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PICO Analysis Hand-Wash Revisionre Add in library

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Question :

Section 1: Identification of appropriate research designs
Give a brief background to set context, and state your question. Using the scholarly literature to support your work, answer the following questions.
(1) What type of question is this?
(2) What is the most suitable research design to answer this question? What ethical considerations that would need to be addressed in order to carry out such a study?
Section 2: Evaluation of a research article
Find an original research article (ie NOT a review) that provides evidence to answer the question. Give the full citation for the article first, and then using the scholarly literature to support your work, answer the following questions.
(1) What is the study design used in the article?
(2) What methods did the researcher/s use to collect and analyse their data, and why?
(3) What are the key findings of the study? 
(4) How do these findings help to answer your clinical question, considering your population and practice setting?



Answer :


Section 1: Identification of appropriate research design

Health care support and knowledge of effective health care practice are two crucial requirements for the wellbeing of the societal health. Similar to the adoption of optimum intervention and treatment regime, it is important to utilize and monitor some of the key requirements in routine practice. Hand washing is one of the effective practices, which is necessary to be followed for effective health restoration of self as well as for the patients to be addressed for effective health care services (Grol 2013, 167). The incorporation of this practice is important for not only the professionals involved in health care practices, but also in the domestic and routine daily life activities. For the purpose of present research, the PICO based approach is aimed in addressing the question, “Does hand washing stop infection?”


(1) The adopted pattern of research in conjunction to the present scope of the report, can be made framed in quantitative approach. Such approach will be based on objective of collective numerical data that can be analyzed using suitable mathematical and statistical methods for finding significance and relevance of the research. It is hence these significant numerical results can be further used to elucidate psychological and relevant noteworthy results. On the other hand, the use of qualitative research is used to collect ideology and views that can be further helpful for prediction and determination of the hypothesis and corresponding inference (Can, 2011, pp.485). Randomized controlled trials (RCTs) are useful in this regard, as they help in making the results valid, robust and precise for the identification of true positive results. In other words, it can be said that the approach is helpful for the exclusion of false positive results.

(2) Use of RCTs in finding the true positive results in conjunction to any research question is important as because it helps in providing predictable, reliable and sufficient results. Furthermore, while accounting of the importance of evidence based research, it is more important to consider the unbiased control study. This not only helps in extracting un-biased information but will also have a provision of including control study. This on the other hand, fetch option towards the ease of comparison and precise way of judgment (Shrank, 2011, pp.546). The concerned question in the present report is to consider the effectiveness and efficacy of hand washing in conjunction to the control and spread of infection. Thus, the group to be considered for the study should be based on a group following regular practice of hand washing, whereas another group not practicing the hand washing practice. Other than this, the individual involved in hand washing practice should be exempted from the consideration of this research work.

The ethical consideration is based on taking consent for the individuals involved in following the requisite guidelines for the scope of research and that the reliance of research output will be based on their views and inference.


Section 2: Evaluation of a research article

In conjunction to the present research scope of this report, the concerned prospect is to find out the effectiveness and efficacy of hand washing practice against the prevention of infection. It is hence for the same work, the adopted research article is, “Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward” (Beggs, 2008, pp. 114).

(1) The quantitative type of research work presented by the author in the article is considered in a medical ward of health care setting. More importantly, the impact of hand washing practice was studies in conjunction to infection caused by staphylococcal species. Based on the general indication that the infection by staphylococcal species can be transmitted with the infected hands from the colony formed by the concurrent species. It is hence, the general indication being that without the practice of proper hand washing, there is higher chances of acquired infection with the species. Such impact of imperfect hand washing can be thus revealed with the help of infection, as per the hypothesis of the authors.

(2) As discussed in the previous section, the hypothesis for the concern is whether hand-washing practice can be helpful in preventing the infection. With the same hypothesis, the authors have concluded the research for the aim of impact of hand cleaning over the transmission of infection.

The grouping of the patients were made by the authors into two parts, one where the members are susceptible with staphylococcus infection and another group where the number of colonized patients are present. The total number of subjects (individuals) under consideration are thus constant throughout the time-period of intervention. Similarly, in another group, one part is individuals not affected with the infection and another part, which are colonized with the infection in temporary terms. The removal rate of the un-colonized patients is thus considered as impact, which also includes removals due to death, transfer to another ward with more severe form of infection and discharge with health recovery. Based on the inference obtained with the help of the experimental results, the numerical terms are not further processed for statistical inference, but are subjected to mathematical modeling.


