Criteria

Article 1

Article 2

Article 3

Article 4

Author

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Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Kampiatu,P.,& Cozean, J.

African journal of infectious diseases.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325352/

Haga, T., Ito, K., Sakashita, K., Iguchi, M., Ono, M., & Tatsumi, K

.

 Internal medicine (Tokyo, Japan).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172553/

Schmier, J. K., Hulme-Lowe, C. K., Semenova, S., Klenk, J. A., DeLeo, P. C., Sedlak, R., & Carlson, P. A. (2016).

. ClinicoEconomics and outcomes research : (CEOR) https://doi.org/10.2147/CEOR.S102505

Lorden, A. L., Jiang, L., Radcliff, T. A., Kelly, K. A., & Ohsfeldt, R. L.

Health services research and managerial epidemiology, 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582652/

.https://doi.org/10.1177/2333392817721109

Article Title and Year Published

controlled, crossover study of a persistent antiseptic to reduce hospital-acquired infection (2015)

Risk Factors for Death from Psychiatric Hospital-acquired Pneumonia (2018)

Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable (2016)

Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections.(2017)

Research Questions (Qualitative)/Hypothesis (Quantitative)

Among hospitalized patients, does the use of alcohol base hand sanitizer reduce HAIs as against hand washing with soap and water alone?

There are significant risk factors for death from Psychiatric hospital Acquired Pneumonia (PHAP).

What is the cost associated with removing an existing effective component of programs to avoid HAIs – the use of health care antiseptic products?

What are the prevalence and patient characteristics of individuals who experience co-occurring potentially Preventable hospitalization (PPH) and Healthcare associated infections (HAI ).

What are the odds of a PPH patient acquiring an HAI during their hospital admission?

Purposes/Aim of Study

The purpose of the study was to find out if the use of alcohol base hand sanitizer will reduce hospital-acquired infection in hospital compared to the use of hand washing alone.

The purpose of this study was to clarify the risk factors for mortality among Psychiatric Hospital acquired pneumonia( PHAP )

 To estimate the incremental hospital costs associated with preventable illnesses that would no longer be prevented if certain health care antiseptics were to be eliminated

The aim of the study is to estimate the period occurrences and likelihood of acquiring an healthcare associated infections (HAI ) for the potentially Preventable hospitalized population( PPH).

Design (Type of Quantitative, or Type of Qualitative)

This is a quantitative research

The study is a quantitative study

This study is a quantitative study

The study is a quantitative study design

Setting/Sample

This study took place at Kikuyu Hospital, which is one of the first private hospitals in east Africa. Three wards consisting of Male, Female and the eye ward were used with a total of 435admitted patient within the three months

The study took place at the Tokyo Metropolitan Matsuzawa Hospital. A total of 409 patients who were transferred to Tokyo Metropolitan Matsuzawa Hospital from a psychiatric hospital for the treatment of PHAP were included in this study. Of these 409 patients, 87 (21.3%) had expired at the time of hospital discharge, while 322 (78.7%) were still alive. 

 A total of 76 articles were found during the search using the National Library of Medicine’s PubMed database. 23 out 76 articles met the criteria for inclusion for the studies.

 The studies were conducted with information gather from 576 acute care hospitals scattered in Texas with  Data File including 2.6 million admissions In Texas state.

Methods: Intervention/Instruments

A controlled, crossover study was conducted in three wards of a hospital over the course of three months. Two months were assigned as control periods, while the third month the test product was added. More than 6,000 patient-days were evaluated. Hospital staff were given a questionnaire to determine overall satisfaction with the product. The product used was a persistent, alcohol-based hand sanitizer (Zylast Antiseptic, 76% v/v ethyl

The clinical files of the consecutive patients transferred from a psychiatric hospital to Tokyo Metropolitan Matsuzawa Hospital for the treatment of PHAP during the 10-year period from September 2007 to August 2017 were retrospectively reviewed

The research study used a model input parameters : the National Library of Medicine’s PubMed database. Targeted searches of authors whose works are prominent in the field and government or quasi-government bodies that engage in documenting or improving the performance of health care systems (eg, Centers for Disease Control and Prevention, and Agency for Healthcare Research and Quality) were also conducted. Reviews and meta-analyses were examined for evidence of original data relevant to this analysis.

