Introduction
Hands are directly involved in the transmission of germs that cause sickness. They can spread germs through touch to the nose, ears, eyes, and mouth that enter the body and cause avoidable infections and conditions. Hands also play an important role in a clinical setting as they provide the last line of defense in the chain of transmission of pathogens. According to Andriani and Nadjib (2018), washing hands is easy as it entails using soap and clean, running water, which increases the effectiveness of averting the spread of germs.
The purpose of this discussion is to provide empirical support for the use of hand-washing agents in helping to eliminate bacteria from the hands. The findings illustrate that the use of proper hand hygiene effectively reduces the transmission of microorganisms.
Describing Quantitative Research
Quantitative research entails collecting and analyzing numerical data to test hypotheses or answer research questions. Harkiolakis (2019) argues that the approach is preferred when looking for objective and reliable data, which is analyzed using statistical tools. The approach can be applied to the POI research to assess whether proper hand hygiene is an effective way to prevent the transmission of microorganisms. Quantitative data can be collected on the number of microorganisms in a person’s before and after hand hygiene interventions.
The research could entail a randomized controlled trial (RCT) involving randomly assigning participants to control and intervention groups. Data could be collected by swabbing the hands and counting the colony-forming units (CFUs) of bacteria or viruses in the samples. The study could then measure the difference in the number of CFUs in the hands of the two groups before and after the intervention to determine whether the additional training and education resulted in a significant reduction in the transmission of microorganisms.
Appraisal Tools, Studies, and Matrix
Author, date, and title
Gizaw, Z., Yalew, A. W., Bitew, B. D., Lee, J., & Bisesi, M. (2022). Effects of local handwashing agents on microbial contamination of the hands in a rural setting in Northwest Ethiopia: a cluster randomized controlled trial.
Type of evidence
Quantitative: randomized controlled trial.
Population, size, and setting
220 mothers and caregivers in 11 clusters in the intervention group and 220 mothers or caregivers in 11 clusters in the control group.
Intervention
Researchers provided health education on effective hand washing procedures to both arms, and provided local rubbing agents such as wood ash to the intervention group.
Findings that help answer the EBP question
Hand washing with water and wood ash is significantly better in reducing the concentration of Escherichia coli counts than washing hands with plain water alone.
Measures used
100mL of sterile peptone buffer used to collect Escherichia coli cells from swab sample.
Limitations
Researchers did not assess the pH and microbial quality of the ash used in trails
Evidence level and quality
Lack of data on the adverse effects of using wood ash
Lack of a soap comparator to wood ash.
Use of proxy outcome and a single indicator organism.
Level: Moderate to high quality.
Author, date, and title
Price, L., Gozdzielewska, L., Matuluko, A., Pittet, D., Allegranzi, B., & Reilly, J. (2022). Comparing the effectiveness of hand hygiene techniques in reducing the microbial load and covering hand surfaces in healthcare workers: updated systematic review.
Type of evidence
Quantitative: systematic review.
Population, size, and setting
A total of 28,615 records generated from the search that were narrowed down to 9 articles.
Intervention
All studies used alcohol-based hand rub (ABHR) to investigate some aspects of the WHO 6-step HH technique.
Findings that help answer the EBP question
The WHO 6-step technique reduced microbial load on healthcare workers’ hands.
Measures used
The reviewers independently extracted data from the eligible studies, using a standardized data collection tool (Supplementary file 2).
Limitations
Low evidence and generalizability of findings.
Evidence level and quality
All studies reviewed involved participants who observed hand hygiene.
Level: Low to moderate quality of evidence.
The Randomized Controlled Trial Discussion
Purpose, Research Design, and Methodology
The article aimed to evaluate the effectiveness of different local hand-washing agents in reducing the microbial contamination of hands. The study employed a quantitative cluster RCT research design, which involved steps beginning with participant recruitment and creating the control and treatment groups (Gizaw et al., 2022). The treatment group was trained on proper hand washing, followed by baseline data collection. Midpoint and endpoint data were collected and analyzed using appropriate statistical methods.
Data Collection Procedure, Validity, Reliability, and Related Terms
The data collection procedure was based on the selection and formation of clusters using a simple random sampling method. The researchers swabbed the participants’ hands and stored the data in test tubes (Gizaw et al., 2022). Using the test tubes and their storage in coolers provided a standardized procedure to ensure data validity.
Reliability was observed by collecting data at baseline, midpoint, and endpoint using the same procedure. The participants were provided with the same instructions for hand washing. Additional considerations involved controlling for confounding variables that could influence the study outcome, such as age and gender.
Results and Clinical Implications
The findings revealed that using the locally available hand washing agent, wood ash helped reduce the microbial contamination of hands compared to only using water. Gizaw et al. (2022) also found that the local hand-washing agent was well accepted and preferred by the participants. The results provide vital clinical implications, especially for low-income settings with limited access to soap. The locally available hand washing agents can be a viable option for promoting proper hand hygiene. This can ultimately help prevent the transmission of infectious diseases even as further research is needed to evaluate the long-term effectiveness and sustainability of such interventions.
