Hand Hygiene Strategies And Prevention Of Hospital-Acquired Infection

Research question (Using PICO format)

As per the world health organization (WHO), millions of people are affected due to infections, acquired during the process of healthcare and it is one of the major contributing factors in increasing mortality rate around the world (Al-Tawfiq et al., 2013). As hand is the primary pathways for germ transmission during healthcare, it is the most important measure using which healthcare associated infections and associated with extended hospital stays are prevented (Allegranzi, Sax & Pittet, 2013).

Throughout the world, the governments of different countries and their health departments are concerned about this most important practice in healthcare as more than 10 million people are affected due to hospital acquired infection nowadays, in which hand hygiene plays the most important role (Rosenthal et al., 2012). The Australian government has also created a portal in which all the details related to hand hygiene has been provided, despite the fact the stats revealed that approximately 165,000 hospital acquired infection incidents are reported in healthcare facilities of Australia (Salgado et al., 2013).

Therefore, the primary aim of this assignment is to conduct a systematic review using several databases (primarily CINAHL and Google scholar and PubMed as secondary database) and find research articles related to hand hygiene strategies and prevention of hospital acquired infection. Further, the chosen articles will be validated using CASP tool, literature summary and literature search flow chart will be provided in this assignment.

Problem	Interventions Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	comparison	Outcome
Hospital acquired infections (HAIs)	Hand hygiene strategies	Other healthcare interventions	Prevention of HAIs and other bacterial and viral infections

The question: Does the hand hygiene strategies are able to prevent the hospital acquired infections (HAIs) and associated bacterial and viral diseases compared to other healthcare interventions in healthcare facilities throughout the world?

In this systematic review related assignment, CINAHL was selected as the primary database in which keywords associated to the research question was searched. Besides that, Google scholar and PubMed were also searched for researched articles associated to the topic. The keywords, search terms, Boolean operators and search outcomes are mentioned below in the table 1.

Table 1

Search terms	CINAHL	PubMed	Google Scholar	Selected articles
Hand hygiene strategies	90	637	210000	1 from CINAHL
Hand hygiene and hospital acquired infections	18	463	128000	2 from CINAHL
Hand hygiene as preventive measures to hospital acquired infections	7	309	47000	1 from CINAHL
Pharmacological interventions vs. hand hygiene for hospital acquired infections	None	0	22000	None selected
Hand hygiene strategies and rate of hospital acquired infections	5	9	64000	1 from CINAHL
Total	120	1418	471000	5 articles

As the search articles contain several relevant and irrelevant search results, the required research articles were refined form the pool of results using several inclusion and exclusion criteria. The inclusion criteria were inclusive of required timeline from 2012 to 2018 so that relevant and new research conducted on the research question could be achieved. Further, English language, where hand hygiene and other pharmacological strategies were used for prevention of hospital-acquired infection and their effectiveness was compared was used in the article.

On the other hand, research articles beyond the timeline decided for the systematic review, language other than English and having only one or two aspect of the required research question were excluded from the systematic review as it had the ability to divert the primary aim of the research article.  Articles non-specific with hand hygiene strategy for infection prevention, books and informative research articles were excluded as well because of their little scope in the research process.

As CASP tool and its criteria are dependent on the use of type of study and level of evidence of the selected research article identification of these aspects are important.

Research article (in text citation)	Level of evidence	Type of study
(van der Kooi et al., 2013)	Level I	Randomized controlled trail
(Jacob, Cozean & Cozean, 2014)	Level I	Systematic review
(Midturi et al., 2015)	Level II	Qualitative study
(Huis et al., 2013)	Level I	RCT trail
(Stone et al., 2012)	Level II	Qualitative study

Presence of Clearly focused research question	Yes both the articles provided a clear and concise focused research question in the study
Did the authors kept the research randomized?	Yes, both the researchers (van der Kooi et al., 2013) and (Huis et al., 2013) were able to keep the research randomized
All the patients were aware of the conclusion of the research	No, patients were not provided with the research conclusion however, in both the research studies, they included the informed consent from the participants
All the patients or participants were blind to the study process	Yes, all the participants were kept blind for the research
Control and research groups were similar at the start of trail	Yes, they were similar at starting but with time, several participants were dropped out of the study due to health related effects
Aside from experiment, did the researchers treated the participants equally	Yes, ethically all the participants were treated equally
How large was the treatment effect	Treatment effect was effective as the healthcare facilities changed their infection control strategy
How precise was the estimated effect of research	It was quite precise as both the researchers identified that infection control will be possible if hand hygiene is followed properly and it was evident from both the RCT studies
Can the research is applicable to local population	Yes, the research is widely applicable in local population for infection control
All the clinically possible outcomes were considered	No, as the target of the research was to identify hand hygiene and its effects in preventing infection, all the outcomes were not addressed
Did the benefits worth the harms associated	Yes, as there were no significant harm from the research studies and both the researches were conducted in the presence of experienced healthcare professionals.

