Healthcare - Infection Control and Prevention.

Running head: RESEARCH TOPIC 1
Infection Control and Prevention
Name of the Student
Name of the University
Author Note

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RESEARCH TOPIC 1
Introduction
I am an enrolled nurse working in a clinic situated in the remote area. The clinic
building is do not have contemporary structure and thus lacks the proper display of the
clinical and client related information like posters. It has been identified that the healthcare
professionals working in that remote clinic are efficient in their respective roles however,
they still nurture certain primitive information associated with nursing practice. The manager
of the clinic have asked me to conduct research over the current information about infection
control and using that information to raise awareness and education among the clinic’s staffs.
The two areas related to the infection control that I have identified to conduct the research
include infection control and prevention and research in the domain of soap water versus
alcohol-based sanitizer in preventing the chances of the hospital acquired infection.
Planning research activity
Rationale behind selection of the topic
According to the Enrolled Nurses Standards of Practice proposed by the Nursing and
Midwifery Board of Australia (NMBA) (2016), it is the duty of the enrolled nursing
professional to deliver safe care to the patient in order to promote comprehensive health and
well-being while reducing the cost of care and length of stay in the hospital (standard 1).
According to Code of Ethics for Nurses in Australia by NMBA it is the ethical responsibility
of the nursing professional to deliver safe care and thus abiding by the beneficence and non-
maleficence. Thus, in order to deliver safe and effective care improvement in the health-
awareness of the nurses in the domain of infection control and prevention. Storr et al. (2017)
stated effective control and prevention of the hospital acquired infection helps in improving
the quality of care of the patient. Study of the effectiveness of the soap water and alcohol-

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RESEARCH TOPIC 1
based hand sanitizer will help to bring change in the evidence-based practice under nursing
settings thus helping to bring improvement in the professional standards.
Understanding the effectiveness of different hand wash liquid for the prevention of
the hospital acquired infection will be helpful in bringing the change in practice and at the
same time is helpful in improving the overall quality of care (Foddai, Grant and Dean 2016).
By increasing the quality of hand washing in clinical practice, the spread of infections can be
ceased and incidence of Hospital Acquired Infections can be reduced.
Research question
 Do educating nurse about the infection control and prevention is helpful to reduce the
chances of hospital-acquired infection (HAIs)?
 What is the effectiveness of hand alcohol-based sanitizer in comparison to soap water
for the prevention of HAIs spreading?
Research objectives
 To study the importance of the nursing education about infection control and
prevention.
 To determine the importance of hand washing as clinical practice in clinical settings.
 To analyse the impact of proper hand washing in reducing incidence of hospital
acquired infections.
Specific (S) Nursing education in the domain of infection control and prevention
Measurable (M) Promotion of proper nursing education will help to bring positive
change in practice
Achievable (A) The goal will be achieved through training and skill development
Reliable (R) The training and education will be conducted under hospital settings
Time (I) 1 month of training

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RESEARCH TOPIC 1
 To conduct a comparative study about the alcohol-based hand sanitizer and soap
water for the prevention of hospital acquired infection
Specific (S) Comparative study about the alcohol-based hand sanitizer and soap
water
Measurable (M) Identification of proper hand wash will help in significant reduction of
HAIs
Achievable (A) The identification will be done through systematic review of literature
under by selection of relevant and authentic articles
Reliable (R) Evidence-based practice approach is selected that is reliable in nursing
profession
Time (I) 1 week
Choice of another discipline connected to this research activity
One other discipline that is greatly connected to the current research study of the
effectiveness of hand alcohol-based sanitizer in comparison to soap water for the prevention
of HAIs spreading can be the surgeons in the health care settings. Prior entering the surgical
suite, it is extremely important that the surgeons and other team members wash and scrub
their hands thoroughly. This discipline is selected as the spread of infection is at the highest
risk in surgical suites, where the primary health care professionals are the surgeons. The
further discussion regarding the use of soap water or alcohol based sanitizers by the nurses
and surgeons is highly debatable. However, recent advancement in the nursing professional
practice highlighted that use of alcohol-based hand sanitizer is effective in reducing the

