Hygiene and Hand Washing

This report will analyse the literature searches and appraise the quality of information available relating to hand washing. All information correlating to this subject will derive from books, journals and websites.

The number of health organisations in the UK alone who provide information is estimated around 60,000 (Coulter et al. 2006). Add this to the number of organisations worldwide which can be accessed via the internet. This sheer volume of medical literature creates an information overload Glasziou PP (2008).

It is vital that key points are taken into consideration when constituting a quality piece of information; the source, the date of publication, the accuracy – is it evidence based, does it add anything new? Also, the relevance, comprehensiveness and accessibility of the piece.

This is crucial in deciding whether the information is valid as it is imperative for medical professionals to ensure they are up to date with information concerning current procedures and policies to enhance their evidence based practice. (Sackett et al.,1996).

This will then be discussed and appraised regarding the quality of information using a systematic approach whereby both strengths and weaknesses are identified, thus enabling the assessment of the usefulness and validity of the given information.

When beginning the search for information, it is crucial to develop a search strategy which will assist to locate relevant information. Riggs et al (2017). To do this, major elements of the question must be identified and then broken down into normal language terms and descriptors. Allied Healthcare 2018.

To achieve a more precise search, the use of Boolean operators, known as “and”, “or” and “not”, are beneficial when creating a reliable search strategy Leiblein et al.

(2016). It allows a much more precise search. The importance of extracting as much irrelevant information as possible is vital. Van Den Bros (2007).

To ensure the best results, it is necessary to create an inclusion and exclusion table to filter the information, providing more relevant articles and extracting unrelated pieces (see appendix 1). To ensure the relevance of the information, as procedures and policies are regularly updated, only information dating between 2008 – 2018 will be accepted. Additionally, only published work will be taken into consideration ensuring reliability of the source (Sackett et al.1996) Finally, only information published in the UK will be considered, owing to differing legislations of other countries. To achieve this, identifying key concepts in the topic is required i.e.”Hand washing”. University of Leeds (2018) advises creating a list of alternative terms used to search databases, i.e.”Infection Control” and ”Hand Hygiene”

When searching for books, Canterbury Christchurch Library was used. When conducting a search strategy, it needs to be taken into consideration that books are far more specific and that the volume and relevancy of books on offer is far less than what an online search engine can offer. This was demonstrated at a local public library as there was nothing of relevance as it was generalised and not specific.

Using LibrarySearch, set to show only books, it revealed nothing on ”Hand washing”, therefore, an advanced search on the system was required using correct, refined words, such as; ”infection control” ”and”, ”Hand Hygiene”. This returned 3 results, However, Damani (2012) was rejected as it did not match the strategy and incorporate the inclusion and exclusion criteria as it was published outside the UK. The two books chosen, were Macqueen et al. (2012) and Weston (2008) Once the books were located in the library, a manual search for information was conducted.

The journals were found using an online library catalogue database called “LibrarySearch”.

As with the books, the initial search of ”hand washing” was futile. As a result, key search words were used; ”Infection control” and ”hands”. This produced 11,116 results. Following this, an advanced search was used whereby it eliminated information not relevant to the subject. ‘Date published’ (2008 – 2018) and ”peer reviewed” was chosen to show only academic journals which were from credible resources. Along with this, the geography was set to Great Britain and language set to English as per the. This provided 41 criteria matching results. The search element was restricted to electronic journals in order that the reviewing of articles was quicker and duplication between hard and electronic copies were eliminated. From these results, six Journals were chosen.

Google search engine was initially used. This is a mainstream public search engine. Again, the search phrase ”hand washing” was used and revealed a whopping 20,200,000 results. Boolean Operator ‘and’ was then applied to refine the results. The search was ”hand hygiene and infection control”, showing 2,590,00 results, which was still far too much, so an advanced search was used to only show results from the UK, time frame and relevance, producing 65,700 results, the top two being Nice (2017) and RCN (2010)

The Great Ormond Street Hospital Manual of Children’s Nursing Practices, Macqueen et al. (2012) was found using an advanced LibrarySearch. Chapter 12.1 – 12.5 concentrates entirely on hand washing. I found this book to be completely credible, as all three authors of the book, (Macqueen, Bruce and Gibson) have recognised and accredited professional backgrounds in nursing. The sections from chapter 12 outlined, demonstrate the guideline recommendations and the high importance of hand washing to reduce and control infection. The information within these relevant sections are well referenced to ensure their credibility and include proven statistics and tables of data to back the information. It is very in-depth and thorough and clearly aimed at the nursing/medical professions.

