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Abstract
In the article Patients Hand Washing and Reducing Hospital-Acquired Infection, Haverstick et al. (2017) aim at defining correlations between post-operative patients hygiene level and the number of HAI cases. The researchers provided individual bottles of hand sanitizer to post-surgical patients in August 2013. During the period, nurse practitioners administered hand hygiene education to every patient of the cohort.
A 6-question survey concerning the inspected issue was conducted before the intervention, at hospital discharge, and one, two, and three months after the intervention. The infection prevention staff also tracked the HAI rate to correlate the data to information received from the surveys. The research resulted in finding considerable interdependence between patients hand hygiene and rates of infection with vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus. While the study seems coherent and straightforward, some flaws can be found in the research design.
Introduction
While in the post-operative hospital, patients are arriving from the intensive care unit experience difficulties standing up and moving. Consequently, their ability to practice hand hygiene in the room is also limited as the sink is by the door and a bottle of hand sanitizer that is placed on the wall opposite the patients bed. Haverstick et al. (2017) encountered a question of whether improved patients hygiene, increased access to hygiene products, and patients education could lower the transmission rates of HAIs. The author hypothesizes that patients handwashing with soap and water, hand sanitizer, or both and improved patients education was to reduce the number of HAIs.
This problem is clearly stated and is practically important, as 1 in 25 patients in the acute care settings develops a healthcare-associated infection during their hospital stay (Haverstick et al., 2017). Moreover, in 2011, 722,000 were diagnosed with HAI, and it was the reason for 75000 deaths in the US. The recent change in Medicare hospital payments that do not cover HAIs also implies financial issues on healthcare providers.
The purpose of the study is to develop an understanding of whether patients hygiene correlates with the number of HAI cases in post-operative settings. The key terms are not defined. In summary, while the problem of the study is clear and important, the authors fail to define key terms and the purpose of the research.
Critical Analysis
Literature Review
Before delving into the research, the authors of the article conducted a literature review concerning the relevancy of the matter. The authors reviewed five outside sources that were mostly up-to-date; however, one outdated source was also referenced. All the sources are relevant, and no evidence of bias can be tracked. While a literature review is present, it seems rather scarce and fails to explain the relevance of the research. The authors do not show the tendency in the number of HAI cases; instead, they provide statistics for just one year.
Moreover, the review does not reference other methods of dealing with HAIs and fails to acknowledge similar studies. The literature review fails to address the financial aspect of the HAIs, especially taking into consideration the recent change in Medicare hospital payments. In summary, although a literature review is present in the introduction to the research, it appears to be inadequate and deficient.
Design and Procedures
The research design of the article is appropriate; however, it imposes credibility issues, as it offers poor control over variables. The research type utilized by the authors is quasi-experimental, which is relevant as it is impossible to create proper control groups for the study. The study design is becoming increasingly popular, as it encourages experiments where true experimental designs cannot be applied (Campbell & Stanley, 2015).
The internal validity of such studies is questionable due to the random assignment being impossible (Campbell & Stanley, 2015). As a result, differences in both observed and unobserved characteristics would become due to a chance rather than to a systematic factor. However, Cambell and Stanley (2015) argue that all the experiments are imperfect, and the only concern with the quasi-experiments is understanding where the results can be equivocal. In short, the research type implies questionable credibility of the study, at the same time, it is the most appropriate design given the circumstances.
The research is original; however, due to the low budget, no pilot study was conducted to investigate whether crucial components of the main research were feasible. There were no special procedures except for patients receiving alcohol-based hand sanitizer and The Importance of Hand Hygiene brochures and nurses providing verbal education about the importance of handwashing. In short, while being original, the study had a straightforward design, and no complicated procedures or measurement tools were needed.
Although the authors describe the sample size for the research as small, it seems appropriate. The study was conducted in an adult 36-bed cardiothoracic surgical step-down unit at the University of Michigan Health System. The authors do not disclose the numbers of HAI cases before the intervention and after the intervention and offer only relative statistics. At the same time, the study shows that the survey was conducted among 300 applicants.
While the number is small, it matches the size of the medical unit and the timeframe. According to Haverstick et al. (2017), surgical site infections have the highest rate among HAIs; thus, surgical step-down unit patients seem to be a relevant sample for the research. The variables were the number of HAI cases and the level of hand hygiene standards adherence among patients that were measured with the help of short surveys. In brief, I believe the cohort chosen by the authors is not biased, although the size can be increased.
Data Analysis and Presentation
To analyze the data, the authors compared HAI rates 19 months before the intervention and 19 months after the intervention. They used a nonparametric Wilcoxon rank-sum test, as the sample size was narrow. The findings supported the hypotheses, as significant correlations were found between hand hygiene and rates of infection with vancomycin-resistant enterococci (P=.003) and methicillin-resistant Staphylococcus aureus.
While the findings were promising, the authors acknowledged the possible weaknesses and problems of the study. They mention that the sample size may be insufficient, as the investigation is limited to only one unit in one medical center. Moreover, the research method may be subject to validity questions, as discussed previously in the current paper. In short, data analysis and presentation are appropriate; however, they pose several questions about internal validity.
Conclusions and Implications
The conclusions of the study are not related to the original purpose; instead, they describe implications and give recommendations about further research. The authors state that observations of patients hand hygiene must be made after the patient uses the restroom, before meals, before touching incisions or wounds, before leaving the room, and upon return to the room (Haverstick et al., 2017, p. e8), and I agree with the matter. The results of the study may affect patients and health care providers, as utilization of the guidelines provided by the research can positively influence the financial situation of hospitals and the health conditions of the patients.
The article is coherent and consistent, and the subject discussed is crucial in todays reality; however, several drawbacks can be mentioned. On the one hand, the authors might consider extending the literature review and eliminating outdated sources from it. On the other hand, the study could be extended to other medical facilities to improve the generalizability of the findings in different settings. Even though the changes may make the matter more complicated, they can improve the reliability of the article.
References
Campbell, D., & Stanley, J. (2015). Experimental and quasi-experimental designs for research. Belmont, CA: Wadsworth.
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. Web.
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