The article discussed in the paper is devoted to the topics of patient safety and specific measures implemented to prevent the spread of infections in intensive care and surgical units. The qualitative study by Hor et al. (2017) was published in the BMJ of Quality and Safety, a peer-reviewed journal with an impact factor exceeding 7. Using the themes from interviews with healthcare providers and videotaped observations, the authors demonstrate the contribution of logistics in healthcare settings to successful infection prevention efforts.
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Background of Study
The clinical problem that encouraged the researchers to conduct this study is inextricably connected to the existing differences between the recommended hygiene practices for providers and their actual uses. In particular, explaining the clinical problem, Hor et al. (2017) state that the average hand hygiene compliance rates do not exceed 40%, which indicates that “perfect compliance” is not possible due to everyday practical issues (p. 552). In general, the theory of infectious disease prevention does not present a research gap. However, its practical applications and related barriers are not fully studied, and the researchers focus on this problem to improve the effectiveness of infection control practices.
The significance of the study is established with the help of statistical data concerning the outcomes of nosocomial infections. In particular, the authors emphasize the contribution of hospital-acquired infections that affect “hundreds of millions of patients” annually to adverse patient outcomes and related healthcare costs (Hor et al., 2017, p. 552). With that in mind, the purpose of this study is to encourage healthcare workers to analyze their efforts aimed at infection prevention and, therefore, learn more about practical problems and considerations that can impact infectious morbidity rates in patients.
The work answers the research questions related to infection control practices other than hand hygiene and the key nurse-perceived problems in transmission prevention. Therefore, both purpose and research questions apply to the studied research problem.
Methods of Study
The experimentations decision to apply qualitative research methods is justified by the nature of the research problem and the great role of subjective experiences in it. Concerning the perspective from which the study was developed, the researchers emphasize the experiences of nurses since they present the majority of participants, but this methodological aspect is not thoroughly analyzed in the work. To support their discussion of the clinical problem and the state of the art, Hor et al. (2017) cite almost thirty peer-reviewed sources that utilize both qualitative and quantitative methods of research.
Some of them are presented by studies with high levels of evidence such as systematic reviews, and experimental studies can also be found among references. Other types of literature used to strengthen argumentation include official reports by international associations tasked with disease prevention and infection control guidelines offered by WHO and local organizations in Australia.
The used references are dissimilar in terms of the date of publication. Thus, the majority of quantitative studies from the reference list are recent (2012-2016), but some older studies are also present. At the same time, professional reports, guidelines, and qualitative sources tend to be less up-to-date, with the oldest one published in 1983 (Hor et al., 2017). Given that some studies are not recent, their findings can seem incomplete compared to more modern works. Despite that, the researchers do not criticize the used literature and discuss their weaknesses; instead, they indicate that some research methods found in earlier studies are used in their project with minor changes.
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Importantly, the article does not have a section fully devoted to the review of literature, and the majority of sources are cited in the introduction. Even though the review is not structured conventionally, the authors manage to include enough information to present logical arguments and proceed from the problem of non-compliance in nurses to their approach to solving it.
For example, the review includes statements concerning the variability of compliance rates and the need to consider the human factor and situational issues when conducting safety audits (Hor et al., 2017). Despite the practical significance of their findings, the researchers do not develop a new framework for infectious disease prevention in acute care settings. However, one of their conclusions points at the potential of boundary work in bridging the gap between the theory and practice of nosocomial infection prevention.
Results of Study
The findings provide explicit and clear answers to the research questions and therefore, align with the purpose of the study. To begin with, having analyzed videotaped observations and interview transcripts, the researchers single out a range of themes in everyday infection control practices. Among them are the use of personal protective equipment, hand hygiene, task distribution in teams, aseptic techniques, and the so-called “from clean to dirty” principle of conducting examinations (Hor et al., 2017, p. 556).
Also, the authors define two practitioner-perceived problems in infection prevention. They are the multitude of “things other than hands” that are not cleaned regularly and the presence of ignored boundaries related to different body parts or wounds of the same patient (Hor et al., 2017, p. 555). Concerning the findings’ practical implications, they include the need to pay focused attention to the logistics of nursing care to create successful infection control strategies.
The findings linked to the existing practical problems contribute to nursing science in several ways. To begin with, they shed light on the causes of healthcare providers’ inability to eliminate the cases of nosocomial infections such as the lack of holistic analysis of everyday care manipulations and their safety. Apart from that, the results help attract modern researchers’ attention to some unobvious factors in pathogen transmission, for instance, doctors’ personal objects.
Due to their nature, the findings can impact both nursing practice and education. As for practice, the need to reconsider the logistics of medical and nursing manipulations may lead to the introduction of new rules regulating the use of personal items in patients’ rooms. Speaking about education, it is possible to use the research results to update educational materials for nurses devoted to infection control.
Speaking about the problems of ethics, the researchers obtained ethical approvals from different institutions in Australia. Among them are the University of Tasmania and other hospital ethics committees (Hor et al., 2017). The privacy of all 177 participants and involved patients was protected, and both written and verbal consents were obtained from them before the use of interviews and videotapes. Considering the used methodology, ethical problems related to treatment or its absence were not relevant.
To sum it up, the reviewed study delves into the topic of hospital-acquired infections and adds to the existing knowledge about everyday applications of disease prevention guidelines. The findings refer to the degree of effectiveness of currently used practices and neglected problems, which explains their relevance to nursing practice and education. In general, when it comes to the knowledge learned, it is linked to the need to reconsider the role of logistics-related concerns in the prevention of nosocomial infections and risk assessment efforts.
Hor, S. Y., Hooker, C., Iedema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O’Sullivan, M. V. N. (2017). Beyond hand hygiene: A qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ of Quality and Safety, 26(7), 552-558. Web.