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PICO Hand Washing Alcohol Final: Research And Evidence Add in library

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Question :

Section 1: identification of appropriate research design

Using the question from assignment 1(or an amended version) and scholarly literature to support your discussion, identify and explain :

(1) What type of questions you are asking ?

(2) The most Suitable research design to answer this question ?

(3) Any Ethical consideration 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 that provides evidence to answer the question. 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 use to collect and analysis their data and why ?

(3) What are the Key finding of the study ?


Answer :

Section 1: identification of appropriate research design

The concern of hygiene and cleanliness is crucial for the health restoration as well as management purpose. The concern of patient safety and avoidance of acquired infection can be maintained with the regulation of proper hand washing problem. The reason being that most of the bacterial and other viral infection are communicable with hands soiled with infection and contaminants containing pathogenic stains or spores of the pathogen. Alcohol or spirit is believed to be an effective agent as disinfectant or agent having potential to kill the pathological agents. It is thus a wise concern to use this agent for handing rubbing either as a solvent, or in combination with other solvent as hand agent (Hugonnet, 2002, pp.1037). In this regard, the question of concern, being, “Is alcohol based hand rub as effective as hand washing?”


(1) The questioning for the concern is related to the efficacy and effectiveness of incorporating alcohol in the preparation of hand washing agents (Israel, Schulz, Parker & Becker, 1998, pp.173). In general this can be related to a qualitative intervention type of question, where the effectiveness of alcohol based hand rubs will be measured and assessed. The assessment should be thus based on two particular concerns, one being the type of alcohol suitable for the use of hand washing agents. Likewise, the second concern being the efficacy of alcohol rubs in comparison to normal soap and water for the purpose of hand washing.

(2) The suitable research design can be made in conjunction to questioning the health care professionals, especially the nurses and other staff. This will help in giving an idea and the associated risk of the disease and hospital acquired infection, in the routine practice. it is hence the efficacy and efficiency of alcohol based hand rubs can be evaluated. It is hence the clinical and specific health related concerns as well as the hygiene satisfaction, maintenance of the health conditions and prevention of risk of infection in any situation can be measured with the help of such intervention approach. Other than this, there does also exist, a scope of quantitative infection, where the reduction in the numbers of hospital acquired infection and maintenance of infection free conditions can be assessed. It is important to note that such consideration and approach will take a lengthening time, compared to question based research.

(3) For the intervention related research, randomized controlled test should be thus used. RCTs being the most valid form of research where the accuracy and validity of the results can be used as evidence in future scope of research and practice (Becker, Bryman & Ferguson, 2012). Furthermore, the consideration of the unbiased control group of study can be incorporated within such design, which is analogues to second position in the hierarchy of evidence based research and facts. This will not only include the ideology and facts from health care professionals as other public can contribute to this health related intervention. The research can also be carried out with the inclusion of patient community under the scope of qualitative based intervention of questions.


Section 2: Evaluation of a research article

For the scope of research article reading and evaluation, the research paper adopted is, “Effectiveness of alcohol-based hand disinfectants in a public administration: Impact on health and work performance related to acute respiratory symptoms and diarrhea” (Nils-Ofal et al, 2010, pp. 250).

(1)  In the said research article, the authors have used intervention control group for the purpose of study, where the epidemiological and economical characteristics where considered for the assessment of alcohol based hand disinfectant study. The type of study can be referred to as RCTs, which was based on quantitative assessment. The research was devised to be carried out in the form of questionnaire and is helpful in collected quantitative inference. The study was carried out in conjunction to workplace, where the prospective, controlled and specific group was considered for the execution of the study. The work was confirmed with the help of statistical significance of the results and was based on significance level of results.

(2) The randomized control study used by the authors in the execution of said study was well discussed in the above section. This study can be said as an example of qualitative study, since the corresponding results were based on numerical inference. It was found that the volunteers working in the public administrative services of the municipality corporation was divided into two groups. It is hence one group was given alcohol-based hand washing agent and the group act as control without any alcohol content in the hand washing agents. The intervention questions were based on the gastrointestinal and respiratory related diseases on monthly basis for a period of one year. In total, the total number of people evaluated for the purpose were 1230 person months. For the ethical consideration, the volunteers involved in the study were declared with written consent for the participation. In total 134 people were included in the study. More importantly, it was found in the paper, that the individuals using the hand wash in regular manner were exempted from the study, whereas those, which are not using the hand washing agents, were involved in the study.

Regarding the use of alcohol, two types of alcohol were used, such as Amphisept E (containing ethanol) was used which have antibacterial, antifungal and virus inactivating agents. Other than this, the participants facing some problem related to skin infection, such as redness, dryness and itching were supplied with Sterillium containing  1-propanol (30% w/w), 2-propanol (45% w/w) and mecetronium etilsulfate.

