Critiquing the literature
Hospital Acquired Infections (HAIs) are regarded as one of the frequently occurring adverse events which hamper the prognosis of the disease of 100s of millions of hospital patients (Ceballos et al., 2013). According to the systematic review conducted by Mitchell et al. (2017), there are 165,000 reported cases of HAIs in Australia during the tenure of 2010 to 2016. The review also highlighted that main reason underlying the HAIs in Australia is increase rate of urinary tract infection like Clostridium difficile, increase in the tendency of surgical site infection, increase in the rate of occurrence of the respiratory tract infection. These conditions are mainly popular among the groups who are admitted with the health issues like skin infections or wound or acute stroke or other diseases which cause immune suppression. People who are recovering from the respiratory tract infection like pneumonia and gastro-intestinal infection and blood infection are also vulnerable in getting affected with this disease (Mitchell et al., 2017). This increase in the rate of occurrence of the hospital acquired infection has leads to an increase in the overall cost of care and increase in the length of stay at the hospital (Ceballos et al., 2013). With the increase in the prevalence of the multidrug resistant bacteria, the overall scenario is becoming worse because the process of treatment of HAIs is becoming complex (Molton et al., 2013). Szilágyi et al. (2013) stated that contact contamination is the main source behind the spread of hospital-acquired infection through the transmission of microbes. Since the nursing professionals spent most of their time with the patients, the spread of infection through touch of contaminated hands of nursing professionals are high. Szilágyiet al. (2013)argued that majority of the nursing professionals fail to abide by the WHOs six steps of hand hygiene protocol and this lead to increase in the tendency of HAIs. However, the study conducted by Monistrolet al. (2012) highlighted that multimodal interventions for the observance of the hand hygiene like the use of alcohol hand rub and of personal protective equipment like use of hand gloves help in preventing the spread of hospital acquired infection in the majority of the cases. The following paper mainly aims analyse whether there are gaps in knowledge which is preventing optimal implementation of hand hygiene (HH) protocol among the nursing professionals. The analysis of the gap will be done through critical analysis of three literary articles which falls within the scope of this paper and at the end, the paper will provide a summative overview of the main findings of the selected research. The analysis of the gaps will help clinical practice improvement (CPI) practice. Implementation of CPI in HH will help to decrease the chances of HAIs and at the same time will help to improve the overall outcome of care by decreasing the cost of care and duration of hospital stay.
Findings and Conclusion
The main critical appraisal tool that is selected for critiquing the articles include CASP tool. According to Nadelson and Nadelson (2014), CASP tool has separate set of templates for qualitative, quantitative and systematic reviews and thus it helps in proper analysis of the research rigour.
The research conducted by Shinde and Mohite (2014) is based on the cross-sectional study design. According to Parahoo (2014), cross-sectional study design helps to overcome the biased outcome in quantitative research. The title of the paper succinctly describes the aim of the assignment and the abstract clearly highlight the background, aims, method results and conclusion. This further helped to increase the overall standard of the research. The study rigorously analyzed the level of knowledge and degree of compliance of the hand hygiene among 100 nursing students and 100 registered nursing professional. Thus the main strength of the study is its sample size. The authors selected 100 nursing staffs and 100 nursing students to conduct the cross-sectional study, use of large sample size helped in generalization of data and prevented in getting unbiased results (Parahoo, 2014).
Smiddy, O’Connell and Creedon (2015) conducted systematic qualitative review in order to highlight the reason behind the non-compliance of hand hygiene among the healthcare workers under the hospital settings. The title of the clearly highlights the aim of the study along with the research design and thus can be regarded as the strength of the research. However, the selection of the research articles for the systematic qualitative review is not solely based on randomized control trial. According to Parahoo (2014), conduction of systematic review over qualitative research decreases the level of evidence of the research and thus it can be highlighted as one of the limitation of the research.
White et al. (2015) conducted a study in order to explore the hand hygiene beliefs among the Australian hospital-based nurses. The authors mainly used the theory of planned behaviour framework in order to explore the nurses belief about “5 critical moments” of hand HH. The title of the research provided as succinct overview of the entire structure of the underlying. According to Parahoo (2014), this may be considered as the main strength of the qualitative study. However, the study has certain limitations, one of the limitation is thematic content analysis of qualitative data was done from the focus group discussion conducted over hospital nurses across five different wards in 3 different hospitals in Queensland Australia. The total sample size of nursing professional is not mentioned and this can be highlighted as one limitation. But selection of 3 different hospitals and 5 different wards helped in extracted data from diverse population thereby promoting generalization of data.
Summary Table
Findings and Conclusion
The summative study findings of three study highlighted that level of knowledge about the importance of hand hygiene is poor among the nursing professionals. The analysis of these gaps upheld the principal of promoting National Safety and Quality Health Service Standards by the Government of South Australia (2012).
The cross-sectional study conducted by Shinde and Mohite (2014) with the help of WHO questionnaire highlighted that the nursing students have better knowledge about five moments of hand hygiene in comparison to the nursing professionals who are working full-time in hospital. However, the overall knowledge is not satisfactory for the prevention of HAIs. The gap exists in lack of proper awareness about hand hygiene and the lack of adequate compliance to HH protocol due to lack of availability of alcohol hand rub at the bedside of the patient.
The main findings of the qualitative systematic review conducted by Smiddy, O’Connell and Creedon (2015) highlighted that there is a lack of supportive hospital environment in order to encourage the healthcare workers to comply with the protocol of HH. Moreover, the systematic review also highlighted that there is lack of proper knowledge of the healthcare worker about the importance of the HH under the hospital settings. Lack of proper guidelines from the hospital authority also another reason behind lack of compliance.
