In Part A, you described the population and quality initiative related to your PICOT (Population/Problem, Intervention, Comparison, Outcome, and Time to achieve the outcome) statement. In this assignment, you will formalize your PICOT and research process.
Use the GCU Library to perform a search for peer-reviewed research articles. Find five peer-reviewed primary source translational research articles.
In a paper of 1,250-1,500 words, synthesize the research into a literature review. The literature review should provide an overview for the reader that illustrates the research related to your particular PICOT. Include the following:
Introduction: Describe the clinical issue or problem you are addressing.
Methods: Describe the criteria you used in choosing your articles
Synthesize the Literature: Part A: Discuss the main components of each article (subjects, methods, key findings) and provide rationale for how this supports your PICOT; Part B: Compare and contrast the articles: Discuss limitations, controversies, and similarities/differences of the studies.  Population Health Research and PICOT Statement Literature Review
Areas of Further Study: Analyze the evidence presented in your articles to identify what is known, unknown, and requires further study.
You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
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 Benchmark – Part B: Literature Review

Introduction

Hospital-acquired infections (HAIs) are infections that inpatients acquire after 48-hours of hospitalization. HAIs present a significant public health issue since they are a leading cause of increased morbidity and mortality; prolonged hospitalization; and higher healthcare costs (Haque et al., 2018). According to Wang et al (2019), the rate of HAIs in developed countries ranges from 3.6 to 12% while in developing countries the prevalence is between 5.7 to 19.1%. Hand hygiene has been demonstrated to play a major role preventing and reducing the rate of HAIs. Therefore, this paper will review the literature regarding the efficacy of alcohol-based hand rubs (ABHRs) Rand handwashing using water and soap in preventing and reducing the rate of HAIs.

PICOT Question

PICOT stands for P (Patient/Population); I (Intervention); C (Comparison); and T (Time). The PICOT question in this literature review is, “Among hospitalized adult patients (P), does the use of alcohol-hand rubs (I), when compared to handwashing using water and soap (I), help in reducing the rate of HAIs (O), within 4 months (T)?”

Method

The literature review involved comprehensively searching the nursing and medical databases including PubMed, CINAHL, Web of Science, and Wiley library. Only studies published in the last five years were considered and articles available in English language. The search and key terms used to search and retrieved research articles were hospital-acquired infections; hand hygiene; alcohol-based hand rubs; and handwashing soap and water. Articles were selected based on their relevance and application to the study topic and the PICOT question. Therefore, thorough scrutiny of the abstracts and titles was done for each retrieved article. After the articles were retired, the Critical Appraisal Skills Programme (CASP) tool was used to critically analyze the articles for quality. Critical analysis using the CASP tool yielded 5 articles that were considered relevant to the PICOT question and the study topic, and also met the set inclusion criteria.

Literature Synthesis: Part A

Saito et al (2017) performed a quasi-experimental study that was conducted to investigates the hand hygiene practices of healthcare workers using ABHRs and the rate of HAIs. The findings of the study showed that observing hand hygiene by healthcare providers significantly improved when ABHRs were used. Similarly, there was also a notable reduction of HAIs when ABHRs were utilized (Saito et al., 2017). This study is relevant to the PICOT question because the findings indicate the efficacy of ABHRs in lowering the incidence of HAIs.  Population Health Research and PICOT Statement Literature Review

Al-Biltagi et al (2014) conducted a study to investigate and compare the efficacy of using alcohol to antiseptic soap, antiseptic soap, and non-medicated soap in the elimination of pathogens through standard appropriate pre-operative hand preparation. The method of the study was a cross-sectional experimental prospective study where health trainees and medical student volunteers were recruited. During the study, 20 participants used all three preoperative hand preparations (alcohol, antiseptic soap & non-medicated soap). The study findings indicate that alcohol-based hand preparation was more effective in eliminating germs when compared to non-medicated soap and antimicrobial soap (Al-Biltagi et al., 2014). Therefore, the findings indicate the efficacy of alcohol-based products in eliminating microorganisms and germs. This article supports the PICOT question by demonstrating the efficacy of ABHRin eliminating germs and microorganisms in the hand of healthcare providers. This can lead to a reduced rate and incidence of HAIs.