The information of the study as collected with the help of intervention studies were based on the health aspects related to respiratory and gastrointestinal infection case were asked routinely on monthly basis for a year. All these results were correlated with control group, where the hand wash agent do not contain alcohol content.


The analysis of the results were made with the help of statistical tools and parameters applied over the results. The popular method used for the study were ANOVA and MANOVA for the analysis of variance. Other non-parametric analysis were made with the help of Puri and Sen’s L-statistic analysis. The significance level of the parameters were carried out with the significance level of p = 0.05. r2 was also used for the analysis which was calculated as ration of statistical significance (from regression analysis) and statistical significance (from total correlation).

(3) With the help of presented research study, the authors were able to find the effectiveness of the alcohol based hand-washing agents over the diseases such as respiratory agents and gastrointestinal infection. It was evidenced from the results that the hand-washing agents or disinfection agents have a positive influence over the reduction in number of ills health condition or occurrence of such incidents. The incidents of the infection episodes are less when there are alcoholic contents included within the hand-washing agents, compared to those agents which is used for control group. These reduction in the incidents of ill health conditions are similar in both summer as well as winter season. Whereas the epidemic level of seasonal occurrence of the infection related to respiratory and gastrointestinal upset is same as usual.

The impact of such hand washing practices also increases the efficacy and output of office work was found to be increasing, owing to the reduced infection episodes. On the contrary, the number of ill working days and taking leave was found to have no correlation with the health condition and improved health practices with alcohol based hand-rubbing agents. The reason for the same was not being discussed by the authors, probably because it is beyond the scope of the research. Whereas, the hypothesis, which was based on the assumption that alcohol based hand rubs have incidents of reducing the infection agents and acquired infection.

It is also important to discuss the limitation and the drawbacks of any research. Inclusion of such contents in RCTs increases the validity, robustness and accuracy of the research work. In the mentioned research work, the authors have mentioned that many of the minute practices were not considered in the study, such as time of washing, number of washing in a day, way of washing and other related activities. Similarly, the infectious disease and disorders, which take more time for disposition and takes longer time to heal, such as sinusitis or bronchitis are not included within the scope. The positive part of the research work and corresponding results supports that the use of hand washing agents, especially containing the alcohol contents where key players in controlling the transfer of community acquired infection related to viral and bacterial contaminations.



In conclusion, it can be said that the present paper put emphasis over the concern of hand washing practices in conjunction to the control of acquired infection. Furthermore, for the increase in efficacy of the hand washing agents, the incorporation of alcoholic agents in the disinfectant agents are studied. The ethical consideration and the use of prospective and controlled groups is necessary for the execution of such research work. The importance of selecting randomized control trials and analysis of PICO (Population, Intervention, Comparison and Outcomes) approach was used for the illustration of research work (Huang, Lin & Demner-Fushman, 2006, pp.359). The said concept was thus based on the framed question, which is elucidation of the effectiveness of alcohol based hand rubs for the purpose of controlling acquired infection and communicable diseases. The importance of the hypothesis and the example, similar to the research proposal was addressed with the help of similar research work.

From the illustrated paper, the method of research design, the hypothesis, and other similar methods were helpful for understanding purpose. Furthermore, the design of control groups, the methods used for the extraction of the information, collection and subsequent analysis for obtaining significant results were understood.  Notably the use of statistical tools for the analysis of results was also displayed and learned from the presented research article. Concisely the incorporation of analysis and literature review of this kind helps in clear understanding and identification of the approach as how to design and execute a research of similar kind. In conjunction to the adopted theme of research work, it can be said that hygienic practice for health management is always effective in preventing many communicable and infectious diseases. Use of alcohol based hand-washing agents in this regard proved to be effective against said viral and bacterial infections.



BECKER, S., BRYMAN, A., & FERGUSON, H. (Eds.). 2012. Understanding research for social policy and social work: themes, methods and approaches. Policy Press. 

HUANG, X., LIN, J., & DEMNER-FUSHMAN, D. 2006. Evaluation of PICO as a knowledge representation for clinical questions. In AMIA Annual Symposium Proceedings (Vol. 2006, p. 359). American Medical Informatics Association. 

HÜBNER, N. O., HÜBNER, C., WODNY, M., KAMPF, G., & KRAMER, A. 2010. Effectiveness of alcohol-based hand disinfectants in a public administration: impact on health and work performance related to acute respiratory symptoms and diarrhoea. BMC infectious diseases, 10(1), 250. 

HUGONNET, S., PERNEGER, T. V., & PITTET, D. 2002. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Archives of Internal Medicine, 162(9), 1037-1043. 

ISRAEL, B. A., SCHULZ, A. J., PARKER, E. A., & BECKER, A. B. 1998. Review of community-based research: assessing partnership approaches to improve public health. Annual review of public health, 19(1), 173-202.


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