On the contrary, with the help of mathematical modeling, the obtained numerical factors were considered with the help of differential equation. More precise detail of the mathematical modeling and coefficient factors that are used with the help of studies can be obtained and read in the paper. Hence, the final conclusion was made with the help of differential equation, which gives inference, either the infection will be removed or will be acquired even after the hand washing practice.

(3) The key finding of the suggested research article, can be said not to be in accordance to the hypothesis of the authors. More accurately, it was revealed with the controlled study, that the effectiveness of hand washing is not probable for the control of the staphylococcus infection. It was found in the that the hand washing in general terms is not an effective control measure, as the transmission being still dynamic in both the groups. Moreover, the return of the infection is also not being controlled. The benefit of hand washing is there as revealed by the authors, but the effect is not more than 20%. The infection state despite of the hand washing, is still dependent on the contact made with the contact made to the infected patients. The complication rate is that was incurred in 40 percent of the colonized patients were also found to be occurring even with the adoption of precise hand washing practice. On the contrary, it was found that ward management, hawthorne effect, and environmental contamination was found to be in control with the adoption of such practices.

For precisely the deterministic mathematical modeling used for the understanding of the hand washing practice was found to be a hygienic practice, but is not effective for the purpose of prevention of staphylococcus infection. The average prevalence of the staphylococcal infection in hospital ward are not found to be reducing in the course of assessment by the authors. Such inference was derived on the basis of inconsistency in the outbreaks of staphylococcal infection.

(4) It can be said that with the help of this study, the authors concluded that simple hand washing practice is not effective in the progression of crucial infection such as by staphylococcus species. Other than this the limitations included within the study, are not being discussed by the authors. These limitations can be attributed to the use of other agents such as disinfectant or alcohol based hand wash agents, or use of medication in the solvent for the hand washing purpose was not being discussed by the authors. Certainly, inclusion of these elements in the study, may have potential to increase the importance and specification for the future course of medication specification. Hand washing in general is an effective practice that should be adopted for the clean and hygienic purpose, that is useful for the effectiveness in health restoration and health management purpose. With respect to the population side, it is useful for the inclusion of criteria such as gastric and respiratory diseases. Certainly, these things are effective for the avoiding of many of crucial infection such as infection caused by pathogenic stains of E. coli and parasitic infection where spores can be transferred with the help of soil contact. Other than this, cleaning of the hospital ward or domestic area with the help of disinfectant agents or medicated solutions is also important for the communication of disease. In other words, hand washing is an effective process for the health restoration and management, but it is also true that the said practice is not effective in control of all kind of infection.


Conclusion :

In conclusion, the said report is based on the clinical question for the research, on the assumption, whether the hand washing practice is effective for the control of the infection. The approach for the research is PICO(T) model and will be considered on the population study (Polit & Beck, 2013, pp.400). In order to collect the evidence in conjunction to the same study, a research paper was collected and reviewed to understand the hypothesis analysis, understanding of the ideology for carrying out the research and the basic inference of the research work was carried out. More importantly, with the help of literature review, designing of randomized controlled study was also analyzed with the help of this study. Particularly, from this paper, it was revealed that hand washing is not found to be effective for the certain infection, whereas there are many infection especially parasitic one, which can be controlled or prevented with the help of routine hand washing practice. It is hence the inclusion of such studies for the future scope of research can prove worthy and make sense for the inclusion of such practice in routine health care practices and domestic purpose.



Beggs, CB, Shepherd, SJ, & Kerr, KG 2008. Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward. BMC infectious diseases, 8(1), pp.114.

Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). 2013. Improving patient care: the implementation of change in health care. John Wiley & Sons, pp.167-189.

Can, OS, Yilmaz, AA, Hasdogan, M, Alkaya, F, Turhan, SC, Can, MF, & Alanoglu, Z 2011. Has the quality of abstracts for randomised controlled trials improved since the release of Consolidated Standards of Reporting Trial guideline for abstract reporting? A survey of four high-profile anaesthesia journals. European Journal of Anaesthesiology (EJA), 28(7), pp.485-492.

Shrank, WH, Patrick, AR, & Brookhart, MA 2011. Healthy user and related biases in observational studies of preventive interventions: a primer for physicians. Journal of general internal medicine, 26(5), pp.546-550.

Polit, DF, & Beck, CT 2013. Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins, pp.400-458


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