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RESEARCH TOPIC 1
chances of HAIs (Carpenter et al. 2017). Thus doing a comparative analysis between hand
sanitizer and soap water will help in the establishment of the evidence-based practice
guidelines and thus helping to bring chance in practice.
Name of source
Two type of sources that would be used for database search include:
1. CINAHL
2. PubMed
Gathering information associated to research
Methods of Gathering information
Two methods of gathering information that I think would be appropriate to answer the
research question are systematic review and conduction of the semi-structured interview with
open ended questionnaire. The interview will be conducted among the doctors who are the
most knowledgeable and educated person under the healthcare settings and remain updated
about the current trends in professional practice, both the visiting and permanent doctors of
the clinic will be selected.
In this paper, I have chosen, systematic review as the method of gathering
information. Systematic review helps to increase the scope of developing evidence-based
practice by selecting articles based on their methodological accuracy and developing
guidelines based on the summative overview of their literatures (Adams et al. 2016). In
addition to this, systematic review of literature is more time efficient in comparison to
conduction of semi-structured interview.

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RESEARCH TOPIC 1
Gathering information through systematic review of literature
The data collection was done in the literature search format. The keywords that
matches with the scope of the research question were used in order to search literary articles
from the selected electronic databases.
Keywords Keyword Keyword Keyword
Keyword 1 Soap water
Boolean AND
Keyword 2 Alcohol
sanitizer
OR Alcohol-based
sanitizer
Boolean AND
Keyword 3 Hospital
acquired
infection
OR Noscomial
infection
Boolean AND
Keyword 4 Hand hygiene
practice
AND Infection
control and
prevention
Data evaluation was done based on the inclusion and exclusion criteria and the
methodological quality of the articles were accessed with the help of JBI tool (Joanna Briggs
Institute Critical Appraisal Checklist).
Factors Inclusion Criteria Exclusion Criteria
Years 2009 to 2019 Articles published before 2009
Type of Articles Peer-reviewed Non peer reviewed

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RESEARCH TOPIC 1
Language English Language other than English
Types of articles Primary and secondary Grey literatures and websites
The search of the literary articles in the electronic database helped in highlighting
three articles that was included in the review.

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RESEARCH TOPIC 1
PRIMSA Chart for the selection of the articles
Articles Retrieved from CINAHL = 5
Articles retrieved from PubMed = 10
Total articles = 15
No. of articles after removing
the redundant articles = 10
Articles removed = 5
Articles removed after
reviewing the title: 2
Articles for abstract review = 8
Articles removed after
abstract review = 2
Articles for JBI analysis = 6
Final articles selected for the
conduction of the research = 4
Articles removed = 2

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RESEARCH TOPIC 1
The review conducted by Mathur (2011) showed that non-medicated soaps like liquid
soaps or bar soaps have no anti-microbial affects. It only reduces the number of the surface
microorganisms that are loosely adhering to the surface. It is good for the removal of the
social and other proteinaceous materials (blood). It also caused irritation of skin leading to
the development of dry skin. The ideal alcohol based hand-rub contains 60 to 95% of ethanol,
or isopropanol or combination of both. The alcohol-based hand rub is available in the form of
liquid rinse, gels or foams. Alcohol based hand rub has potential anti-microbial activity and
thus helping to reduce the bacterial counts. The addition of chlorohexidine further results in
increasing the anti-bacterial activity of the alcohol-based hand rub. However, alcohol-based
hand rub is not appropriate for use when the hand is visibly dirty or contaminated with soil or
blood. Frequent use of the alcohol-based hand rub can lead to drying of skin. However, the
systematic review conducted by Parahoo (2014) did not highlight the steps that was used for
the selection of the articles in the review.
Zubair et al. (2017) conducted an observational study in order to determine the
frequency of the microbial flora over the hands of the nurse during the process of patient care
and to compare the efficacy of different hand washing agents under the tertiary care hospital
settings. The observational analysis over 40 healthcare workers showed that proper
identification of the microbial contamination is an important constituent toward reducing the
nosocomial infections that are transmitted through health care workers. The study also
showed that alcohol-based had hub is efficient in removing mircrobial flora from hands. The
poor sample size can be consider as one of the limitation of the study (Parahoo 2014).
Eiref, Leitman and Riley (2012) conducted study under the surgical intensive care
unit of urban hospital settings in order to analyze the impending threats coming from alcohol-
based hand sanitizer dispensers. The results showed that hand sanitizer dispensers can

