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Evidence Based Practise in Nursing

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Submitted By marielamereles
Words 1068
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Hand hygiene is a practise of evidence-based medicine and the number one way to prevent health-care associated infections (Garbutt, 2011). The term of hand hygiene applies to adequate hand washing, antiseptic hand-wash, antiseptic hand-rub, or surgical hand antisepsis (Garbutt, 2011). Evidence-based practices have been put into place to prevent such infections from occurring.
The present paper will examine ways in which health professionals use the five steps of evidence based practices (EBP) to locate, appraise and apply the best available research evidence. In this case, the five steps of EBP will be assessed in conjunction to the practise of good hand hygiene.

Liamputtong (2013, p.267) has explained evidence-based practise (EBP) as the use of the best research evidence, clinical expertise, available resources, and patient preferences in respect to clinical decision-making. EBP is taught and practised using five steps to reduce inconsistency and increase efficiency and effectiveness of health care (Liamputtong, 2013, p.267).
According to Liamputtong (2013, p.267) the first step of EBP is to ask an answerable question stating the population, intervention, comparison and outcome of the question (PICO). Next, acquire the best available evidence using research strategies (Liamputtong, 2013, p.267). This evidence is then appraised to determine its quality and relevance (Liamputtong, 2013, p.267). The fourth step it to apply the evidence integrated with clinical expertise and patient preference (Liamputtong, 2013, p.267). Finally, the process is to be accessed, reflecting on steps one to four and identifying ways to improve efficacy (Liamputtong, 2013, p.267).

The five-step approach to EBP is essential in the field of nursing as it ensures high-quality patient care to fit the patient’s needs (Beyea & Slattery, 2006, p.8). This minimizes potential risks to the patient, with benefits outweighing harm (Beyea & Slattery, 2006, p.9). EBP provides nurses with the skills and knowledge to evaluate healthcare literature, increasing their confidence in decision-making (Beyea & Slattery, 2006, p.9).
The Centre for Evidence Based Medicine and the National Health and Medical research Council have developed a hierarchy of evidence to reflect various types of biomedical research, with a ranking according to its validity (Davidson & Iles, 2013). This hierarchy is known to inform and guide health professionals with clinical decision-making.

Mariela Mereles S00107898
The top three levels provide the best quality of evidence as very rigorous procedures (formal methods) have been used to conduct such studies (Davidson & Iles, 2013). Systematic reviews have been found to provide excellent effectiveness, appropriateness and feasibility in research evidence, and thus are located at the top of the hierarchy (Evans, 2003).
This type of research provides scientific summary of literature on a specified topic (Liamputtong, 2013, p.463). Systematic reviews are classified as level I evidence. This type of evidence is best found using the Cochrane Library database, as it is a source of high-quality systematic reviews (Davidson & Iles, 2013).

Level II evidence includes randomized-controlled trails with research evidence providing a good level of effectiveness, appropriateness and feasibility (Evans, 2003). This type of research tests the effectiveness of medical interventions within a patient population (Liamputtong, 2013, p.461). Randomized-controlled trials may be found using PubMed or PsychINFO database.
The following three levels of the hierarchy includes non-research based evidence and have been conducted using less rigorous procedures (informal sources) (Davidson & Iles, 2013). Such research includes cohort studies, case series and reports found to have poor effectiveness, appropriateness and feasibility of research (Evans, 2003).

Healthcare professionals must refer to the 5-step approach to connect EBP with clinical decision-making. Firstly, an answerable question must be asked and for the purpose of this paper, the question will be: ‘For health professionals is alcohol-based hand agents or hand washing more effective in reducing the spread of infection’.
In respect to this question, research suggests the transmission of microorganisms spread due to contamination from health care personnel after patient contact (Allegranzi & Pittet, 2009). However, adherence to hand hygiene remains low (Hass & Larson, 2008).
Pratt et al. (2001) suggested that liquid soap and water could effectively decontaminate hands. Further research suggested that hand washing using antiseptic soap or waterless hand disinfectants, are more effective in reducing bacteria on hands and the spread of infection (Lucet et al., 2002; Stone, 2001; Voss & Widmer, 1997).

Mariela Mereles S00107898
Additionally, barriers of noncompliance for good hand hygiene practices have been identified and corrective actions proposed. Lack of time and the imbalance between workload and staffing has led to little attention of hand hygiene (Parett et al., 2001; Bittner, Rich, Turner, & Arnold, 2002). Immediate access to hygiene facilitators, such as alcohol-based rubs, will improve compliance as little time is required to apply this and is fast actioned (Voss & Widmer, 1997). Skin sensitivity and irritation to such agents have been found, yet providing access to hand lotions or creams will minimize this effect (Kampf & Löffler, 2007)
Lack of knowledge has also presented a barrier to regular hand washing (Dalheim, Harthug, Nilsen & Nortvedt, 2012). Education and motivation is critical in teaching of basic hygiene practises to reduce the spread of pathogens (Stone, 2001).

Evidence-based practise has shown to have limitations as well. This may include focussing treatment on groups rather than individuals (Beyea & Slattery, 2006). In such case, the evidence will provide a guideline as to how individuals within a group should be treated and not the individual themselves. Additionally, if evidence is misinterpreted, EBP may be problematic. This may be when evidence is generalized to a wider group than they should be (Beyea & Slattery, 2006).

In conclusion, research has shown hands to be the main pathway of pathogen transmission during health care (Alleganzi & Pittet, 2009). Hence, good hand hygiene is highly important to prevent the spread of infections (Alleganzi & Pittet, 2009).
Alcohol-based agents, including antiseptic soaps and sanitizers are more effective in eliminating pathogens in comparison to hand washing with soap and water (Lucet et al., 2002; Stone, 2001; Voss & Widmer, 1997).
Lack of time, knowledge and access to hygiene facilitators has been identified as barriers restricting good hand hygiene to be actioned (Parett et al., 2001; Bittner, Rich, Turner, & Arnold, 2002). Additionally, health professionals must be aware of the risks involved, when failing to practise good hand hygiene while treating patients.

Mariela Mereles S00107898

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