Appraisal of Evidence Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use

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Appraisal of Evidence

‘Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use’

M. Winnefeld, M.A. Richard, M. Drancourt, J.J. Grob 2000

British Journal of Dermatology 143 546-550                                                                                                                         

For this assignment I am going to appraise an article from the British Journal of Dermatology, 2000, 143, 546-550. To locate this piece of research it was important to adhere to a focused search strategy. Due to the huge amount of research available today, in books, journals and online databases, it is simply not feasible to look through everything to discover a piece directly relevant to you (Flemming 1999).  To retrieve information that is related, it helps to develop a focused question. The PICO framework devised by Sackett et al (1997) is useful in helping you to do this (cited by Craig and Smyth 2002). It helps you to focus on specifics, the population you want to look at, the intervention, a comparison intervention should there be one, and finally the outcomes of the research. For instance, you know you want to look into the area of infection control and this framework helps you to create a focus surrounding this. For example, the population you want to look at may be nurses and healthcare professionals, and their daily hand washing routine.  A comparison may be introducing a new or alternative hand hygiene method. Finally the outcomes you would like to see from this research, it could be whether one method is more effective at disinfecting hands.

From a focused question you can choose key words. These can be used as search terms in data bases to retrieve pieces of specific research. Each data base contains some different pieces of information (Craig and Smyth 2002), so it is important to keep a list of the data bases and search terms used. You may only want resent research so specifying a year to search from, and also setting language limitations helps to facilitate the search. From the above focused question, I choose the search terms, ‘nursing staff, hand disinfection, everyday’, then entered these terms into MEDLINE. This retrieved the article under appraisal.

The aims of the study are clearly set out within the research, to asses the properties of an alcohol-based disinfectant, compared with a non-antiseptic soap at eliminating bacteria’ and, their effect on the skin. It is very important that research clearly states its aims so that you can assess whether these have been met by the end of the piece (Thompson 1999). The reasoning behind why the research was carried out is also discussed, with an explanation surrounding bacteria, and how it is carried and transferred in the hospital. It explains that damaged skin is a factor in higher levels of bacterial activity on hands, making skin tolerance important to optimum performance of hand disinfectants.

There were 78 people contacted to take part in the study. 52 people agreed to participate, only two of which were male. The participants came from a total of 16 different departments. However, as these were all in the same hospital, it could be suggested that this was a sample of convenience. Although sample size can not be relied upon by itself to give accurate findings, it is important that the sample gives an overview of the population it intends to study (Thompson 1999). In this case, 52 is a small sample and often large sample sizes are needed to get valid results from intervention studies (Thompson 1999). From the outset this is shedding doubt on the validity of any research findings. For a sample to represent the broader population, the sample must be selected using a random selection process (Cormack 2000). This would mean that everyone within the population would have had an equal chance of being involved in the study, thus eliminating any sampling bias. As there is no mention of how the sample was chosen for this piece of research, we can not eliminate the possibility of sampling bias.  It would therefore be difficult to generalise any findings from this study to the broader population of nursing staff.

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Another issue is that of volunteer bias, the possibility that non responders may not be as healthy as the participants themselves (Thompson 1999). In this instance 26 out of 72 people contacted did not take part. It may be that some of these people had sensitive skin or skin problems, making them less inclined to participate. Should this be the case and these people had taken part, it could have made a difference to the overall results regarding skin condition.

The design used to collect the data was a Randomised Control trial (RCT). This is a quantitative approach, ...

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