Level and Quality of Evidence
The study was characterized by a moderately high level and quality of evidence. RCTs are designed to minimize bias and provide a fair comparison between the intervention and control groups, which fits under level 2 of evidence. The research manifested moderate to high-quality evidence based on the procedure that observed the established RCT standards and analysis supported by appropriate statistical tools. The information can be used in practice, especially in low-income settings, with viable and effective alternatives for proper hand washing.
The Systematic Review Discussion
Purpose, Research Design, and Methodology
The study compared and evaluated the effectiveness of different hand hygiene techniques in reducing microbial contamination on healthcare workers’ hands. The research design entails a systematic review with the methodology centered on a comprehensive literature search of electronic databases (Bale et al., 2021).
The authors used explicit criteria to select studies and assess the full texts. Data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Finally, the findings were synthesized, and meta-analysis was performed when appropriate. The authors used the GRADE approach to rate the quality of evidence.
Data Collection Procedure, Validity, Reliability, and Related Terms
Data collection procedures entailed searching electronic databases, including PubMed, Embase, and the Cochrane Library. Price et al. (2022) focused on identifying relevant articles published from 1978 to February 2021. The articles were screened using predefined inclusion and exclusion criteria, and data were extracted from the selected studies using a standardized data extraction form. The process helped to enhance the study’s validity despite the low quality of the included studies and the potential for publication bias.
Reliability was enhanced using a standardized data extraction form and performed by two independent reviewers who resolved disagreements by discussion and consensus. Other considerations include bias and generalizability, as the study aimed to minimize bias. Regarding generalizability, the study focused on healthcare workers, and the results may not apply to other populations.
Results and Clinical Implications
The study included nine articles that met the inclusion criteria, and the results showed that the WHO 6-step technique reduced microbial load on hands. There were mixed results in comparing the effectiveness of the WHO method to the 3-step technique (Bale et al., 2021). The study’s clinical implications are significant as the findings suggest that healthcare workers can use either technique. However, further research should be conducted to identify the most effective and feasible technique.
Level and Quality of Evidence
The research involved the use of a systematic review design. It ranks under Level 1 of evidence as it involves a comprehensive literature review. The quality of evidence could be higher due to limitations in study design and potential biases. Regarding the strength of the evidence, there is some uncertainty in the estimates of the treatment effects. However, the consistency of the evidence regarding the effectiveness of the WHO 6-step technique and the 3-step technique suggests that the evidence is still valuable for making decisions in practice.
Applicability to Practice and Future Research
The Institute of Medicine (IOM) aims to improve healthcare quality by focusing on six dimensions of care: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The study conducted by Gizaw et al. (2022) recommends using locally made hand washing agents, which are cost-effective and accessible in resource-limited settings. This recommendation is consistent with the IOM aim of efficiency as it emphasizes the importance of using resources to maximize their value.
The study also emphasizes the importance of patient-centeredness, which recognizes the importance of incorporating patients’ values and preferences into healthcare decisions. The authors note that participants prefer using locally-made agents because they are familiar with the ingredients and feel they are effective. The agents are also considered effective as they are centered on the local culture. This is particularly relevant in reducing microbial contamination in resource-limited settings where access to commercial agents may be limited.
Additionally, the study in the second article observes the IOM aims by emphasizing the importance of effectiveness by comparing the efficacy of different hand hygiene techniques. The IOM aim of timeliness is using ABHR, which is quick and easy to use and can improve compliance with hand hygiene protocols (Price et al., 2022). The recommended use of ABHR is consistent with the aim of safety as it emphasizes the importance of preventing healthcare-associated infections (HAIs).
Conclusion
Proper hand hygiene is critical in managing the spread of disease by preventing the spread of microorganisms. Different hand-washing agents enhance the effectiveness of the hands is reducing microorganisms carried by hands. The use of ABHRs and wood ash were found to be more effective than the use of water only. The analyzed articles provide a high level and quality of evidence that allow the practical application of findings in clinical settings.
References
Andriani, Y., & Nadjib, M. (2018). The importance of implementation of hand hygiene practice in reducing healthcare-associated infections: A systematic review. KnE Life Sciences, 4(9), 135. Web.
Bale, T. L. A., Ramukumba, T. S., & Mudau, L. S. (2021). Evaluation of compliance to the World Health Organization’s five moments of hand hygiene: Cross-sectional observation of healthcare professionals. Southern African Journal of Infectious Diseases, 36(1). Web.
Harkiolakis, N. (2019). Quantitative research methods: From theory to publication. Createspace.
Gizaw, Z., Yalew, A. W., Bitew, B. D., Lee, J., & Bisesi, M. (2022). Effects of local handwashing agents on microbial contamination of the hands in a rural setting in Northwest Ethiopia: A cluster randomised controlled trial. BMJ Open, 12(5), e056411. Web.
Price, L., Gozdzielewska, L., Matuluko, A., Pittet, D., Allegranzi, B., & Reilly, J. (2022). Comparing the effectiveness of hand hygiene techniques in reducing the microbial load and covering hand surfaces in healthcare workers: Updated systematic review. American Journal of Infection Control. 46, 814 – 823. Web.