Did the authors included focused research question	Yes, the research included a focused research question in the study
Did they searched right type of paper	From the research finding it is evident their inclusion and exclusion criteria was perfect for this research study
Quality of the research was good	Yes the research quality was appropriate as included peer reviewed articles in the study
All the important studies were included or not	Yes, all the studies were important to answer research question
Did the review included quality in the study	Yes the study included was appropriate for the research quality
Is it okay to combine the result of the research	As all the studies included in the study focused on the identification of single aspect, it was okay to combine the results
What is the overall result of the review	The results indicated towards the fact that hand hygiene was able to prevent the infection in patients suffering from hospital acquired infection
How precise was the estimated effect of research	The research finding was precise as finding supported the research question
Can the research is applicable to local population	Yes, the finding of the result is applicable to local population
Did the benefits worth the harms associated	Being a systematic review this assignment did not included any harm and benefits were important for healthcare reform

Qualitative methodology was appropriate	Yes it was appropriate
aim of the research was clearly stated	The researchers were able to provide a concise aim to the study
Research design was appropriate to the aim of the research	As the researchers were reviewing a process, qualitative approach was perfect for the study
Recruitment strategy supported aim of the research	Yes the strategy was able to support the aim of the research for both the research articles
Data collection way supported research issue	The data collection process and review of the research clearly supported the research issue
Relationship of researchers and participants were considered	To some extent this aspect was not followed in both the research as both the studies reviewed mainly the research findings and research aims.
Ethical issues were taken into considerations	Yes, researchers were able to consider the ethical aspects
Data analysis was sufficiently rigorous	Yes the data analysis and statistical approach was sufficiently rigorous
Findings are clearly stated	The researchers were able to provide clear and concise result regarding research findings.
Is the research valuable	Yes, as it provided a direct finding that hand hygiene is able to prevent any bacterial viral or nosocomial infection in healthcare facility

Search strategy

Evidences collected from the research of Stone et al. (2012) indicated towards the fact that including the practice of alcohol hand rub, and liquid soap for washing helped the healthcare facility to reduce infections such as Clostridium difficile infection, staphylococcus aureus bacteraemia and other hospital acquired infection within the patients (Salgado et al., 2013). Further Huis et al. (2013) conducted a cost effective analysis that indicated that mean difference in the emergence of infection for experimental, control group of patients were 18.5%, and hence, it could be stated that nurses that used hand hygiene strategy was able to prevent infections in the patients. Further Midturi et al. (2015) conducted research to understand the compliance rate of hand hygiene in healthcare facilities and found that 72.7% healthcare facilities followed the hand hygiene principle however, the rest were not using the strategy and incorporated into the high mortality rate due to nosocomial infection. On the other hand, the evidence from the research of Jacob, Cozean and Cozean  (2014) suggested that besides on hand, if the alcohol is applied on hospital surfaces properly, it could prevent a great percentage of patients from infection. The final included research article included indicated that difference between hospital-acquired infectio0ns in Europe was due to inability to widespread the hand hygiene technique (van der Kooi et al., 2013). Therefore, it could be stated that healthcare facility related infections are due to presence of less hygienic technique and other protective equipment related negligence due to which healthcare acquired infection occurs (Salama et al., 2012). Hence, hand hygiene is the only technique, which can be implemented without any delay so that these negative consequences could be prevented (Monistrol et al., 2012).

Conclusion  

This systematic review assignment focused on the research question related to hand hygiene and its effects in prevention of hospital-acquired infection and for this purpose, searches in several databases and primarily in CINAHL so that appropriate research articles could be searched. Further the five article selected were evaluated through CASP tool and then their research findings were combined to provide a specific research finding that indicated that usage of hand hygiene is able to prevent several serious healthcare acquired infection and hence it should be implicated worldwide. 

References 

Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change within multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.

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.

Huis, A., Hulscher, M., Adang, E., Grol, R., van Achterberg, T., & Schoonhoven, L. (2013). Cost-effectiveness of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. International journal of nursing studies, 50(4), 518-526.

Jacob, S., Cozean, C., & Cozean, J. (2014). Impact of Alcohol Sanitizers on Hospital-acquired Infections: A Systematic Literature Review of Controlled Hospital Clinical Trials. American Journal of Infection Control, 42(6), S46-S47.

Midturi, J. K., Narasimhan, A., Barnett, T., Sodek, J., Schreier, W., Barnett, J., … & Arroliga, A. C. (2015). A successful multifaceted strategy to improve hand hygiene compliance rates. American journal of infection control, 43(5), 533-536.

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.

Rosenthal, V. D., Bijie, H., Maki, D. G., Mehta, Y., Apisarnthanarak, A., Medeiros, E. A., … & Martínez, M. D. R. G. (2012). International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. American journal of infection control, 40(5), 396-407.

Salama, M. F., Jamal, W. Y., Al Mousa, H., Al-AbdulGhani, K. A., & Rotimi, V. O. (2013). The effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital. Journal of infection and public health, 6(1), 27-34.

Salgado, C. D., Sepkowitz, K. A., John, J. F., Cantey, J. R., Attaway, H. H., Freeman, K. D., … & Schmidt, M. G. (2013). Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infection Control & Hospital Epidemiology, 34(5), 479-486.

Stone, S. P., Fuller, C., Savage, J., Cookson, B., Hayward, A., Cooper, B., … & Roberts, J. (2012). Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. Bmj, 344, e3005.

van der Kooi, T., Wolkewitz, M., van Benthem, B., de Greeff, S., Grundmann, H., Zingg, W., & PROHIBIT study group. (2013). O083: Prohibit (preventing hospital-acquired infections by intervention and training): preliminary results of a European multi-center study on the effectiveness of a hand hygiene campaign and a central venous catheter bundle. Antimicrobial Resistance and Infection Control, 2(S1), O83.