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The study by Andriani & Nadjib (2018) aimed to evaluate the hand-hygiene practices among healthcare providers that are effective in reducing HAIs. The study is a systematic review and research articles for this study were retrieved from various databases like SAGE and ProQuest. The keywords used to locate articles were hand-washing, hand-hygiene, and healthcare-associated infections. After critique analysis for quality and relevance, 5 articles were selected. The findings from the systematic review showed that hand hygiene is very effective in preventing and reducing the rate of HAIs (Andriani & Nadjib, 2018). This study is relevant to the PICOT question as it provides evidence regarding the efficacy of hand hygiene in preventing and reducing the rate of HAIs. Population Health Research and PICOT Statement Literature Review

The purpose of the study by Shobowale et al (2016) was to evaluate the adherence of healthcare providers to the World Health Organization (WHO) stipulated 5 moments of hand hygiene. The study used an observational, cross-sectional methodology where the adherence of healthcare providers to hand hygiene was monitored through observation for 60 days. The findings indicate that the compliance to hand hygiene practices among healthcare providers in the study was very low especially with handwashing practices (Shobowale et al., 2016). The article is relevant to the PICOT question because it provides evidence regarding low adherence to handwashing. Low compliance with hand-hygiene practices is allied to high rate of HAIs.

The study by Al Kuwaiti (2017) performed a prospective interventional study to examine the impact of a multicomponent HH intervention strategy in improving adherence to hand hygiene and lowering the rate of HAIs at King Fahd Hospital. The adherence of healthcare providers to the recommended hand hygiene practices was observed and the rate of HAIs pre- and post-intervention examined. The findings of the study showed that the multicomponent intervention in improving adherence to hand hygiene among the hospital staff and reducing the rate of HAIs in the hospital (Al Kuwaiti, 2017). This study is relevant to the PICOT question as it provides evidence regarding the efficacy of hand hygiene in reducing the rate of HAIs.

Literature Synthesis: Part B

The study by Andriani & Nadjib (2018) is a systematic review and thus provides the highest evidence level about the efficacy of hand hygiene in preventing and reducing the rate of HAIs in healthcare organizations. Al Kuwaiti (2017) is a retrospective study that was performed for a long-time duration and data collection done at regular time intervals and this increased the validity and reliability of the study’s findings. Al-Biltagi et al (2014) and Shobowale et al (2016) performed cross-sectional studies using large sample sizes and the studies were conducted in different phases which increased the reliability and validity of the findings. This allows the generalization of the finds.  Lastly, Saito et al (2017) performed a quasi-experimental study. The limitations associated with this study include being conducted for a relatively short time period and small sample size. This may limit the generalization of the findings and also limit the application of the findings to practice.

However, all the five studies included in the literature review indicated that hand-hygiene is an effective intervention in reducing the rate of HAIs, and also healthcare providers tend to show increased compliance to the recommended hand hygiene measures when ABHR are used as the hand hygiene technique.

Areas of Further Study

The synthesized literature indicates the efficacy of hand hygiene in prevention of HAIs. Additionally, the literature also shows alcohol hand rubs promote increased adherence to hand hygiene and thus reduces the incidence of HAIs. However, the synthesized literature does not indicate other measures that can be used to reduce the rate of HAIs in healthcare organizations. Further research is needed to understand if the integration of surveillance of HAIs into routine practice reduces the rate of HAIs and to identify other strategies and measures that can further prevent and reduce the rate of HAIs, especially in healthcare settings with limited resources. Moreover, it is necessary to conduct further research on educational programs that can address the issue of poor adherence to hand hygiene techniques.  Population Health Research and PICOT Statement Literature Review

References

Al-Biltagi, M., Al-Ata, J., Jiman-Fatani, A. A., Sindy, A., Alghamdi, A., Basabrain, A., … & Alzomity, A. (2014). Comparative Study of the Efficacy of Brushless Surgical Hand Preparation Techniques Using Antiseptic Soap, Alcohol, and Non-medicated Soap. Journal of Advances in Medicine and Medical Research, 1663-1671.

