The Use of Alcohol Rub in Preventing Infection - Essay Example

? Appraisal of evidence topic- The use of Alcohol Rub in Preventing Infection Number Submitted The Use of Alcohol Rub in Preventing Infection Introduction Evidence based practice is a process by which ineffective practices are discarded and better form of practice is identified and implemented by the practitioners (Jolley, 2010). As cited in Barker J (2010), The Nursing and midwifery Council NMC (2008) states nurses who deliver care that is either based on best practice or on best evidence are considered qualified. The most important aspect of evidence based practice in nursing is increased efficiency of the nurses. Once the nurse makes the decision, which is backed by the research, then the whole process of choosing the type of care that needs to be provided to the patient becomes easy. As an adult student nurse, I believe that evidence based practice is very essential for us. As we are responsible for the patients’ care, therefore, at times we have to take certain crucial decisions related to the health of patients. Once we are educated through evidence based learning, we know the possible outcome of decisions, which makes it easy for us to choose the best intervention for a situation at hand. I will start with the part of the essay which is to select an aspect of practice relevant to my professional discipline, such as use of alcohol rub in preventing infection control. I will provide a brief rationale why I chose that particular topic. I will define the evidence based practice and its importance to my professional practice and then discuss the factors that hinder or facilitate evidence based practice. Finally, I will discuss some of the types of evidences such systematic review, randomised controlled trails, and quantitative evidence, with relevant evidence to support my chosen topic (i.e. use of alcohol rub in preventing infection control). Moreover, I will discuss the areas why alcohol rub should be implemented in certain cases. Evidence Based Practice: For the helping professions like medicine and nursing, evidence based learning is one of the most important developments in decades. I believe evidence-based practice represents a method as well as an ideology. The method of evidence based practice is the way of finding and later implementing the interventions that take place. According to Bloom, Fischer & Orme(2009) the ideology is derived from the ethical principle that is required by the clients for the most effective and possible interventions. For evidence based practice, typically, they use reviews of research on intervention effectiveness and then critically assess the reviews on the bases of validity and utility of practice. According to Children’s Workforce Development Council (2011), evidence based practice is a combination of the best external research and practitioner expertise and evaluation that is based on the evidence. I have found that evidence based practice is a way to update knowledge; essentially it can be used in different scenarios. As pointed out by McEwen and Wills (2002), evidence based nursing will fill the gap of research, theory and practice. According to him, it de-emphasizes isolated, rituals and unsystematic clinical experiences and traditions as the basis of practice. Therefore, once a nurse starts opting for evidence based practice, they come to know different ways through which they can use the experience of other practitioners (Cluett 2006). This is one of the basic reasons why, as an adult nurse, I prefer evidence based practice. Evidence Based Practice in Nursing: Evidence based practice, help the nurses tend to stay updated on the new discoveries (Beyea & Slattery, 2006).In my experience, I have noticed that as the nurses are sure that their decisions are based on valid information, the confidence in their practice increases, and their decisions power is increased. As cited in Barker J (2010), Pearson et al. (2008) identifies that a nurse is expected to understand the quality of evidence that is used in the practice and deliver care support by using best evidence. This stance should be adopted by every nurse, irrespective to her post in the nursing profession. On the other hand, in the same book, Dicenso et al. (2008) argues that, for clinical expertise, and decision making, evidence based practice is a central link. Therefore, when general guideline is given, it must be same for both the processes. In essence, evidence based learning is a discipline in which nurses make clinical decisions which are later approved by the policies and clinical guidelines, judgement and expertise (Ervin, 2002). Following are considered to be few of the factors that hinder or facilitate evidence based practice. Picheansathian’s (2004) systematic review concludes that alcohol-based hand rubbing effectively removes microorganisms in less time and irritates hands less. Although while practising, it is seen that most of the health workers are satisfied with alcohol rub as the application of the process is less time consuming. This helps to increase the efficiency of our work as we are not distracted much by going to the wash basin all the time. When the problem in the health care centre is discussed with