Explanation:
Introduction
Clinical governance is important for providing safe care to patients and is essential to continuous improvement in patient safety.(vicgov) One of the key components in relation to this safety and quality issue in health care is preventing and controlling healthcare associated infections(HAI) which plays a significant role in poor outcomes of patients.(sahealth) To prevent transmission of HAI, Hand Hygiene should be done which is one of the most effective ways. Clinical professionals, especially nurses who have high risk of HAI transmission to patients, need to review the effects and great importance of Hand Hygiene to minimize the risk of HAI. Also, study tells that a number of infections can be prevented by adherence to established infection control practices.(sahealth) However, when accessing articles, they need to know the review methods such as a systematic review and randomized control trial, to satisfy evidence based practice with having analysing skills for quality resources. Five articles were reviewed to practice this.
Critique
Larson et al did research to examine the impact of the new practice Guideline on HAI and this compared the infection rates of pre- and post-Guideline implementation in a sample of US hospitals in different time. The problem is the result can be affected by time. Some components, such as how surveillance is conducted, how infections are defined and other concurrent infection prevention activities over time, might play a significant role in the result. Also, there were no control groups in this research so that the outcome of this research cannot be compared with the control group’s infection rates in the same time of post-Guideline implementation. And there was only 2 days observation which is unlikely to be an accurate reflection of practice.Monistrol et al used no control group as well. And Hand Hygiene compliance, the consumption of alcohol-based hand rub (AHR), HAIs and MRSA hospital acquisition incidence were measured. Hand Hygiene compliance was measured by direct observation of health care workers during daily work routine. Observations covered all the 8 hour shifts on weekdays, which is more acceptable than Larson et al’s only 2 days observation. However, infection control nurses undertook the observers and also part of the educator. This could explain the high Hand Hygiene compliance in all periods due to the presence of observers.
Meanwhile, Allegranzi et al assessed the effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country, evaluating hand hygiene infrastructure, compliance, healthcare workers’ knowledge and perceptions, and handrub consumption.
The ideal design for these researches would be Randomized Clinical Trial (RCT), because the research outcomes can be compared by control groups for more exact data in a same time. However, those cannot be done properly with RCT and this is the reason why they did not choose RCT for the research strategy. Once the new practice Guideline is published, the control groups will be informed as well. And this might withhold best practices from patients, raising ethical concerns.
The most rigorous study among those three articles was Allegranzi et al’s research. To examine the effectiveness of WHO’s hand hygiene improvement strategy, they prepared well with training the observers for a long time according to the WHO observation method. And for the baseline evaluation and follow-up evaluation WHO knowledge questionnaire was administered. Also, more scientific and specific categories such as hand hygiene infrastructure and healthcare workers’ level of knowledge were shown in this research than others.
Stout et al and Melissa et al reviewed articles by using a systematic review. In regards to the search strategy, Stout et al searched only PubMed for relevant articles. While Melissa et al searched MEDLINE, EMBASE, CINAHL, HMIC, the Web of Science and the Cochrane Library databases. There is evidence that single electronic database searches lack sensitivity and relevant articles may be missed if only one database is searched(Akobeng 2005). Meanwhile, Stout et al evaluated and reviewed 3,463 articles published between January 1, 2000 and March 31 2013. Forty two articles were selected and grouped into 1 of 4 categories after quality assessment of articles. Also, the earliest year of 2000 was selected because alcohol-based hand rub was not widely in use in prior years. This is a quite scientific strategy. While, there was no specific reason for Melissa et al to pick the articles between May and November 2004, as well as there was no mention about quality assessment of studies.
A systematic review was selected for these articles to examine primary studies on focused clinical questions so that specific answers from narrowly defined review questions were given.
Findings & Conclusion