Texas Inpatient Discharge Public Use Data File was used for data collection. This includes 2.6 million admissions from 576 acute care hospitals. Agency for Healthcare Research and Quality Prevention Quality Indicator software identified PPH, and existing administrative data identification methodologies were refined for Clostridium difficile infection, central line–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia. 

Analysis

Pearson’s Chi-Squared Test for independence was used to analyze the data for statistical significance. The hypothesis tested in this crossover study was that healthcare associated infection would decrease in the treatment group using alcohol base hand sanitizer over the control group using hand-washing (n=6772). The level of significance was established at p<0.05.

The quantitative data are presented as the mean±standard deviation. The differences between survivors and non-survivors were analyzed using the chi-squared test for categorical variables and Student’s t-test for quantitative variables. 

A spreadsheet model tool was used for data analysis. For the analysis Four basic types of information are required to populate the model: first, the number of cases of each type of HAI of interest; second, the proportion of all HAIs that are preventable; third, the proportion of preventable HAIs attributable to the use of health care antiseptics; and finally, the average hospital cost associated with each HAI

A correlation matrix that included variables for PPH, HAI, and other independent characteristics was examined for confounding relationships. Period occurrences were tabulated and reported by evaluation variables. Odds ratios were calculated using 45 logistic regression models. 

Key Findings

The study shows that there was no reported HAIs during the month that the alcohol based hand sanitizer was used but month that hand washing alone was the hospital returned to their previous rate of HAIs.

Advanced age, underweight, and extensive pneumonic infiltration were identified as the risk factors for death among

Psychiatric Hospital associated infection patients

The key finding of the study hsows that the low –and –high estimates of national, annual Healthcare associated infections in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively.

The study shows that 272 923 PPH, 14 219 HAI, and 986 admissions with PPH and HAI. Odds of acquiring an HAI for diabetic patients admitted for lower extremity amputation demonstrated significantly increased odds ratio of 2.9 (95% confidence interval: 2.16-3.91)

Recommendations

The researchers recommended the need for a practice change by moving from hand washing with soap and water alone to the use of alcohol base hand sanitizer on non soiled hands as it has proven to prevent HAIs .

The research recommended that the A-DROP classification, (Age, Dehydration, Respiratory failure, Orientation disturbance, shock blood Pressure) may be useful for managing the treatment of PHAP patients

The research recommended that a study be carried out to ascertain the burden of healthcare associated infections in certain racial and ethnic groups as HAIs may cause disproportionate burden based on the racial or ethnic group.

The study recommended the need for the identification of rare events for inpatient subpopulations and the need for improved codification of HAIs to improve cost and policy analyses regarding allocation of resources toward clinical improvements

Explanation of How the Article Supports EBP/Capstone Project

This article is directly supports the EBP because study compared the same variables that are being compared and the result also support the use of alcohol-based hand sanitizer for prevention of HAIs

This article exposes the risk factors to patient developing severe PHAP. This Capstone project is focused on the prevention of PHAP. This article support the need for the prevention of PHAP to prevent patients death.

This article directly support the EBP/Capstone as it estimates the amount of funds that will be lost if health care associated infection is not prevented.

The study exposes the risk factor exposing individuals to preventable healthcare associated infections. This article supports the EBP/capstone as it stresses the need for the prevention of healthcare associated infections

Article 5

Article 6

Article 7

Article 8

Sadule-Rios N, Aguilera G.

Journal of  Intensive and  Critical Care Nursing

doi: 10.1016/j.iccn.2017.02.05

https://www.ncbi.nlm.nih.gov/pubmed/28366521

White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W., Gee, P., Haneman, L., Page, K., Campbell, M., Martin, E., & Paterson, D.