staff, and those who are involved in implementing change, diverse action plans can arrive, which can lead to successful results of evidence based practice (Spring, 2003). Thus good organizational leadership is needed in order to implement evidence based clinical practice that improves the quality of patient care (Gomez, 2011). Funding by the government to support nursing research and health information system can also help in promoting evidence based practice. Using evidence based curricula in the institutions can moreover encourage evidence based practice (Canadian Nurses Association, 2002). The hindrance that nurses came across is the possibility of lacking the experience in reading and critiquing research reports and facing difficulty in interpreting study design and statistical findings (Beyea and Nicoll 2004). Moreover, in the busy working area they do not have much time for reading. Lack of information technology skills and access affects nurses’ use of research evidence. Likewise, they are unable to get latest information about nursing and thus practice it less (Bertulis, 2008). I believe that at times, personal experience of the nurses and their personal beliefs can also become a major hindrance in the evidence based practice. The discussion on three types of evidences is as follows: Systematic review is different from traditional literature review (South African Medical Research Council, 2011). Systematic review is a way to collect the evidence. In this method, the findings of all methodologically sound studies are summarized (KT Clearninghouse, 2011). The process reviews can help the practitioners to keep abreast of the medical literature. It involves the application of scientific strategies (Cook, 2000). In the nutshell, Cochrane Collaboration (2011) summaries that a systematic review is a high level overview of primary research on a particular research question that tries to identify, select, synthesize and appraise all high quality research evidence relevant to that question in order to answer it. I believe, when such a form of research is used in nursing, the decision making regarding health and the ratio to get benefits increases. In order to find that alcohol rub helps in preventing the spread of infection, different studies in this area can be reviewed. Through this, particular circumstances can be known in which alcoholic hand rubs must be used, and instances where it must not be made use of. Randomised controlled trails help to determine whether a cause-effect relationship exists between treatment and outcome, and to assess the cost effectiveness of a treatment (Roland, 2000). It is used to examine the effect of interventions on particular outcomes such as death or the recurrence of disease. Some consider randomizing controlled trials as the best research design (Norman & Trop, 2004). Therefore it is considered to be the most powerful type of experimental research (Massachusetts Institute of Technology, 2011). Other than these two types of evidences, quantitative research can also be used, in this type the effect, one technique is compared to the other (Shields, 2003).It is used to determine the effectiveness of interventions, therefore ,the treatment having a better effect on the patient, can be identified (Houser, 2008). This research plays an important part in developing nursing knowledge (Nursing Research, 2011) and providing evidence for practice in nursing (Bailey, 2002). For the project at hand, through quantitative research, the effective results of using alcohol rub can be monitored. Thus, the evidence that are inferred by these researches and is applied by in other similar situations can be further labelled as evidence based practice (Moule& Goodman, 2008). Studies: In 1942, Semmelweis (cited in Widmer 2000) was the person who discovered the importance of hand disinfect. After being further studied by the practitioner, it is discovered that in the general conditions of health care settings, alcohol based hand rub is the preferred method of hand hygiene. Evidence that can further support the stance: alcohol rub is a better option to prevent infection, as only alcohol can easily kill microorganisms and all corona viruses (Widmer et al. 2002). Tranpuz (2004) discusses that about 10% of hospitalized patients have to prolong their stay due to the nosocomial infections. I have observed that multi-disciplinary team (MDT) is the primary mode of transmitting infection to the patients. Therefore, it can be concluded that if we manage to plan proper hand hygiene, we would be able to practice the only most important and least expensive means of health care that can prevent the spread of antimicrobial infection. Lister and Dougherty (2004) stated that with the ease of alcohol hand rub, during a medical procedure the nurse does not need to leave the patient and rush to the nearest basin to wash hands, as in this time duration, contamination can occur. It is seen that to prevent people from the infections, hand hygiene is considered to be one of the most basic components. Although, it was proved that hand disinfect prevents the infection. However, with the passage of time and technological advancements, multiple complex forms of bacteria have been discovered. Thus, to prevent infection