NRS433V Research Critique: Hand Hygiene in Nursing

This essay provides a critical analysis of two qualitative research articles related to hand hygiene practices in healthcare settings. The assignment begins with an introduction to research critique and then provides a background of the studies, including their aims, significance, and relevance to a chosen nurse practice issue and a PICO question focusing on hand hygiene interventions. The essay compares the methodologies of the studies, one being a systematic review and meta-analysis and the other a systematic review, highlighting the benefits and limitations of each approach. The results of each study are summarized, including findings related to the WHO-5 campaign and patient hand hygiene interventions. Ethical considerations, such as informed consent and de-identification of data, are discussed in relation to how the researchers addressed them. The essay concludes by emphasizing the efficacy of interventions for reducing healthcare-associated infections and their implications for nursing practice.

Running head: ESSAY
Introduction to nursing research
Name of the Student
Name of the University
Author Note

1ESSAY
Introduction- A research critique refers to an examination of a particular research,
primarily focusing on determination of its strengths and weaknesses (Cobb, Jackson &
Dunlap, 2016). In addition, critiquing encompasses a systematic procedure for assessing the
aims, methodology and results of a particular study. This assignment will cover a critique of
two qualitative research articles.
Background- The aim of the research by Luangasanatip et al. (2015) was to assess the
relative efficacy of the WHO-5 campaign, and other interventions, in relation to promotion of
hand hygiene amid healthcare workers across hospital settings. The researchers also aimed to
summarize associated information on usage of resources. The significance of this research
can be accredited to the fact that numerous patients are subjected to healthcare associated
infections (HAIs) that increases rate of mortality and morbidity. Therefore, the researchers
tried to evaluate whether the WHO-5 is effective in increase adherence of the healthcare
workers to hand hygiene protocols, which in turn would prove beneficial for the prevention
of infections. The study by Srigley, Furness and Gardam (2016) was conducted in order to
assess the effectiveness of patient hand hygiene interventions, in relation to reduction of HAI
and improvement of hand hygiene rates amid patients, when compared to usual care. The
study was based on the premise that patients often acquire nosocomial pathogens from
unclean hands, which increases infection rates and deteriorates health and wellbeing. The
significance of the research can be accredited to the fact that it tried to identify interventions
that are most beneficial in decreasing HAI incidence, which would thereby improve health
outcomes of patients.
Support the practice issue- The PICO question formulated in the previous assignment
was as follows:

2ESSAY
In patients admitted to hospitals, how effective is alcohol based hand sanitizer
compared to soap and water, in controlling nosocomial infection or cross infection during
their length of stay?
Both the selected articles are relevant to the aforementioned question since they focus
on the prevalence of nosocomial infections in healthcare settings, and recognized the fact that
direct contact between healthcare workers and patients acts as the major route of pathogen
transmission from different organisms. This in turn increases the likelihood of patients of
being infected and colonised. This can be accredited to the fact that healthcare workers are
most commonly contaminated with the pathogens. The article by Luangasanatip et al. (2015)
identified that usage of alcohol hand rub, together with soap and water are two common
interventions that are implemented for preventing HAI across hospitals. Likewise, Srigley,
Furness and Gardam (2016) also stated that dispensing alcohol based hand rub to different
patients and supervising hand rubbing plays an important role in infection control. However,
the researchers did not focus on the effectiveness of using soap and water for hand cleaning.
Methodology- While the research by was a systematic review and meta-analysis, that
by was only a systematic review. Hence, the primary method of both the investigations was
the same. Luangasanatip et al. (2015) included articles from different electronic databases
like Medline, CINAHL, Embase, NHS Economic Evaluation Database, Cochrane Library,
NHS Centre for Reviews and Dissemination, and the EPOC register. Articles published from
December 2009- February 2014 were included in the meta-analysis. In contrast, Srigley,
Furness and Gardam (2016) searched grey literature and electronic databases published till
August 2014 and included quasi-experimental and experimental studies. Systematic reviews
are defined as overview of primary articles that utilize reproducible and unambiguous
research methods. The major advantage of systematic reviews is that they critically appraise a
range of research studies, following which the findings are synthesized quantitatively or