Weston (2008), was also found by advanced LibrarySearch and matched all the required criteria. Like Macqueen et al. (2012), Weston is credible as she is an Infection Prevention and Control Specialist Nurse. Chapter 12 focuses solely on hand washing. The subject is covered in great comprehensive detail. It has clear drawings to demonstrate the correct procedure, lots of statistics, data and references to prove the validity of the piece. It is written in a generalised form, so is an excellent reference for hand washing to any profession, thus can accommodate a far larger market.

Dawson C.H (2015) is an in-depth review of the measurement and importance of hand hygiene. It examines the acknowledged flaws from the methods available and stresses that “opportunities to change practice and improve hand hygiene ante being missed”. This article is peer reviewed and its audience is healthcare professionals. It is well referenced and written, though it did not conclude with any solid ideas as to how the problem raised can be resolved.

Ward D.(2016), is peer reviewed and an evidence based study which considers the role of the link nurse and explores the barriers faced and the qualities required from the role.

There is a brief mention of infection control, however, there was no direct link to hand washing. In contrast to Dawson C.H (2015), the article is not referenced and is aimed at community health nursing, therefore it is the least relevant of the articles

Balsells et al.(2016) is also a peer reviewed article which investigates different guidelines which are available to infection control. The authors are clinical researchers and medical PhD students,so are credible in their writing, which is referenced and includes a lot of statistics. Even though the information is detailed, there is only a small mention of hand washing in relation to infection control. The article is also aimed solely at medical staff within a hospital environment, therefore, even though it does mention the importance of hand washing, it concentrates mainly on C.difficile.

Malhi H (2017) explores the importance of infection prevention control in nursing and how hand washing is forefront. The authors is a Nutrition Nurse Specialist, so the information is credible and the article is peer reviewed and referenced throughout. Although the article is primarily aimed at nurses, it would be useful to anyone with a medical background.

Ford C et al. (2018) is a peer reviewed detailed study of maintaining good skin health and reducing the risk of infection. The authors are all clinical researchers making the article credible. It is well written but there are little statistics and no pictorial information, which makes it a factual, but long read.

Aziz A M (2013) is a detailed and informative journal on hand washing. Written by a credible author with a background in infection prevention control and peer reviewed. Despite the fact it is not the most recent of the journals discussed, the information is logical and well written with referencing, graphs and tables throughout. As the information is related to the relevant topic, it is the most useful of all the journals.

The two websites chosen were: NICE (2017) and RCN (2010) Both are reputable organisations and are made up of recognised field experts.

The RCN (2010) website is a registered charity. Although visually, both websites are not the easiest to navigate, the RCN(2010) is slightly clearer. It uses basic language and has simple illustrative tables. All this in mind, the RCN(2010) is the weaker site as it is purely for nurses and the majority of it comprises of nurses welfare. Hand washing is only covered by a small section.

In contrast, the NICE (2017) website is up to date and sponsored by the British governments Department of Health and was founded to guide the NHS. It is made up of doctors, clinicians and scientists. It is recognised in primary UK legislation, therefore, this is an extremely credible website and fairly easy to use. Hand washing is covered in great depth with statistics to back up the information making the NICE (2017) website the best of the two.

The search for information is immense and as a result, very time consuming, particularly when using the internet which has a plethora of information. By applying a search strategy, this enables a far more comprehensive appraisal of information in a more manageable system. This report has highlighted factors in order to create and adapt a relevant search strategy for books, journal articles and websites to thus evaluate and compare the quality of these different resources.

Books proved to be the most testing as I chose a specific subject, so places to access the information was limited, plus time consuming to travel to! Owing to the length it takes to publish, there are less relevant texts with up to date information, which therefore, rendered books to be the most outdated and least worthy resource type.

This in mind, journal articles were found to offer the most current and reliable information, as they are far easier to access and the publishing turnaround process is by far quicker and more efficient. The journals had the most calibre by far as they were written for professionals and by professionals after undergoing an independent peer review. This in turn made them far more accurate and accredit able.

In contrast, websites, though the easiest to access, proved a lack of comprehension and precision as generally, they are aimed at the general public.

In summing up this report, by using this process, it has promoted honing thought processes about combining relevant search terms to formulate focused search strategies along with the importance of more advanced search tools, (Boolean operators and inclusion and exclusion lists). Most importantly, it has shown the requirement for a strong research question; one that is able to find enough information at the same time as having the ability to filter to only the most relevant information. This has demonstrated an excellent and effective tool which can and will be applied to future work.


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