NURS 6052 Evidence-Based Project Part 4A: Critical Appraisal of Research

NURS 6052 Evidence-Based Project Part 4A: Critical Appraisal of Research

NURS 6052 Evidence-Based Project Part 4A: Critical Appraisal of Research

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NURS 6052 wk 6-7 Assignment Critical Appraisal Tools

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.

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Abstract

The World Health Organization and the Centers for Disease Control guidelines have been driving hand hygiene practices for more than a decade. These guidelines specify that handwashing with soap and water is the preferred means when hands are visibly dirty or soiled with blood or body fluids, after using the restroom, and with suspected (or confirmed) outbreaks of spore-forming pathogens including Clostridium difficile. In all other clinical situations, routine hand hygiene should involve alcohol-based hand rubs (ABHRs). ABHRs typically contain ethanol, n-propanol, and isopropanol at concentrations of 60% to 95%, offering fast-acting broad-spectrum antimicrobial action.3,4 

Nurses encounter hundreds of hand hygiene opportunities every day. Of these hand hygiene events, use of ABHRs varies widely by setting. A recent systematic review indicated that nurses used ABHRs no more than 15 times per hour and 141 times…

Full citation of selected article Article #1 Article #2 Article #3 Article #4
 

 

 

Conceptual FrameworkDescribe the theoretical basis for the study

 

 

 

 

Design/Method Describe the designand how the study

was carried out

 

       
Sample/SettingThe number and

characteristics of

patients,

attrition rate, etc.

  

 

 

 

     
Major Variables StudiedList and define dependent and independent variables
MeasurementIdentify primary statistics used to answer clinical questions
Data AnalysisStatistical or

qualitative

findings

Findings and RecommendationsGeneral findings and recommendations of the research
AppraisalDescribe 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?

General Notes/Comments  

 

 

 

 

Levels of Evidence Table

 

Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article Article #1 Article #2 Article #3 Article #4
 

 

 

Study DesignTheoretical basis for the study

 

 

 

 

Sample/SettingThe number and

characteristics of

patients

Evidence Level *(I, II, or III)

 

Outcomes

 

 

General Notes/Comments  

 

 

 

 

 

* Evidence Levels:

  • 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

Outcomes Synthesis Table

 

Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

CLICK HERE TO ORDER NURS 6052 Evidence-Based Project Part 4A: Critical Appraisal of Research

Author and year of selected article Article #1 Article #2 Article #3 Article #4
 

 

 

Sample/SettingThe number and

characteristics of

patients

Outcomes 

 

Key Findings
Appraisal and Study Quality
General Notes/Comments  

 

 

 

 

 

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template (1)

Critical Appraisal Tools Worksheet Template

Introduction

This paper systematically and carefully examines four studies to determine their relevance, value and trustworthiness in addressing the issue of HAIs to influence good health outcomes in clinical settings. It includes a literature evaluation table, a level of evidence table and an outcomes synthesis table. For nurses to  safeguard  public health  and provide high quality services, valid and reliable information is needed on what is likely or not likely to harm  patients and the approaches to care  that represent good value.

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 citation of selected article Article #1 Article #2 Article #3 Article #4
Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164–1166.

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. BMC Infectious Diseases, 17, 1–9 Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118. Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. American Journal of Critical Care, 27(4), 334–337.
Conceptual FrameworkDescribe the theoretical basis for the study

 

Not provided Not provided Not provided Not provided
Design/Method Describe the designand how the study

was carried out

Design- Clinical practice guidelinesMethod- clinical guidelines based on the review of literature of hand hygiene and handwashing by NICE, WHO and other studies. Design-

Randomized control trial

Method- 1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).On a weekly basis self-reported data of GTI and RTI symptoms were collected through emails. The multilevel binary regression model was used to analyze data.

Design-

Observational cross-sectional design

Method-

a questionnaire was administered electronically to 872 medical and nursing students in a university and outcome data analysed using relevant software.

Design- Systematic reviewMethod- a comprehensive search was conducted in the electronic databases of MEDLINE and CINAHL using the keywords: contact dermatitis, handwashing, dermatitis and hand hygiene.
Sample /SettingThe number and

characteristics of

patients,

attrition rate, etc.