BMC health services research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341863/ 

Saito, H., Inoue, K., Ditai, J., Wanume, B., Abeso, J., Balyejussa, J., & Weeks, A. (2017).

(‘Wa. Antimicrobial resistance and infection control journal,  https://doi.org/10.1186/s13756-017-0287-8

Correa, J.C., Pinto, D., Salas, L.A., Camacho,J.C.,Rondon,M.,Quinte o.J.

Pan American Journal of Public Health.

https://scielosp.org/pdf/rpsp/v31n6/v31n6a05

Nurses’ perceptions of reasons for persistent low rates in hand hygiene compliance .(2017)

Using a theory of planned behavior framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses.(2015)

Alcohol-based hand rub and incidence of healthcare associated infections in a rural regional referral and teaching hospital in Uganda(2017)

A cluster randomized controlled trial of hand rubs for prevention of infectious diseases among children in Colombia.(2012)

Among critical care nurses, what are the perceived reasons for a low rate in hand hygiene compliant.

What are the beliefs underpinning nurses decision to performing hand hygiene as guided by the WHO ,5 critical moments

The use of alcohol- base hand sanitizer does reduce the incidence of healthcare associated infection.

The use of alcohol-base hand sanitizer does not have any effect on the incidence of healthcare associated infection.

To examine how effective alcohol-based hand rubs (ABH) is in reducing infection of acute diarrheal diseases and respiratory infections (ARI) among children between the age of 1 to 5 years1-5 year in childcare centers plagued with limited water supply

Purposes/Aim of Study

The purpose of this study was to explore nurses’ perceptions of reasons for persistent low rates in hand hygiene compliance in the Critical Care Unit and their recommendations for improvement.

The study was to explore hospital-based nurses’ beliefs associated with performing hand hygiene guided by the World Health Organization’s (WHO) 5 critical moments

The purpose of the study was to evaluate Hand hygiene (HH) practices of health care providers (HCPs) utilizing locally made ABHR and the incidence of HAIs.

The study is a qualitative study.

This is a qualitative study

This study is a quantitative study with a quasi- experimental design

This is a quantitative study of experimental design

The study took place in a 452 beds magnet hospital in south Florida, United states.

A convenience sample of critical care nurses was selected. Critical care nurses who worked 12 hours day or night shift were invited to participate .The criteria for inclusion is that the nurse must be working full time in critical care. A total of 47 nurses were used for the study.

The study took place in 5 wards across 3 hospitals in Queensland, Australia. The total sample size = 27 nurses; 23 females, 4 males. These Participants were aged between 22 to 49 years (Mdn = 32 years) and ranged in nursing experience from 3 months to 23 years (Mdn = 5 ye

Ars).

The research was conducted at Mbale Regional Referral Hospital, a teaching hospital in rural Uganda. Patients from the obstetrics/ gynecology pediatric and surgical departments were enrolled for the study. A total of 3335 patients (26.3%) were enrolled into the study from a total of 12,665 admissions on the study wards over a 24-week period. 

This research took place at 42 childcare centers in 6 towns in Columbia. A total sample size of 209 across the selected 42 childcare centers.

This study used an exploratory, descriptive survey design to identify critical care nurses’ perceptions of barriers to hand hygiene compliance in the unit and their recommendations for improvement

 Focus group discussion using semi-structured questions were use for data collection. The theory of planned behavior (TPB) and the 5 moment’s protocol provided a framework for the identification and coding of themes. The semi-structured discussion guide was developed according to TPB guidelines. The questions were designed to stimulate discussion about nurses’ hand hygiene beliefs.

.