from them, alcohol rub was introduced (Widmer et al. 2011). This type of hygiene is fundamentally different as the micro-organisms are killed by the disinfectant and are not physically removed, as they are in case with hand washing. However, while using the alcohol rub, those micro-organisms that are not in direct contact with the alcohol rub will not be affected. In ‘A Systematic Review on the Effectiveness of Alcohol-based Solutions for Hand Hygiene’ Picheansathian (2004) has reviewed different studies published on effectiveness of alcohol-based solution between January 1992 and April 2002. According to the results of the study, it was supported that alcohol-based hand rubbing effectively removes microorganisms in less time and irritates hand less as compared to hand washing with soap or other antiseptic agents and water. The solution must be rubbed on the wrists and the hands until the solution is evaporated and hands become dry. Such a practice will help to kill all micro-organisms that might be present on the hand (Gott and Gartside, 2008). Moreover, the availability of bedside alcohol based solutions increases compliance with hand hygiene among the nurses. Moreover, in ‘Systematic Review of the Efficacy of Alcohol Preparations and Other Agents for Hand Hygiene in the Healthcare Setting’ all the included reviews recommend to use alcohol-based hand rubs only when hands are not visibly soiled (Maiwald, 2009). As a result, being a nurse I concluded that during routine patient care, hand-rubbing with an alcohol based solution is significantly more efficient in reducing hand contamination than hand-washing with antiseptic soap. In a randomized control trail conducted by Girou (2002), 23 healthcare workers participated. Out of them, 12 used alcohol based solution and 11 health workers used antiseptic soap when hand hygiene was indicated before and after the patient care. Imprints of fingertips and palm of dominant hand was taken before and after hand hygiene procedure. Result showed that due to hand-rubbing the reduction in bacterial contamination was significantly higher when compared with hand-washing. As a result, being a student adult nurse I conclude that during routine patient care, hand-rubbing with an alcohol based solution is significantly more efficient in reducing hand contamination than hand-washing with antiseptic soap. For the purpose of using evidence based practice; Royal College of Nursing (2010) has given some standard regulations in the “Standards for Infusion Therapy”. According to their prescribed standard, the hands must be disinfected before and after contacting the patient, as well as before putting on and after removing the gloves. I believe that alcohol hand rub can be used after every small interval, even after small jobs like bed making and giving medicine to the patients. Same stance has been discussed in the National Institute of Clinical Excellence (NICE, 2003) guidelines of infection control, where it is recommended to use alcoholic hand rub between the care of different patients or between different activities for the same patients when the hands are not visibly soiled. However, evidence has shown that after dealing with patients of diarrhoea or vomiting, hands’ soap and water must be used to decontaminate. Moreover, the National Patient Safety Agency (2004) advises to use alcohol hand rub in addition to the above mentioned process. Being a health care worker, I have also witnessed that poor hand hygiene practice is observed in the hospitals because there is less inflow of scientific knowledge among the nurses and hence, they are also unaware of the risks. Moreover, the unavailability of hand hygiene facilities and lesser ratio of role models among the colleagues or superiors are one of the main reasons. Conclusion: Numerous studies have provided the evidence that hands are the main source of propagating microorganisms within the vicinity of the healthcare environment, which ultimately leads to the patients. Moreover, it is seen that healthcare workers’ hands lead to patient-to-patient transmission of bacteria and this ultimately leads to contaminating the environment (Pittet & Allegranzi, 2009). Therefore, to eliminate the bacterial infection, alcohol rub is the most effective technique. This technique not only decontaminates the bacteria form nurses’ hands but also removes it from the environment. References Bailey C, Froggatt K, Field D, Krishnasamy M. (2002). The nursing contribution to qualitative research in palliative care 1990-1999: a critical evaluation. Journal of Advance Nursing 40(1):48-60. Barker J (2010) Evidence-based practice for nurses London: sage publication limited. Bertulis.R. 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G &Trop.I (2004).Randomized Controlled Trails.183 (6). 1539-1544. Accessed on 26th November 2011 http://www.ajronline.org/content/183/6/1539.full Tranpuz.A. (2004).Hand Hygiene: A Frequently Missed Lifesaving Opportunity During Patient Care Assessed on 27th October 2011 from http://www.mayoclinicproceedings.com/content/79/1/109.full.pdf+html Widmer AF, Conzelmann M, Tomic M, Stranden A. (2002). Hand hygiene: impact of a training program on the microbiological efficacy of the alcoholic hand-rub. 42:323 Read More