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting.  1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap). 323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines. 3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.
Major Variables StudiedList and define dependent and independent variables Dependent variable-noneIndependent variable-none

 

Dependent variable– RTI and GTI symptomsIndependent variable– alcohol hand rubs, water and soap

 

Dependent variables-

body fluid exposure, patient surrounding

Independent variable – alcohol hand rubs, use of soap and water

 

Dependent variable– dermatitisIndependent variable-alcohol-based handrubs and handwashing

 

MeasurementIdentify primary statistics used to answer clinical questions Guidelines provided by NICE and the WHO on hand hygiene and handwashing. Weekly prevalence of RTI and GTI symptoms Compliance with WHO hand hygiene model, compliance with hand hygiene practices after contact with the surrounding of a patient or exposure to body fluids. Incidence and prevalence of dermatitis/contact dermatitis
Data AnalysisStatistical or

qualitative

findings

Decontamination of the hands through handwashing using soap and water is the most effective and easy way to prevent the spread of infections in the clinical setting. Within 16 months of the trial, 238 people who used alcohol-based handrubs, 297 who used soap and water and 230 who used nothing provided their reports. An increase in RTI and GTI exposure was reported in both the intervention and control groups. Among those who used soap and water, the prevalence of GTI reduced to 24% as compared to the control group. Alcohol rubs did not affect the prevalence of the symptoms.

 

 

 

 

Of the 872 participants, 323 responded. Nursing students complied more with the WHO “my five moments for hand hygiene” model as compared to medical students. Compliance with hand hygiene was high after being exposed to body fluids (MS 91%. NS 99.5%) and low after contact with a patient’s environment (MS-57.5%, NS-61.5%). Both disciplines had a positive attitude towards hand rubbing. 45% of MS and 16% of NS were not aware of the clinical contraindications to using ABHR. 36% of MS and 9% of NS did not know when to use ABHR and when to use soap and water. 22% NS and 46% MS routinely used ABHR for decontamination.  

3 relevant studies were retrieved. ABHRs were not linked to reduced skin hydration, allergic reactions and disruption of the skin barrier. Skin tolerance of ABHRs was high with reports from healthcare providers on less irritation of the skin and less dryness in comparison to the use of lotions, creams or handwashing. 

 

 

Findings and RecommendationsGeneral findings and recommendations of the research Washing hands with soap and water is the best decontamination method in preventing HAIs. Handwashing with soap and water safeguarded the participants from GTI and RTI. In clinical settings, it should be adopted as an infection control measure to prevent/reduce the incidence and prevalence of HAIs.

 

 

 

Gaps in knowledge on hand hygiene and handwashing are a potential barrier to deficits in hand hygiene practice and use of ABHRs. In clinical settings, leadership should identify potential knowledge gaps, frequently review hand hygiene policies and address them as required. Evidence on how ABHRs influence contact dermatitis and the effectiveness of antiseptic hand hygiene protocols in preventing dermatitis was level II and III. Lipid-emulsifying alcohols or agents disrupt the skin barrier and cause a lot of skin irritation thus should be avoided.
AppraisalDescribe 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?

Adds to clinical knowledge on how to prevent the transfer of pathogens in healthcare settings through handwashing and hand hygiene. It has no risks associated with implementation in clinical practice and is highly feasible in my practice. The study adds to the nursing knowledge on how to prevent RTI and GTI infections in the clinical setting.A major strength is that since a wide study sample was used, the results can be applied to wide population settings. However, since the data collected on RTI and GTI symptoms were based on electronic self-reporting; varied reports might include biased data which affects the validity and reliability of the results. The research is however feasible in my practice. The research adds to nursing knowledge on the potential barriers in observing hand hygiene practices in clinical settings. Its major limitation is that since it had a self-reporting design, the likelihood of potential biases is high. However, the huge random study sample increases the validity, reliability and applicability of the results. The study is highly feasible in my practice. The study adds to the nursing knowledge on health worker perceptions that influence compliance with hand hygiene practices and its influence on the rates of HAIs. Since it is a systematic review that included only 3 articles, the reliability and applicability of its findings is not entirely guaranteed. A major strength of the study is that it recommends the use of ABHRs to reduce bacterial count since it causes less irritation to the skin.ate
General Notes/ Comments Will be included in the EBP project since it matches the scope and proposed EBP-intervention.

 

 

Will be included in the EBP project since it matches the scope and proposed EBP-intervention. Will be included in the EBP project since it matches the scope and proposed EBP-intervention. Will be included in the EBP project since it matches the scope and proposed EBP-intervention.

CLICK HERE TO ORDER NURS 6052 Evidence-Based Project Part 4A: Critical Appraisal of Research

Levels of Evidence Table

 

Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article Article #1 Article #2 Article #3 Article #4
Ford, C., & Park, L. J. (2018). Hand hygiene and Handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164–1166.

 

 

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. BMC Infectious Diseases, 17, 1–9 Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118. Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs. Handwashing. American Journal of Critical Care, 27(4), 334–337.
Study DesignTheoretical basis for the study

 

Clinical practice guideline that is based on the review of literature on hand hygiene and handwashing by NICE, WHO and other studies.