Analysis of the results of the qualitative study conducted by White et al. (2015) highlighted that busy emergency condition, unsupportive doctors, lack of training and unavailability of proper resources is the main barrier towards optimal implementation of hand hygiene among the nursing professionals. The study also reported that the level of knowledge about the importance of hand washing with sanitizer both before and after the patient care is limited among the nursing professionals leading to increase in an incidence of HAIs.
Thus it can be concluded that that lack of proper knowledge, unavailability of resources and lack of proper training is the main reasons underlying lack of proper compliance of hand hygiene among the nursing professionals under the hospital settings.
|
Article no. |
Author/s (year) Country |
Aims or Purpose |
Sample/ setting or Key stake-holders and their roles |
Design/ methods or Type of paper |
Main findings or Primary argument |
Strengths and limitations of the paper |
|
1 |
Shinde, M. B., & Mohite, V. R. (2014); Karad |
The aim of the study was to access the knowledge attitude, knowledge and level of practice of five moments of hand hygiene among the healthcare workers |
The main focus group was the healthcare workers and this include 100 nursing staff and 100 nursing students in a tertiary medical college |
A cross-sectional quantitative study under which the WHO hand hygiene questionnaire was used to access the level of hand hygiene among the healthcare workers. Z test was used to compare the results and the percentage of correct responses between the nursing and the medical students |
The main findings of the study highlighted that knowledge of hand hygiene is moderate among the total study population. The majority of the students had poor attitude towards the observance of hand hygiene. The nursing students (52%) has significantly better knowledge and attitude in comparison to the nursing staffs (12%) in using WHO five step of hand hygiene |
The main strength of the study is its sample size. The study has total sample size of 200. This is an optimal sample size and helps to get authentic results. Other strength of the study is cross-sectional design. However, the study has certain limitations like it was based on the setup of tertiary care medical college of Karad. This limited the global aspect of the study |
|
2 |
Smiddy, M. P., O’Connell, R., & Creedon, S. A. (2015) |
Highlighting the reason behind the non-compliance of hand hygiene among the healthcare workers under the hospital settings |
The analysis of the qualitative research articles published in electronic databases |
Systematic qualitative review with thematic analysis and inductive research approach |
Lack of supportive hospital environment in order to encourage the healthcare workers to comply with the protocol of HH. Moreover, the systematic review also highlighted that there is lack of proper knowledge of the healthcare worker about the importance of the HH under the hospital settings. Lack of proper guidelines from the hospital authority also another reason behind lack of compliance. |
The title of the clearly highlights the aim of the study along with the research design and thus can be regarded as the strength of the research. However, the selection of the research articles for the systematic qualitative review is not solely based on randomized control trial. Conduction of systematic review over qualitative research decreases the level of evidence of the research |
|
3 |
White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W., … & Martin, E. (2015) Australia |
The aim of the study is to o explore the hand hygiene beliefs among the Australian hospital-based nurses |
Survey was conducted over nursing professionals operating in five different wards of 3 different hospitals in Queensland Australia. |
Thematic content analysis of qualitative data |
Busy emergency condition, unsupportive doctors, lack of training and unavailability of proper resources is the main barrier towards optimal implementation of hand hygiene among the nursing professionals. The study also reported that the level of knowledge about the importance of hand washing with sanitizer both before and after the patient care is limited among the nursing professionals leading to increase in an incidence of HAIs |
The main strength of the study is its succinct design of the title. Selection of 3 different hospitals and 5 different wards helped in extraction of data from diverse population thereby promoting generalization of data. One limitations of the study is, exact number of nursing professionals selected for the study is not highlighted |
References
Australian Commission on Safety and Quality in Health Care (2012). National Safety and Quality Health Service Standards. Access date: 16th November 2018. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf
Ceballos, K., Waterman, K., Hulett, T., & Makic, M. B. F. (2013). Nurse-driven quality improvement interventions to reduce hospital-acquired infection in the NICU. Advances in Neonatal Care, 13(3), 154-163.
Mitchell, B. G., Shaban, R. Z., MacBeth, D., Wood, C. J., & Russo, P. L. (2017). The burden of healthcare-associated infection in Australian hospitals: a systematic review of the literature. Infection, Disease & Health, 22(3), 117-128.
Molton, J. S., Tambyah, P. A., Ang, B. S., Ling, M. L., & Fisher, D. A. (2013). The global spread of healthcare-associated multidrug-resistant bacteria: a perspective from Asia. Clinical Infectious diseases, 56(9), 1310-1318.
Monistrol, O., Calbo, E., Riera, M., Nicolás, C., Font, R., Freixas, N., &Garau, J. (2012). Impact of a hand hygiene educational programme on hospital?acquired infections in medical wards. Clinical Microbiology and Infection, 18(12), 1212-1218.
Nadelson, S., &Nadelson, L. S. (2014). Evidence?based practice article reviews using CASP tools: a method for teaching EBP. Worldviews on Evidence?Based Nursing, 11(5), 344-346.
Shinde, M. B., & Mohite, V. R. (2014). A study to assess knowledge, attitude and practices of five moments of hand hygiene among nursing staff and students at a tertiary care hospital at Karad. International Journal of Science and Research, 3(2), 311-321.
Smiddy, M. P., O’Connell, R., & Creedon, S. A. (2015). Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. American Journal of Infection Control, 43(3), 269-274.
Szilágyi, L., Haidegger, T., Lehotsky, Á., Nagy, M., Csonka, E. A., Sun, X., … & Fisher, D. (2013). A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps”. BioMed Central Infectious Diseases, 13(1), 249.
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. BioMed Central Health Services Research, 15(1), 59
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