Andriani, Y., & Nadjib, M. (2018). The Importance of Implementation of Hand Hygiene Practice in Reducing Healthcare-associated Infections: A Systematic Review. KnE Life Sciences, 135-145.

Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Healthcare-associated infections – an overview. Infection and drug resistance, 11, 2321–2333. https://doi.org/10.2147/IDR.S177247

Saito, H., Inoue, K., Ditai, J., Wanume, B., Abeso, J., Balyejussa, J., & Weeks, A. (2017). Alcohol-based hand rub and incidence of healthcare-associated infections in a rural regional referral and teaching hospital in Uganda (‘WardGel’study). Antimicrobial Resistance & Infection Control, 6(1), 129.

Shobowale, E. O., Adegunle, B., & Onyedibe, K. (2016). An assessment of hand hygiene practices of healthcare workers of a semi-urban teaching hospital using the five moments of hand hygiene. Nigerian medical journal: journal of the Nigeria Medical Association, 57(3), 150–154. https://doi.org/10.4103/0300-1652.184058

Wang, L., Zhou, K. H., Chen, W., Yu, Y., & Feng, S. F. (2019). Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015. BMC infectious diseases, 19(1), 145.

Population Health Research and PICOT Statement

Grand Canyon University

June 17

Benchmark – Part A: Population Health Research and PICOT Statement

Population’s Demographics and Health Concerns

The selected health concern is hospital-acquired infections (HAIs). According to Wang et al., (2019).) HAIs are a major public health issue that affects millions of patients in healthcare organizations. HAIs refer to the infections that occur to inpatients after being admitted for over 48 hours. HAIs are among the leading cause of elevated mortality, morbidity, prolonged admissions, and increased healthcare costs. The prevalence of HAIs ranges from 3.6 to 12% in developed countries, while the prevalence in developing countries ranges from 5.7 to 19.1% (Wang et al., 2019). The predisposing factors to HAIs include prolonged hospital stay, presence of a serious illness, and excessive use of antibiotics, especially in patients within the intensive care unit (ICU).

Ineffective hand hygiene among healthcare providers is the leading contributing factor to the high occurrences of HAIs. The hand of healthcare providers harbor micro-organisms like resistant gram-negative bacteria, MRSA, and clostridium difficile (Wang et al., 2019). Additionally, the skin contains numerous epithelial cells that are normally shed and contain viable pathogens that can cause contamination to the medical devices and equipment within the patient’s environment. The units with the highest incidents of HAIs within hospital settings include the ICU, critical care unit, the emergency department, and the surgical unit due to the high rates of hand contamination (Haque et al., 2018). The hands of the healthcare providers gets contaminated when the provider touches the intact skin of the patients, touches the medical equipment, or when performing medical procedures such as catheterization or taking the vital signs of the patients.

Health data from the CDC  show that every year over 2 million patients are admitted to hospitals and get HAIs when being treated for other health conditions. Out of the 2, 000, 000 patients, approximately 10, 000 patients die from the HAIs (Despotovic et al., 2020). Accordingly, this shows that the mortality rate from HAIs is very high and therefore this health concern should be addressed. For the provision of high-quality care that ensures patient safety, the prevention of HAIs should be a priority. In the United States, 1 out of 136 patients gets severe health conditions due to HAIs. This is equivalent to 1.7 million cases every year; this leads to about 90, 000 deaths annually and an increase of healthcare costs between $ 4.0–5.0 billion (Despotovic et al., 2020).