 

Randomized control trial where 1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).On a weekly basis self-reported data of GTI and RTI symptoms were collected through emails. The multilevel binary regression model was used to analyze data. Observational cross-sectional design where a questionnaire was administered electronically to 872 medical and nursing students in a university and outcome data analysed using relevant software. Systematic review that involved a comprehensive search of literature in the electronic databases of MEDLINE and CINAHL using the keywords: contact dermatitis, handwashing, dermatitis and hand hygiene.
Sample/SettingThe number and

characteristics of

patients

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting. 1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap). 323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines. 3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.
Evidence Level *(I, II, or III)

 

Level VII Level II Level IV Level I
Outcomes

 

 

Decontamination of the hands through handwashing using soap and water is the most effective and easy way to prevent the spread of infections in the clinical setting. Within 16 months of the trial, 238 people who used alcohol-based handrubs, 297 who used soap and water and 230 who used nothing provided their reports. An increase in RTI and GTI exposure was reported in both the intervention and control groups. Among those who used soap and water, the prevalence of GTI reduced to 24% as compared to the control group. Alcohol rubs did not affect the prevalence of the symptoms.

 

Of the 872 participants, 323 responded. Nursing students complied more with the WHO “my five moments for hand hygiene” model as compared to medical students. Compliance with hand hygiene was high after being exposed to body fluids (MS 91%. NS 99.5%) and low after contact with a patient’s environment (MS-57.5%, NS-61.5%). Both disciplines had a positive attitude towards hand rubbing. 45% of MS and 16% of NS were not aware of the clinical contraindications to using ABHR. 36% of MS and 9% of NS did not know when to use ABHR and when to use soap and water. 22% NS and 46% MS routinely used ABHR for decontamination.   3 relevant studies were retrieved. ABHRs were not linked to reduced skin hydration, allergic reactions and disruption of the skin barrier. Skin tolerance of ABHRs was high with reports from healthcare providers on less irritation of the skin and less dryness in comparison to the use of lotions, creams or handwashing. 

 

 

General Notes/Comments Low evidence

 

 

 

High evidence

 

Medium evidence

 

 

High evidence

 

* Evidence Levels:

  • 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 NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

Outcomes Synthesis Table

 

Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article Article #1 Article #2 Article #3 Article #4
Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164–1166.

 

 

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. BMC Infectious Diseases, 17, 1–9 Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118. Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. American Journal of Critical Care, 27(4), 334–337.
Sample/SettingThe number and

characteristics of

patients

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting. 1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap). 323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines. 3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.
Outcomes 

 

Key Findings Washing hands with soap and water is the best decontamination method in preventing HAIs. Handwashing with soap and water safeguarded the participants from GTI and RTI. In clinical settings, it should be adopted as an infection control measure to prevent/reduce the incidence and prevalence of HAIs. Gaps in knowledge on hand hygiene and handwashing are a potential barrier to deficits in hand hygiene practice and use of ABHRs. In clinical settings, leadership should identify potential knowledge gaps, frequently review hand hygiene policies and address them as required. Evidence on how ABHRs influence contact dermatitis and the effectiveness of antiseptic hand hygiene protocols in preventing dermatitis was level II and III. Lipid-emulsifying alcohols or agents disrupt the skin barrier and cause a lot of skin irritation thus should be avoided.
Appraisal and Study Quality Adds to clinical knowledge on how to prevent the transfer of pathogens in healthcare settings through handwashing and hand hygiene. It has no risks associated with implementation in clinical practice.Medium  quality The study adds to the nursing knowledge on how to prevent RTI and GTI infections in the clinical setting.A major strength is that since a wide study sample was used, the results can be applied to wide population settings. However, since the data collected on RTI and GTI symptoms were based on electronic self-reporting; varied reports might include biased data which affects the validity and reliability of the results.

High quality

The research adds to nursing knowledge on the potential barriers in observing hand hygiene practices in clinical settings. Its major limitation is that since it had a self-reporting design, the likelihood of potential biases is high. However, the huge random study sample increases the validity, reliability and applicability of the results.Medium quality The study adds to the nursing knowledge on health worker perceptions that influence compliance with hand hygiene practices and its influence on the rates of HAIs. Since it is a systematic review that included only 3 articles, the reliability and applicability of its findings is not entirely guaranteed. A major strength of the study is that it recommends the use of ABHRs to reduce bacterial count since it causes less irritation to the skin.High quality
General Notes/Comments Highly feasible in practice Feasible in practice Feasible in my practice Feasible in my practice

Conclusion

Based on this critical appraisal, the studies recommend routine hand hygiene with soap and water as the effective decontamination method to reduce the spread of pathogens and rates of HAIs in the clinical setting.

NURS 6052 Evidence-Based Project Part 4A: Critical Appraisal of Research References

Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164–1166.

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. BMC Infectious Diseases, 17, 1–9.

Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118.

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. American Journal of Critical Care, 27(4), 334–337. https://doi.org/10.4037/ajcc2018727