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RESEARCH TOPIC 1
become contaminated with pathogens that might increase the cause of hospital acquired
infection. Grayson et al. (2009) contradicted the findings of Mathur (2011) and Zubair et al.
(2017) and stated that soap-based hand rub is effective for the prevention of the cross-
transmission of H1N1 Influenza Virus in comparison to alcohol-based hand rub. Analysing
the findings of this research, the importance of sanitizing the dispensers at regular intervals
can be highlighted, as they have deemed to be more effective than alcohol based rub and
needs to address the issue of contamination of dispenser.
Distinguishing relevant and irrelevant information
The piece of work published by Mathur (2011) and Zubair et al. (2017) coincided
with the scope of the study as it helped to get a comparative over-view of the soap based hand
rub and alcohol based hand sanitizer towards the control of the hospital acquired infection
and helping to promote infection control and safety. The results identified by these two
studied coincided with the guidelines published by Center of Disease Prevention and Control
(CDC) and World Health Organization (WHO) as both these internationally acclaimed
institutions selected alcohol-based hand rub in comparison to the soap water for effective
prevention of HAIs. However, the study conducted by Eiref, Leitman and Riley (2012) can
be considered irrelevant in comparison to the scope of research question as it did not provide
any comparative overview. Mathur (2011) and Zubair et al. (2017) was conducted under the
hospital-based settings thus can further considered to be relevant. Grayson et al. (2009)
studied that efficacy of the hand rubs over single viral infection and reducing the overall
strength of reliability and validity.
Analysis and organization of information
Year Author Findings
2009 Grayson et al. Soap-based hand rub is effective for the prevention of the
cross-transmission of H1N1 Influenza Virus in comparison to

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RESEARCH TOPIC 1
alcohol-based hand rub
2011 Mathur Alcohol though have certain limitations is effective for
reducing the chances of HAIs
2012 Eiref, Leitman and
Riley
The dispenser bottle of alcohol-based hand rub remains
contaminated and thus increasing the tendency of infection.
2017 Zubair et al. Alcohol-based had hub is efficient in removing mircrobial
flora from hands in comparison soap based hand rub
Hierarchy of evidences
Level 1 (systematic
review)
Mathur, P., 2011. Hand hygiene: back to the basics of infection
control. The Indian journal of medical research, 134(5), p.611.
Level 2 (Randomised
Control trial)
Grayson, M.L., Melvani, S., Druce, J., Barr, I.G., Ballard, S.A.,
Johnson, P.D., Mastorakos, T. and Birch, C., 2009. Efficacy of
soap and water and alcohol-based hand-rub preparations against
live H1N1 influenza virus on the hands of human
volunteers. Clinical Infectious Diseases, 48(3), pp.285-291.
Level 3 (cohort) Zubair, M., Zafar, A., Yaqoob, A., Javed, H. and Ejaz, H., 2017.
Comparison of Different Hand Washing Techniques to Control
Transmission of Microorgenisms. Pakistan Journal Of Medical &
Health Sciences, 11(3), pp.1118-1120.
Level 4 (Case control) Eiref, S.D., Leitman, I.M. and Riley, W., 2012. Hand sanitizer
dispensers and associated hospital-acquired infections: friend or
fomite?. Surgical infections, 13(3), pp.137-140.

