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NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template
Evaluation Table
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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 |
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| Conceptual Framework
Describe the theoretical basis for the study
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| Design/Method Describe the design
and how the study was carried out
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| Sample/Setting
The number and characteristics of patients, attrition rate, etc. |
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| Major Variables Studied
List and define dependent and independent variables |
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| Measurement
Identify primary statistics used to answer clinical questions |
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| Data Analysis
Statistical or qualitative findings |
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| Findings and Recommendations
General findings and recommendations of the research |
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| Appraisal
Describe 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? |
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| General Notes/Comments |
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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 |
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| Study Design
Theoretical basis for the study
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| Sample/Setting
The number and characteristics of patients |
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| Evidence Level *
(I, II, or III)
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| Outcomes
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| General Notes/Comments |
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* 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
| Author and year of selected article | Article #1 | Article #2 | Article #3 | Article #4 |
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| Sample/Setting
The number and characteristics of patients |
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| Outcomes
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| Key Findings
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| Appraisal and Study Quality
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| General Notes/Comments |
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NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template (1)
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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.
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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 Framework
Describe the theoretical basis for the study
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Not provided | Not provided | Not provided | Not provided |
| Design/Method Describe the design
and how the study was carried out |
Design- Clinical practice guidelines
Method-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 review
Method-a comprehensive search was conducted in the electronic databases of MEDLINE and CINAHL using the keywords: contact dermatitis, handwashing, dermatitis and hand hygiene. |
| Sample/Setting
The 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.
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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 Studied
List and define dependent and independent variables |
Dependent variable-none
Independent variable-none
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Dependent variable-RTI and GTI symptoms
Independent variable-alcohol hand rubs, water and soap
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Dependent variables-body fluid exposure, patient surrounding
Independent variable– alcohol hand rubs, use of soap and water NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template
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Dependent variable-dermatitis
Independent variable-alcohol-based handrubs and handwashing
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| Measurement
Identify 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 Analysis
Statistical 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.
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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.
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NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template
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.
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| Findings and Recommendations
General 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.
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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
Describe 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.
NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template |
| General Notes/Comments | Will be included in the EBP project since it matches the scope and proposed EBP-intervention.
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Will be included in the EBP project since it matches the scope and proposed EBP-intervention.
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Will be included in the EBP project since it matches the scope and proposed EBP-intervention.
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Will be included in the EBP project since it matches the scope and proposed EBP-intervention.
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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 Design
Theoretical 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/Setting
The 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. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template
|
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
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High evidence
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Medium evidence
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High evidence
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* 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/Setting
The 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
|
NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template | |||
| 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.
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. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template
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. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template