 The study was conducted over 24 weeks between October 2014 and April 2015, with the first 12 weeks of the baseline (pre-intervention) phase followed by 12 weeks of the intervention phase. Data on compliance rate among healthcare professionals was assessed by direct observations performed by the trained research assistants on the wards

This is cluster-randomized controlled trial. Participants were randomly assigned to use ABH as a complement to hand washing (intervention arm: 21 centers/794 children); or to continue existing hand washing practices (control arm: 21 centers/933 children). Acute diarrheal diseases (ADD) and acute respiratory infections (ARI)cases were identified through teacher-reported signs and symptoms of illness. Adverse events were monitored. Hazard ratios (HR) were obtained using Cox proportional hazards multivariate regression shared frailty models

Thematic analysis was used for this study. The focus groups transcripts were analyzed using an iterative process. Coding was carried out by an independent researcher (PO) who did not attend the focus groups and who had not been privy to the initial design of the study

Means, standard deviations (SD) with t-tests, and proportions with chi-squared tests were calculated for continuous and categorical variables in bivariate analyses, respectively, in order to describe demographics and clinical variables of the study participants. Poisson regression analysis was used to compare hand hygiene

(HH) compliance rates before and after the intervention. Linear regression analysis was used to compare HH compliance rate and ABHR consumption during the intervention.

Incidence densities for ADD and ARI were calculated as number of new cases divided by number of susceptible childdays at risk. To compare infection rates by arm, a shared frailty model was selected: this is a Cox proportional hazards regression for recurrent events in which an unobserved gamma-distributed random factor, called frailty, is introduced at the individual (child) level to account for clustering, event dependence, and unobserved heterogeneity in ADD and ARI risk factors

The research shows that nurses implicated high workload, understaffing lack of time as the main problems with hand hygiene compliance in the critical care unit. Another key finding is that they identified difficulty accessing sinks and as major barriers to hand hygiene compliance.

Nurses were of the opinion that hand hygiene have some advantages (protection of patient and self), and some disadvantages (time wasting, hand damage), They also identify some barriers to compliance which include: being too busy, emergency situations, it waste time and poor sitting and accessibility of sinks were identified

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The research shows that the baseline for hand hygiene compliance was only 9.2%, but compliance rates by department during the intervention phase increased to 75.9% at the pediatric department, 54.4% at the surgical department, and 44.1% at the OBGYN department, resulting to a significant reduction in healthcare associated infections (HAIs) on the selected units.

The research shows that that Alcohol base hand rub was effective in preventing acute diarrheal and respiratory infection with the hazard ratio(HR) of acute diarrheal and respiratory infection = HR=0.55, P<0.001 and 0.80,P <0.05 respectively

The study recommended that further studies on the relationship between nurses’ workload, unit staffing, and hand hygiene compliance rate should be carried on

Efforts to increase compliance should comprise individual strategies tackling prioritization of hand hygiene among competing tasks, peer-based initiatives to cultivate adherence norms, as well as more systemic, organizational-level factors encompassing personnel and resources

The study recommended that a further research is required to integrate HAIs surveillance into routine practice and to identify measures to further prevent HAIs in resource limited settings.

The researcher recommends that Colombia’s national public health policies in regards to the prevention of acute diarrheal and respiratory infection should include the use of alcohol base hand rub for hand hygiene. especially in areas where there is problem with water supply

Explanation of How the Article Supports EBP/Capstone

This article explores the nurse’s perception as regards the barriers to compliance with hand hygiene. The problems they listed as the obstacles are things that the use of alcohol based hand sanitizer can fix thereby improving compliance and reducing the incidence of HAIs which is the goal of the PICOT question for the capstone

This study is to explore the nurses belief regarding hand hygiene and their opinion regarding the disadvantages and the barriers to hand hygiene implementation. This article supports the EBP because their opinion on the disadvantages of hand washing with soap and water and the barriers to implementation of the new hand hygiene will be solved by the introduction of the EBP hence increasing the compliance rate

These studies endorsed the efficacy of alcohol-based hand sanitizer in the prevention of healthcare associated infection as well as increasing the hand hygiene compliance among healthcare workers. This is exactly the main purpose of the EBP/capstone project.

This study is to establish whether alcohol hand rub is efficacious in the prevention of acute diarrheal and respiratory disease among children .The study proves the efficacy of alcohol based hand sanitizer in the infection prevention thereby given credence to the EBP supporting its implementation.