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RESEARCH TOPIC 1
Analysis of the information
Only two studies, conducted by Mathur (2011) and Zubair et al. (2017) are selected and kept
for further analysis.
Given in appendix A
Drawing conclusions
Thus from the analysis of the two articles selected and presented in the review, it can
be stated that alcohol-based hand sanitiser in comparison to soap-based hand sanitizer is
helpful for promoting proper infection control and prevention under hospital-based settings
and thus preventing the chances of hospital acquired infection. However, the alcohol-based
hand sanitizer becomes in-effective in presence of blood or dirt in hands. For the removal of
blood stains and dirt from hand, soap-water is considered to be effective. The soap water also
helps in reducing the number of the HINI virus of influenza that are loosely adhered to hands.
Evidence-based practice (EBP)
The EBP will promote change in the hand hygiene practice. The practice will promote
cleansing of dirt and blood stains form hand by the use of the soap based hand sanitizer. This
will be followed by the use of the alcohol-based hand-rub. From this research it can be
concluded that hand washing in rural health care settings can be critical infection preventive
measures.
Use information in practice
The information can be used community-based rural healthcare settings and can be
implemented at the personal level by the family members who are caring for immune-
compromised patient.

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RESEARCH TOPIC 1
Issues for further research
Eiref, Leitman and Riley (2012) stated that body of the alcohol-based hand rub
dispenser can lead to the generation of cross contamination of hands. Further research are
required to be undertaken in order to elucidate the chances of reducing cross-contamination.
(Feedback- Ensure this makes sense I can see what you are trying to say but need to word it
better)

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RESEARCH TOPIC 1
Flyer
Step 1 of hand hygiene
Use of soap based hand wash
Step 2 of hand hygiene
Use of alcohol-based hand rub
Use of WHO’s five step of hand hygiene

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RESEARCH TOPIC 1
References
Adams, R., Jeanrenaud, S., Bessant, J., Denyer, D. and Overy, P., 2016. Sustainability‐
oriented innovation: A systematic review. International Journal of Management
Reviews, 18(2), pp.180-205.
Carpenter, B., Buckler, M., Campell, C., Thompson, N. and Morgan, S., 2017. Evidence
Based Practice for Soap and Water Handwashing.
Center of Disease Prevention and Control (CDC). (2019). Handwashing and Hand Sanitizer
Use. Access date: 16th December 2019. Retrieved from:
https://www.cdc.gov/handwashing/pdf/hand-sanitizer-factsheet.pdf
Eiref, S.D., Leitman, I.M. and Riley, W., 2012. Hand sanitizer dispensers and associated
hospital-acquired infections: friend or fomite?. Surgical infections, 13(3), pp.137-140.
Foddai, A.C., Grant, I.R. and Dean, M., 2016. Efficacy of instant hand sanitizers against
foodborne pathogens compared with hand washing with soap and water in food preparation
settings: A systematic review. Journal of food protection, 79(6), pp.1040-1054.

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Grayson, M.L., Melvani, S., Druce, J., Barr, I.G., Ballard, S.A., Johnson, P.D., Mastorakos,
T. and Birch, C., 2009. Efficacy of soap and water and alcohol-based hand-rub preparations
against live H1N1 influenza virus on the hands of human volunteers. Clinical Infectious
Diseases, 48(3), pp.285-291.
Mathur, P., 2011. Hand hygiene: back to the basics of infection control. The Indian journal of
medical research, 134(5), p.611.
Nursing and Midwifery Board of Australia (NMBA) 2016. Enrolled Nurses Standards of
Practice. Access date: 14th December 2019. Retrieved from:
Nursing and Midwifery Board of Australia (NMBA) 2018. Code of Conduct for Nurses.
Access date: 14th December 2019. Retrieved from:
Nursing and Midwifery Board of Australia (NMBA) 2019. Code of Ethics for Nurses in
Australia. Access date: 14th December 2019. Retrieved from:
Parahoo, K., 2014. Nursing research: principles, process and issues. Macmillan International
Higher Education.
Storr, J., Twyman, A., Zingg, W., Damani, N., Kilpatrick, C., Reilly, J., Price, L., Egger, M.,
Grayson, M.L., Kelley, E. and Allegranzi, B., 2017. Core components for effective infection
prevention and control programmes: new WHO evidence-based
recommendations. Antimicrobial Resistance & Infection Control, 6(1), p.6.
World Health Organization (WHO). (2019). Alcohol-Based Handrub Risks/Hazards. Access
date: 16th December 2019. Retrieved from: https://www.who.int/gpsc/tools/faqs/abhr2/en/

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Zubair, M., Zafar, A., Yaqoob, A., Javed, H. and Ejaz, H., 2017. Comparison of Different
Hand Washing Techniques to Control Transmission of Microorgenisms. Pakistan Journal Of
Medical & Health Sciences, 11(3), pp.1118-1120.

