A critical analysis of knowledge gaps in hand hygiene among nursing professionals

Research Critique 0
Introduction
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.
Critiquing the literature
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.
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