Hands Hygiene in ICU, Article Critique Example

Critique of the Effectiveness of a Promotion Programme on Hand Hygiene Compliance and Nosocomial Infections in a Neonatal Intensive Care Unit

The Effectiveness of a Promotion Programme on Hand Hygiene Compliance and Nosocomial Infections in a Neonatal Intensive Care Unit (2008), is a quantitative study written by a panel of nursing professors. Wilawan Picheansathianis an Associate Nursing Professor at the Chiang Mai University in Thailand, Alan Pearson is a Nursing Professor at the Joanna Briggs Institute in Adelaide, Australia, and Prakin Suchaxaya is an Associate Nursing Professor for the World Health Organization’s Regional Office for South-East Asia in New Delhi, India (Picheansathian, Pearson, & Suchaxaya, 2008, p. 315).All three authors have significant nursing backgrounds, both in practice and education, which indicate that they are experts on the topic of this article. Although the title suggests key variables of the study, which are hand hygiene compliance and nosocomial infections in a neonatal intensive care unit, it does not successfully identify the study population. That fact is only revealed in the study’s abstract.

Abstract

The abstract clearly summarizes the main points of the study by stating the problem, methods, results, and conclusion of the study. The study examined the effect of a hand hygiene compliance program in the neonatal intensive care unit of a university hospital in Thailand. The study population consisted of 26 nursing employees. The study showed a significant improvement in the amount of staff members who adhered to a hand-hygiene program after such a program was implemented. Although the participants agreed that the implementation of a hand hygiene program motivated them to practice better hygiene, hand hygiene compliance did not correlate with the intensity of patient care. The study concluded that constant encouragement resulted in increased hand hygiene among nursing personnel (Picheansathian, Pearson, & Suchaxaya, 2008).

Problem Statement

The study problem, the fact that healthcare workers do not follow a consistent hand hygiene program, is easy to identify. The problem statement therefore builds a convincing argument for the new study. The problem is significant to the field of nursing because it directly relates to the well-being of patients. Ineffective hand hygiene practice by healthcare workers results in poor patient care. The research method used for this study is appropriate for the type of study. A quantitative approach is fitting because this is a systematic, experimental investigation.

Purpose

The purpose of this study is to “identify the impact of a promotion programme on hand hygiene practices and its effect on nosocomial infection rates in a neonatal intensive care unit of a university hospital in Thailand,” (Picheansathian, Pearson, & Suchaxaya, 2008). In addition to an explicitly stated research question, the study also offers a clear hypothesis. All questions are appropriately worded and the researchers offer a clear specification of key variables and study population. The hypothesis (a hand hygiene compliance program will reduce infections in neonatal intensive care units) is supported by the study’s problem statement. Therefore, the study’s outcome is implied; increased compliance with hand hygiene procedures will effectively reduce infections.

A study conducted in 2001 found that the point of prevalence of nosocomial infection in more than 42 hospitals were 6.4 percent. Of that percentage, intensive care units had the highest infection rate. Nosocomial infections refer to economic burden, high-morbidity, and mortality and it is therefore crucial that methods to minimize nosocomial infections require increased attention. This study aimed to do just that. Its aim was to demonstrate that appropriate hand hygiene significantly reduces hospital infection rates. During the course of the study the researchers found that less than 30 percent of healthcare workers are committed to a strict hand hygiene routine.

Literature Review

The literature review used for this study was up-to-date as most sources were published within five years of the study. The literature review also predominantly focused on primary sources. The literature was successful in providing a solid basis for the new study. The conceptual framework for this study is a working hypothesis. The researchers want to determine the effect of a hand hygiene compliance program to determine if compliance will reduce infections in the neonatal intensive care unit. In order to implement a hand hygiene compliance program, the researchers take several approaches, each building on the one before, to attempt the implementation of a permanent hand hygiene compliance program. For instance, the study commences with educating nursing staff on the importance of hand hygiene. First, the information is presented in written form. Next, nursing staff is verbally reminded to comply with hand hygiene procedures. The process continues when stations with alcohol-based solutions are placed in areas where it is easily noticeable by study participants. This method continues until the staff is constantly made aware of the importance of complying with a hand hygiene program.

Scope and Delimitation

This study examined the hand hygiene practices of 26 nursing employees to determine if a hand hygiene program would effectively increase hand hygiene practices and consequently reduce nosocomial infections in a neonatal intensive care unit. This study implemented a multifaceted approach with the objective to successfully implement a permanent hand-hygiene compliance program.