Evidence shows that there are various reasons why the rate of HAIs has been rising at an alarming rate (Kalata et al., 2015). First, the medical and surgical procedures have significantly increased, as well as the weakened immunity associated with illness during hospitalization. Therefore, the transmission of pathogens from healthcare providers to patients during care and development of infection is very possible among the admitted patients. Population Health Research and PICOT Statement Literature Review

Moreover, even though the majority of healthcare organizations have implemented hygiene protocols, including hand hygiene, adherence to these protocols is poor. Therefore, the leadership within healthcare organizations should facilitate the effective implementation of the hygiene protocols necessary in preventing HAIs (Vermeil et al., 2019). Healthcare providers should utilize the well-established and effective techniques to assist in preventing infections such as infection control policies and procedures (Vermeil et al., 2019). Healthcare providers also need to adhere to the implemented hand hygiene procedures, personal protection equipment, and other infection control procedures.

There is a significant advancement in the healthcare industry regarding the pathology of communicable diseases and the spread of multi-drug resistant infectious diseases from one individual to another within healthcare organizations. The evidence further indicates that the hands of nurses are the major sources of HAIs among hospitalized patients with critical illnesses (Vermeil et al., 2019). Such evidence supports the need for further research regarding how adherence to basic hygiene principles in healthcare organizations can be used to prevent HAIs.
Among hospitalized adult patients (P), does the use of alcohol-hand rubs (I), when compared to handwashing using water and soap (I), help in reducing the rate of HAIs (O), within a period of 4 months (T)?
Health equity involves the provision of equal care in terms of quality regardless of personal aspects such as socioeconomic status, ethnicity, gender, or age. For the healthcare-acquired infections, research institutions, and health bodies such as CDC and WHO  have published policies and guidelines that outline the appropriate hand hygiene practices within healthcare organizations. All hospitals are obligated to adhere to these policies and guidelines. According to the guidelines, healthcare providers are supposed to use alcohol-based hand rubs in decontaminated their hands while the visibly soiled hands, handwashing using water should be used as the hand hygiene technique (Toney-Butler & Carver, 2018).

References

Despotovic, A., Milosevic, B., Milosevic, I., Mitrovic, N., Cirkovic, A., Jovanovic, S., & Stevanovic, G. (2020). Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. American Journal of Infection Control, 1(1). DOI number or Retrieved from info is required.

Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Healthcare-associated infections – an overview. Infection and drug resistance, 11, 2321–2333. https://doi.org/10.2147/IDR.S177247.

Kalata, N. L., Kamange, L., & Muula, A. S. (2015). Adherence to hand hygiene protocol by clinicians and medical students at Queen Elizabeth Central Hospital, Blantyre-Malawi. Malawi Medical Journal, 25(2), 50-52. DOI number or Retrieved from info is required.

Toney-Butler, T. J., & Carver, N. (2018). Hand, washing (Hand hygiene). Treasure Island (FL): StatPearls Publishing.

Vermeil, T., Peters, A., Kilpatrick, C., Pires, D., Allegranzi, B., & Pittet, D. (2019). Hand hygiene in hospitals: anatomy of a revolution. Journal of Hospital Infection, 101(4), 383-392.

Wang, L., Zhou, K. H., Chen, W., Yu, Y., & Feng, S. F. (2019). Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015. BMC infectious diseases, 19(1), 145. DOI number or Retrieved from info is required.

Rui, please review all comments/corrections in the graded paper. Dr. Pampkin

Heading should be in bold typeface. Correct all headings in the paper, as applicable.

All acronyms must be defined with first use. To use acronyms, you must write the written words with the acronym beside the written words in parentheses. After the acronym is identified appropriately with first use, using the acronym is appropriate. Correct all undefined acronyms in the paper.

Population Health Research and PICOT Statement Literature Review