Running head: RESEARCH TOPIC 1
Appendix A
Article: 1: Mathur, P., 2011. Hand hygiene: back to the basics
of infection control. The Indian journal of medical
research, 134(5), p.611.
Article: 2 Zubair, M., Zafar, A., Yaqoob, A., Javed, H. and Ejaz,
H., 2017. Comparison of Different Hand Washing Techniques to
Control Transmission of Microorgenisms. Pakistan Journal Of
Medical & Health Sciences, 11(3), pp.1118-1120.
Currency 2011 2017
Study Findings Alcohol-based hand sanitizer is effective in comparison to soap-
based water
Alcohol-based hand sanitizer is effective in comparison to soap-
based water
Strength of study It is systematic review of articles. Quantitative observational study
Relevance to
objectives
The article falls within the scope of the research questions and is
compliant to the research hypotheses as it highlights the critical
importance of hand washing in rural health care settings.
The aim of the article falls within the research questions.
Reliability The study can be deemed as reliable as the findings are well
supported by evidences.
Validity Internal validity: The overall study lacks a definite methodology
that was used for the conduction of the systematic review. Thus
Internal validity: Observational study with a detailed structure of
the sample size with proper illustrations of the data analysis

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RESEARCH TOPIC 1
internal validity of the study is poor
External validity: The external validity of the study is complete
with no particular threat, increasing the reliability of the study’s
research findings.
External validity: The external validity of the study is poor as the
results is based on the Pakistan healthcare settings and the same
might not be implemented under global healthcare setup. Hence,
a serious threat to the generalisability of the research findings if
accounted in the study.
Benefits The results highlights that maintaining hand hygiene is the most
low cost infection prevention procedure.
The research study is helpful in providence evidence supporting
the use of alcohol in hand washing to effectively remove
microbes.
Risks If the information presented in the study is wrong then
implementation of this results under healthcare practice might
increase the chances of HAIs.
If the information presented in the study is wrong then
implementation of this results under healthcare practice might
increase the chances of HAIs.
Feasibility associated
with information
The information highlighted in the study is feasible under the
healthcare practice settings as it change in the hand hygiene
practice that provides evidence supporting the implementation
of hand washing in clinical practice of rural health settings.
The information highlighted in the study is feasible under the
healthcare practice settings as it change in the hand hygiene
practice and can be applied in rural health care settings.
Conclusions The use of alcohol-based hand sanitizers is effective in reducing the chances of hospital-acquired infection in comparison to the soap-
based hand sanitizer.

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RESEARCH TOPIC 1
Tutor feedback basically advise while writing Research assignment for topic 1 Question 1-18 has to be included while writing assignment.
Plan the research activity
1. In order to complete this assessment, you need to identify TWO (2) areas related to the
topic, where research can help support and improve your own practice as an EN.
E.g topic: Infection control and prevention (or as agreed with your educator)
2. IIdentify the reason(s) for undertaking your research from the list below.
 YYou may select several reasons.
 PProvide a brief rationale for each.
E.g reasons: Comparison / hypothesis testing / trend identification / own knowledge
extension / strengthen quality of own practice.
3. Write a clear statement highlighting your research question or hypothesis, e.g. “Is there
a difference between hand washing protocols and actual practice”.
It may include:
 NNursing interventions applicable to the topic
 CClient perceptions of the provision of this topic
 MModels of nursing care that utilise the topic
 PPolitical issues confronting nursing practice and health care provision in relation
to the topic
An example of a question (the student can NOT use this example), would be:
Does hand washing among healthcare workers reduce hospital acquired infections?
An example of a hypothesis (the student can NOT use this example), would be:
Hospital acquired infections are more likely to be passed on by hand washing with