Operational Definitions

Hand hygiene refers to the behavior of nurses and their repeated compliance with hand hygiene procedures. It involves cleaning all surfaces of the hands and fingernails for at least 15 seconds; this is relevant for soap-based hygiene procedures as well as cleaning hands with alcohol-based solutions. Non-compliance refers to the fact that health care workers do not consistently follow hand hygiene procedures when conducting care to patients. Study participants cited forgetfulness, hurriedness, and the idea that their hands were not dirty as reasons for non-compliance with hand hygiene procedures. Upon the conclusion of the study, hand hygiene compliance among study participants increased from 6.3 percent to nearly 82 percent (Picheansathian, Pearson, & Suchaxaya, 2008, p. 319). The study was successful in demonstrating that a strict compliance program was conducive in improving the hand hygiene routines of healthcare workers. All key concepts were adequately defined. The researchers also followed a clear rationale during this study and it was appropriate to adequately answer the research question.

Article Critique 2

Design

For the purpose of this study, a more rigorous research design could have been used. Only 26 participants were used for this study. Although the premise of the study was one hospital, it would have added to the validity of the study if more participants were involved. Results for this study were compared to a similar study conducted in 2001 which enhanced the interpretability of the findings. The quasi-experimental design used for this study effectively minimized biases and threats to the internal construct of the study. To further isolate study findings, the researchers focused on the prenatal intensive care unit of one hospital. This directs the study in one specific direction without the possibility of confusion.

Sampling Methods

The research method for this study was a quasi-experimental time-series design which sampled 17 registered nurses and nine practical nurses. The population and sample was adequately identified and described. Although sample biases were minimized, it is not conclusive that the best possible sampling design was used for this study. The researchers gave a comprehensive explanation of all factors pertaining to the study. The study was conducted in three phases.

Setting

The study was conducted in a university teaching hospital in the northern part of Thailand. More specifically, the study focused on the neonatal intensive care unit of the hospital.

Data Collection

The study was conducted in three phases; the first of which included an 8-week control period. Furthermore, the researchers collected data related to nosocomial infections, the intensity of patient care, and nurse compliance with hand hygiene procedures. Most of this data was collected through participatory observations. More data was collected one month after the 8-week intervention, and again one month after that.

Because data was collected through participatory observation, the process in and of itself does not provide the study with high reliability and validity. This method is typically more effective when used in conjunction with other methods of data collection. As a secondary basis for data collection, the study relied on the feedback from participants after one-on-one interviews were conducted. The researchers are all adequately trained in the field of nursing and were therefore amply qualified to collect data. Data collection took place in a manner that minimized bias as study participants were observed through the duration of the study by the researchers. As stated above, in addition to being observed, the participants also took part in interviews. The research question was adequately answered through a comprehensive analysis of all collected data.

Methods

Key variables for this study were operationalized using a previous study, observations, and interviews. In the setting of this study, these are the most effective methods to study key variables. The description of the instruments used for this study were mentioned, but not adequately described. The study mentions that the instruments used for this study included a checklist of criteria to determine nurse compliance with hand hygiene routines. However, none of the criteria are listed; instead, the researchers mention only the purpose of the checklist. Furthermore, the study mentions that the validity of the criteria was evaluated by five experts, but it fails to provide adequate information about these experts.

Appropriate statistical methods were used to measure the variables. All collected data was presented in a table format which was accompanied by an ample explanation to interpret the data. For the purpose of this study, which included only 26 participants, this was the most appropriate statistical method used and aided in minimizing Type 1 and Type 2 errors.

Information about statistical significance was presented, as was information about effect size and precision of estimates. Although this study contributed to an increase in hand hygiene among healthcare workers in the neonatal intensive care unit, it did not contribute to a decline in nosocomial infections.

Ethical Considerations

No significant mention is made about procedures to safeguard the rights or identities of study participants. However, based on the fact that no study participants were identified, it is safe to say that such measurements were appropriately taken. The study was designed to minimize risk and maximize benefits to nurses who work in a hospital setting. As a result, all patients who are treated by nurses who comply with hand hygiene routines will also benefit from the results.

Works Cited

Picheansathian, W., Pearson, A., & Suchaxaya, P. (2008). The Effectiveness of a Promotion Programme on Hand Hygiene Compliance and Nosocomial Infections in a Neonatal Intensive Care Unit. International Journal of Nursing Practice, 14, 315-321.