504-u5-a3: Evidence Based Medicine Systematic Review Clinical Question

504-U5-a3
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Introduction
When it comes to the medical field, good results are often a foundation for subsequent better outcomes in terms of healthcare and disease prevention or management. The ultimate goal of any medical process or treatment, is the realization of patient recovery or stabilization. For this to be realized, there is always a need to keep exploring and pursuing even better ways of various practices concerning treatment and prevention. It is this ability to fact-find better practices and new experiences which can be borrowed from both within and outside the field, that act as the motivation behind clinical studies. Research that incorporates not only the medical personnel but also the larger society, is crucial in ensuring that the solutions obtained are holistic. This also creates harmony between the two entities. Additionally such collaboration helps in actualizing or making the findings and recommendations of the research study relevant. It all goes down to a seamless collaboration between the main stakeholders in the sector.
Evidence Based Medicine and Practices
The decisions and policies made by healthcare personnel as well as patients, should be particularly informed or depend on the most accurate, reliable, and up to date piece of research findings. This brings to the fore the importance and applications of evidence based practices. Evidence-based medicine hinges on the combination or collaboration of personal medical experience and expertise, with additional outside findings that depend on a systematic review and patient expectations (Gopalakrishnan & Ganeshkumar, 2013). For example, physicians in primary care need a host of evidence for the purposes of their practice at the clinical level as well as policy and decision making in the public domain. Making of informed decisions is key since it simply works off the benefit of an earlier precedent set by previous research findings.
Due to the time factor and availability of extensive literature in the field of nursing and medicine in general, taking articles for review constitutes a primary method of performing evidence based practice. Additionally, considering the fact that most medical personnel are usually so busy to go through all these pieces of literature and synthesize them accordingly, their best alternative is usually systematic reviews (Gopalakrishnan & Ganeshkumar, 2013).The use of systematic reviews has therefore increased flexibility and convenience for the ever-busy medical environment.
The increased need for evidence-based practices in the healthcare sector has been as a result of the increased need for the latest scientific practices incorporated into the system. This is because of the obvious doubts over the underlying threat of limited knowledge by the physicians or responsible personnel in charge. To frame, assess, allocate, repeat and evaluate a question according to the requirement is a process in all the Evidence-Based models. Carrying out a PICOT analysis is one such instance . PICOT stands for P (Problem or Population or Patient), I (Intervention or Indicator), C (Comparison), O (Outcome) and T (Time). The last element, time, however, is optional. This paper is a practical application for implementing a PICOT idea under a particular setting.
PICOT Question
Can Hospital Acquired infection be reduced by increasing compliance to hand hygiene among medical practitioners for four months?
Systematic Review of the PICOT
A systematic review is usually a set of strict and extensive procedures that focus on a comprehensive insight into the interpretation of data and findings of a certain subject, based on a predefined set of questions. Carrying out a systematic review calls for the input of experienced personnel such as methodologists as well as experts (Gopalakrishnan & Ganeshkumar, 2013). Just like a basic selection process, a systematic review aims at sifting out the unsatisfactory sources, to only remain with the best possible pieces of research studies and findings.
In studies that involve more than just one inquiry question, there is the need to come up with a framework or model, known as the evidence-based model, which helps create a chain of interrelationships between the questions involved. Having such a framework essentially helps to create a clear picture of what is needed or what is involved in terms of resources, for the entire process.
In the PICOT question formulated above, the P (Problem/ Population/ Patient) is the hospital-acquired infections which stand to be the problem. The population being investigated is the medical practitioners. The intervention or Indicator (I), is hand washing. The comparison (C) is no hand washing. The outcome (O) is reducing infection. The time (T) is four months. Having such a framework helps create a form of a skeleton upon which the entire study would be wound.
Description of the Systematic Review
A systematic review is very crucial in evidence-based models since it helps the researchers or medical practitioners to fill the gaps left by other literature. It is usually the case in a majority of studies, where the research team focuses on only a specific set of factors for study, thereby making them ignore about the other external aspects that might also impact the study. Through them, the need for further research can be identified. Statistical errors, for instance bias are inevitable in any research. It is, therefore, crucial that they are detected earlier to improve the accuracy of the results of the research. Analysis and evaluation of statistical errors can effectively be evaluated using systematic review. Without the recognition of these errors, the research design will have a lot of inaccuracies which would thereafter spell a catastrophe if put into use.
Review of the Article
The article, Healthcare Workers and Hand Hygiene Practice: A Literature Review authored by Shabib Al Busaidi is a literature review of the research on the topic Hospital hygiene through hand washing. The study is based on the fact that most hospital-acquired infections are caused by poor hygiene. The article uses literature reviews to deduct the importance of hygiene in the hospital sectors. It also provides hand-hygiene procedures that are cost effective and efficient as well.
It also compares the hand washing as a method of improving hygiene to other cost-effective methods such as hand rubbing using alcohol hand-rubs. It points out hand washing as one of the major methods that can lead to improved hygiene and thus reduce hospital-acquired infections. It is also noted in the article that there are various barriers that hinder these methods from being practiced. Among the barriers is the lack of awareness, culture, attitudes among the medical practitioners.
Among the sources that the article covered include both online and printed sources. Some of these sources include the following; ScienceDirect, Medline, and CINAHAL. The criterion through which the sources were selected includes;
1) The source must have been in full text,
2) Published within ten years and
3) Published in English.
Findings indicate that hand hygiene was one of the most cost-effective and easier ways of preventing cross infections. It was also found that the best hand hygiene technique was hand washing either with alcohol hand-rubs or medicated soaps. Despite hand hygiene being the most effective method to curb this menace, compliance has been the biggest hurdle. It was found that for the strategy to become effective, several intervention approaches must be put into place. Some of the identified organizational and professional barriers to hand hygiene include lack of awareness, culture, and attitudes among others.
The evidence the author of the above-named article used was the review of recent research on the same topic. Applying the same on my practice, I will use the following recent researches. Studies by Sickbert-Bennett & Wolak et al. 2016 on Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices showed that a change from high compliance to very high compliance to hand hygiene. This was a study conducted within two years that is, between 2013 and 2015. This took place at the University of South Carolina Hospitals. The outcome of the research was that an increased compliance (p< 0.001) reduced hospital-acquired infections by the rate of p=0.0066.
Studies by Nair & Hanumantappa et al., 2014 titled Knowledge, Attitude, and Practice of Hand Hygiene among Medical and Nursing Students at a Tertiary Health Care Centre in Raichur, India show the following. Among the 46 nursing and 98 medical student participants, the results are as quoted below. "Only 9% of participants (13 out of 144) had go...