Introduction
The purpose of this paper is to provide a critique of a quantitative research paper dedicated to reducing hospital-acquired infection in hospital patients. One of the ways to fight hospital-acquired infections in patients is through handwashing. The reviewed article is titled “Patients’ Hand Washing and Reducing Hospital-Acquired Infection,” written by Haverstick et al. (2017) and published in June’s issue of Critical Care Nurse, which is a peer-reviewed journal. The study sought to understand if there is a correlation between increased access to hand hygiene and patient education with the rate of infection and transmissions of hospital-acquired infections (HAI) (Haverstick et al., 2017). The bio-organisms of interests included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, as well as Clostridium difficile, which are some of the most frequent causes of HAI (Haverstick et al., 2017).
The article does not feature a dedicated literature review section, instead focusing on the components of experiment and its results. The data pulled from other literature sources was used generally to set up the background, citing that out of 72,200 HAI patients in 2011, over 75,000 died, showing a mortality rate of over 10% (Haverstick et al., 2017). Additional literature sources were used to formulate the experiment’s framework and its hypothesis, as well as to serve as points of comparison for the results. The researchers hypothesized that the outcomes of the study would mirror other similar experiments, and result in moderate-to-significant reductions in bacteria populations as well as risks of acquiring infections (Haverstick et al., 2017). Since the article does not feature extensive literature review, it is hard to determine whether any biases towards predicated sources is present.
Summary of Methods
The study was experimental, as the researchers introduced an intervention, which constituted of handwashing and patient education, into a hospital setting, and studied its effects. The research used a convenience sampling method, including all of the patients of the 36-bed cardiothoracic surgical step-down unit at the University of Michigan Health System (Haverstick et al., 2017). Participants were chosen based on their availability either as patients of the surgical unit or as doctors and nurses working in it. Prior to conducting research, a staff questionnaire was conducted in order to determine the levels of knowledge and attitudes of nurses and doctors in regards to handwashing (Haverstick et al., 2017). A similar question was also introduced to patients.
Data about the infection rates after the intervention was recorded post-factum. Researchers validated their chosen instruments for data collection by citing other researches with similar methods of data collection and analysis. In order to compensate for the relatively low number of patients participating in the study, the research design justified the use of parametric Wilcoxon rank sum test (Haverstick et al., 2017). Due to the relatively small size of the article, they did not directly address the issues of validity and reliability of their findings beyond comparative analysis with other articles and findings. This constitutes a weakness to the research.
Summary of Results
Statistically significant results included drastic reduction in median infection rates from Vancomycin-resistant enterococci and Methicillin-resistant Staphylococcus aureus. The former went down from 0.82 to 0.50, while the latter saw a more than three-times decrease in incidence rate, going from 1.60 to 0.50 (Haverstick et al., 2017). Clostridium difficile showed no significant changes, indicating that this type of bacteria may be more resistant to handwashing and alcoholic solutions applied to the skin as part of the intervention. The article claimed practical significance in reducing the number of incidents involving at least two types of bacteria found in generic hospital settings. The authors connect their conclusion to these findings, indicating that hand hygiene should be used before and after most essential practices, such as moving in and out of rooms, using the restroom, and taking meals (Haverstick et al., 2017). They did not directly cite the reduction of infection rates achieved in the scope of their study.
Ethical Aspects
The article has a dedicated section to various ethical aspects of the research. Since the intervention was conducted at Michigan university, it is safe to assume the institutional review board gave the researchers a go-ahead prior to the study being conducted (Haverstick et al., 2017). In order to protect patient and nurse confidentiality, distributed questionnaires were anonymous. In addition, the data regarding numbers of individuals acquiring hospital infections was anonymized. Patient consent to participate was waved for this intervention, as the project met the criteria for quality improvement. The University of Michigan provided a grant of 2350 dollars, which was mentioned in this paper. That money was spent on purchasing alcohol-based hand sanitizer and wipes (Haverstick et al., 2017). No ethical issues with this study were reported.
Evaluation of Study
The study implemented an experimental research design, which is the primary method of generating new quantitative data in a medical setting (Newman, 2016). It accounted for various dependent and independent variables by evaluating the amount of knowledge and the intensity of handwashing practice in the hospital from the patient and nurse perspectives, in order to establish discrepancies and justify the use of educational intervention in addition to the physical provision of alcohol-based solutions and handwipes (Haverstick et al., 2017). In that regard, researchers used appropriate methods in order to investigate research questions.
The strength of the study lies in its straight-forwardness of implementing the intervention and in the simplicity and economic viability of it (Newman, 2016). It proved to be relatively low-cost, with only 2,350 dollars spent on handwipes and alcohol solution for the entire duration of the intervention, while significantly reducing the number of hospital-acquired infections and saving the hospital money, while protecting patients from negative outcomes (Haverstick et al., 2017). In addition, the study featured a robust statistic framework in order to compensate for some of the weaknesses of the study.
Weaknesses are many, however, as the article does not feature a dedicated literature section, making certain claims made in the scope of the research doubtful (Ratelle, Sawatsky, & Beckman, 2019). Some of the limitations acknowledged by the authors include small sample size, homogeneity of the participants, the issues with self-reporting nature of questionnaires, and general levels of busyness of the staff, which could have distorted the effectiveness of the intervention (Haverstick et al., 2017). The authors also did not mention the lack of a longitudinal follow-up in order to see if the situation remained stable after the intervention was finished. The authors made suggestions to further investigate the practice of handwashing with alcohol-based solutions as means of reducing the number of HAIs, only in a larger setting with more heterogeneous population in order to account for the limitations of the present article. I think that the research design could be improved by utilizing handwashing methods that are effective on all three types of bacteria. As this research proved, alcohol-based solutions seemed to have no effect on Clostridium difficile, and no other information presented suggested otherwise.
Conclusion
The article presented offered a simple experiment design. Its findings correlated with other research in the same area. The article had some limitations regarding literature background and the number of patients participating. Its results cannot be easily extrapolated to other locations and larger settings. Utilizing handwashing solutions effective against all three types of bacteria is necessary, and additional research is required.
References
Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017). Patients’ hand washing and reducing hospital-acquired infection. Critical care nurse, 37(3), e1-e8.
Newman, M. (2016). Research methods in psychology. (2nd ed.). San Diego, CA: Bridgepoint Education.
Ratelle, J. T., Sawatsky, A. P., & Beckman, T. J. (2019). quantitative research methods in medical education. Anesthesiology, 131(1), 23-35.