3ESSAY
qualitatively. They also provide an idea about application of the findings to common practice,
and also reduce bias at the time of drawing conclusions. However, combining the results of
different articles is typically difficult since the investigations have been conducted in varied
ways. Usage of only readily available or published studies acts as a risk to validity of the
review. Publication bias can also occur due to the decisions taken by peer reviewers and
journal editors.
In contrast, meta-analysis refers to a formal, quantitative and epidemiological research
that is performed with the aim of systematically assessing the findings of previous
investigations, in order to draw definite conclusions about the research. The primary
objective of this research design is to analyze the differences in findings amongst different
studies, following which it determines the need of conducting new research. The advantage
of meta-analysis is that by pooling a range of studies, there occurs an increase in the effective
sample size, thereby facilitating examination of more variables and research outcomes.
However, the major limitation of meta-analysis is the potential for publication bias, which
often results in skewed data. Furthermore, articles generating findings that fail to reject the
null hypothesis often remain unpublished, thus might often get excluded from electronic
databases.
Results- The findings from Luangasanatip et al. (2015) retrieved 3639 studies, of
which41 were able to meet the inclusion criteria. Findings from the meta-analysis
demonstrated that incorporation of goal setting to WHO-5 campaign was allied with
enhanced hand hygiene compliance (pooled odds ratio 1.35, 95% confidence interval 1.04 to
1.76; I2=81%). Network meta-analysis specified substantial uncertainty in the comparative
efficacy of interventions, nonetheless found that WHO-5 is an effective intervention and
addition of reward incentives, goal setting and accountably can increase compliance. The
estimated expenditure of interventions fluctuated from $225 to $4669 (£146-£3035; €204-

4ESSAY
€4229) per 1000 bed days. Results published by Srigley, Furness and Gardam (2016)
included 10 studies, with seven of them having multimodal interventions that comprised of
components identical to hand hygiene programs. These components typically comprised of
reminders, education, feedback and audit, and adequate provision for hand hygiene resources.
HAI outcomes and rate of patient hand hygiene were reported in six and four articles,
respectively. All the included studies demonstrate significant improvement in patient hand
hygiene, which might decrease the incidence and prevalence of HAI.
Ethical considerations- Informed consent and de-identification of data prior to its
publication. Informed consent for secondary research involves obtaining voluntary agreement
from the authors of the original research articles, in relation to usage of the article in the
review. Presence of an informed consent suggests that the authors have a sound
understanding of the research that is intended to be conducted, and are also aware of the
associated risks. De-identification of research information encompasses the procedure used
for prevention of personal identity being revealed. Luangasanatip et al. (2015) established
contact with the authors of all literature included in the systematic review and meta-analysis
in order to obtain additional information about the investigation, thus followed informed
consent ethical principle. Moreover, they did not reveal any personal information about
hospitals or HAIs amid patients. However, they did not obtain any ethical approval for the
research. Though Srigley, Furness and Gardam (2016) stated that there were no conflicts of
interest about usage of articles in the research, they did not talk about consulting the authors.
However, no personal information about patients had been shared in this review as well, thus
adhering to the ethical principles.
Conclusion- To conclude, both the qualitative articles highlighted the efficacy of
interventions for reducing HAI amid hospitalized patients. While the WHO-5 was found
effective in increasing hand hygiene compliance amongst healthcare workers, audit,

5ESSAY
feedback, education and reminders were also considered beneficial in decreasing HAI
incidence.
References
Cobb, P., Jackson, K., & Dunlap, C. (2016). Design research: An analysis and
critique. Handbook of international research in mathematics education, 481-503.
Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A. S., Harbarth,
S., ... & Cooper, B. S. (2015). Comparative efficacy of interventions to promote hand
hygiene in hospital: systematic review and network meta-analysis. bmj, 351, h3728.
Srigley, J. A., Furness, C. D., & Gardam, M. (2016). Interventions to improve patient hand
hygiene: a systematic review. Journal of Hospital Infection, 94(1), 23-29.