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RESEARCH TOPIC 1
water than when hands are washed with soap.
4. Establish and define the general research objective.
Tips:
 A research objective summarises what is to be achieved by the study.
 Ensure your objective is S.M.A.R.T and relevant, logical, feasible, observable and
measurable.
 The objective should be clearly phrased – use verbs, e.g. to assess, to establish, to
determine, to compare, etc.
5. IIdentify ONE (1) other discipline that could be connected to this research activity.
 BBriefly explain your choice of discipline.
6. IIn order to gather information about the research topic, you will need to access credible
sources of data and evidence.
 List two (2) sources you intend to use for this assignment.
 Copy the link address of the source and paste it next to the source’s name – this will
provide the proof to your assessor that you accessed it.
o E.g. PubMed - http://www.ncbi.nlm.nih.gov/pubmed
 Source 1:
 Source 2:
HINT: This is a good time to contact your educator and discuss your research topic
and verbally gain confirmation that you and your partner are still on track.
Gather information for your research
7. Evaluate and select a maximum of two (2) methods of gathering information you think
would be most appropriate to answer your research question.
 Briefly explain why you have chosen a particular method over another, e.g. more

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RESEARCH TOPIC 1
time efficient.
Tips:
Methods of gathering include search engine using correct key words, literature reviews,
systematic reviews, interviews, surveys, seminars, and surveys.
8. You are now to gather information for your research topic using a systematic approach.
Stages for your information gathering activity
1. Statement of objective – you should have already completed that step
2. Data collection, i.e. a literature search
3. Data evaluation – critiquing articles to include or exclude them from the
review.
 You may use the appraisal tools developed by JBI to help you
http://joannabriggs.org/research/critical-appraisal-tools.html
4. Analysis – comparing, contrasting, challenging & reflecting
5. Presentation of findings
At this stage, select four (4) sources
Please find the hierarchy of evidence, below:
1. Systematic reviews and meta-analysis
2. Randomised controlled trials (RCTs)
3. Cohort studies
4. Case-control studies
5. Cross-sectional surveys
6. Case reports
9. Distinguish between relevant and irrelevant information.
 Briefly explain why one (1) piece of your information is particularly relevant
according to your objectives and your workplace requirements.

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RESEARCH TOPIC 1
10. In order to facilitate your analysis, organise the information you have found.
Tips:
 You may summarise each source of information using key words.
 You may choose to order your articles in chronological order if your focus is to
show an evolution of practices.
 You may order your articles following the rules of evidence, i.e. RCT > case report.
HINT: Contact your educator and discuss your research topic and verbally gain
confirmation that you and your partner are still on track.
Analyse the information
11. Prioritise information based on the research objectives.
 Using questions 9 and 10 to help you, select only TWO (2) articles that you will
keep for the rest of this assignment.
12. Compare and contrast your two (2) sources of information.
 Use the table provided in Appendix A.
 You must complete all the sections.
 Instructions in italics are to be removed.
13. You have now thoroughly analysed the information available to you. Now draw
conclusions based on your findings.
14. As your findings may be used to establish evidence-based practice, identify one (1)
impact your conclusions may have, in terms of duty of care requirements.
 E.g. in order to do no harm to the clients and prevent disease transmission, all
nurses should wear gloves when touching the client.
HINT: Contact your educator and discuss your research topic and verbally gain
confirmation that you and your partner are still on track.
Use information in practice

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RESEARCH TOPIC 1
15. AAssess one (1) way in which different aspects of information may be used in your
workplace.
16. UUsing and reflecting on what you have learnt from your research
 IIdentify one area for change in your workplace or current practice.
17. IIdentify issues that require further research and evaluation.
18. UUsing one piece of A4 paper or PowerPoint (1 slide) (portrait format), develop a poster
or a flyer to address outcomes of research, i.e. select a method to disseminate your
findings.
 YYou will be required to scan it and upload it on Blackboard with this assignment.
 RRefer to your learning activities 11 and 12 for more ideas about how to do a
poster or a flyer using PowerPoint.
Tips:
 Consider your audience, the time and resources available.
 IIt is recommended you adopt a flyer or poster style with a mix of text and pictures
– do not put in too much information.
HINT: Contact your educator and discuss your actions verbally gain
confirmation that you and your partner are still on track.