegani et al., 2013). Peer reviewed articles are more reliable and relevant evidences which can be utilized in research studies and hence, I have used this database for the research conducted as well. The keywords used for the research include “alcohol based sanitizers”, “alcohol rubs”, “soap and water”, “infection control”, “hand hygiene”, “infection control and nurses”, “hand hygiene and nurses”, and “hand hygiene Australia”. We selected three relevant articles for the review based on timeline, concurrent content, recent evidence, apt methodology, and novel information provided.

Best Evidence

Best Practice Level of Evidence Study Design In-text Citation in CDU APA 6th Format

Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility 4 Cross sectional study Schweon, S. J., Edmonds, S. L., Kirk, J., Rowland, D. Y., & Acosta, C. (2013). Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. American journal of infection control, 41(1), 39-44. Doi: 10.1016/j.ajic.2012.02.010

Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections 3 Uncontrolled Longitudinal study Al-Tawfiq, J. A., Abed, M. S., Al-Yami, N., & Birrer, R. B. (2013). Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections. American journal of infection control, 41(6), 482-486. Doi: 10.1016/j.ajic.2012.08.009

Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby

5 Observational study Birnbach, D. J., Nevo, I., Barnes, S., Fitzpatrick, M., Rosen, L. F., Everett-Thomas, R., ... & Arheart, K. L. (2012). Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby. American journal of infection control, 40(4), 340-343. Doi: 10.1016/j.ajic.2011.05.006

Findings

The first article by Schweon, Edmonds, Kirk, Rowland and Acosta, 2013 state that alcohol based sanitizers are exceptionally effective in decreasing the rate of HAIs, especially the respiratory tract infections; which is the most common type of HAI as well. This cross sectional study could effectively prove that the use of alcohol rubs within an integrative comprehensive hand hygiene program can considerably reduce the rate of hospital acquired infections from 0.97 to 0.53 and also increased compliance rates to 54%.

The second article by Al-Tawfiq, Abed, Al-Yami and Birrer (2013) is an uncontrolled longitudinal studies that has compared the use of alcohol based sanitizers with soap and water by introducing an infection control program with the alcohol based hand sanitizers. The results indicated a drastic decrease in the HAI from 0.42 to 0.8 per 1000 patients. The authors also reported increase in the compliance rate to the hand hygiene program by 9% in just one year.

The third and final article by Birnbach et al. (2012) is an observational study that has compared the effectiveness of alcohol based hand sanitizers in three service settings to reduce the risk of HAI in using visitors. The three service settings included a desk sign for using AHS, a combination of a freestanding AHS dispenser and a sign, and a free-standing AHS dispenser directly in front of a security desk. The results indicated 9.33% improvement in case of freestanding dispenser and an improvement of 11.67% in case of combination of dispenser with sign. Hence, a similar strategy can be employed to enhance compliance among nurses with alcohol based sanitizers to decrease HAI rates and enhance compliance.

References

Aghaei Chadegani, A., Salehi, H., Yunus, M., Farhadi, H., Fooladi, M., Farhadi, M., & Ale Ebrahim, N. (2013). A comparison between two main academic literature collections: Web of Science and Scopus databases. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2257540

Al-Tawfiq, J. A., Abed, M. S., Al-Yami, N., & Birrer, R. B. (2013). Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections. American journal of infection control, 41(6), 482-486. Doi: 10.1016/j.ajic.2012.08.009

Birnbach, D. J., Nevo, I., Barnes, S., Fitzpatrick, M., Rosen, L. F., Everett-Thomas, R., ... & Arheart, K. L. (2012). Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby. American journal of infection control, 40(4), 340-343. Doi: 10.1016/j.ajic.2011.05.006

Jamal, A., O'grady, G., Harnett, E., Dalton, D., & Andresen, D. (2012). Improving hand hygiene in a paediatric hospital: a multimodal quality improvement approach. BMJ Qual Saf, bmjqs-2011. Doi: 10.1136/bmjqs-2011-000056

Ory, J., Zingg, W., de Kraker, M. E., Soule, H., & Pittet, D. (2018). Wiping is inferior to rubbing: a note of caution for hand hygiene with alcohol-based solutions. Infection Control & Hospital Epidemiology, 39(3), 332-335.  https://doi.org/10.1017/ice.2017.307

Pires, D., Soule, H., Bellissimo-Rodrigues, F., Gayet-Ageron, A., & Pittet, D. (2017). Hand hygiene with alcohol-based hand rub: how long is long enough?. infection control & hospital epidemiology, 38(5), 547-552. https://doi.org/10.1017/ice.2017.25

Roberts, S. A., Sieczkowski, C., Campbell, T., Balla, G., & Keenan, A. (2012). Implementing and sustaining a hand hygiene culture change programme at Auckland District Health Board. The New Zealand Medical Journal (Online), 125(1354), 75. Retrieved from https://search.proquest.com/openview/4512cf8d1953302414e4cf5580383f14/1?pq-origsite=gscholar&cbl=1056335

Schweon, S. J., Edmonds, S. L., Kirk, J., Rowland, D. Y., & Acosta, C. (2013). Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. American journal of infection control, 41(1), 39-44. Doi: 10.1016/j.ajic.2012.02.010

White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W., ... & Martin, E. (2015). Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses. BMC health services research, 15(1), 59. Doi: 10.1186/s12913-015-0718-2

WHO | Alcohol-Based Handrub Risks/Hazards. (2018). Clean Care is Safer Care. Retrieved from https://www.who.int/gpsc/tools/faqs/abhr2/e