Coventry University
Faculty of Health and Life Sciences

Dip HE Adult Nursing Cohort 1-11

220PH – Research and Evidence Based Practice Candidate Number: 2994886

A Report On the Evidence: ‘Does hypochlorite cleaning in the hospital environment reduce the risk of clostridium difficile infection?’
Set Word Limit: 2000
Word Count: 2200 (+10%)

Submission Due Date: 18/09/2012 Actual Submission Date: 18/09/2012

Introduction

The International Council of Nurses (2009) raised some key points in the process of identifying some priorities for the process of nursing. The need to prioritise nursing research in the delivery of care and prevent illness and the impact of interventions on outcomes for patients. Evidence based practice uses research to identify best methods in delivering, preventing and resolving illnesses in patients.

Nurses are advocates for patients (NMC 2008), therefore it is imperitive for nurses to consider all evidence available and use what is considered best evidence (Garish and Lacey 2010). Evaluating the quality of research is a skill every nurse requires; in order to put something into practice it needs to be reliable, trustworthy and valid (Sacket et al 1996).

There is evidence to show that progress has been made in reducing clostridium difficile infections (office for national statistics 2011) but the Department of Health (2008a) recognises that there is a need to further reduce this type of infection and therefore improve patient outcomes. McFarland et al (1999) identified that there is a 45-60% chance of a second occurrence of clostridium difficile following initial contact.

The Department of Health (2008a) recommend the use of chlorite solutions, and an occupational hazard of being a healthcare practitioner is that they are in contact with infection control issues all of the time. Whilst it is important to recognise the need for Department of Health recommendations, it is also recognised that nurses can challenge existing evidence and even use evidence to justify or influence a change in policy (Polit and Beck 2008).

Search Process

Our initial idea was to tackle the topic of clostridium difficile. The reason for choosing this topic is because despite efforts to isolate infected patients, it would appear that there isn’t enough evidence to support the use of a single cleaning regime which effectively destroys spores of this type of infection (Wilcox et al 2003). Therefore, it was our aim to use government guidelines and investigate the effectiveness of their recommendations using a research paper.

Keywords used can be found in appendix 1 along with our search process, and PICO was used as the basis of our search (Garish & Lacey 2010). Several searches around the topic of infection control, cleaning, barrier nursing and the use of chlorite were done to generate some search results. Combining search results to compare one type of cleaning to another along with clostridium difficile returned two sets of results (two seperate final searches) with a reasonable number of articles to efficiently look at and make a decision on which is to be used.

CINAHL database was used as the content concentrates on many other health professions, rather than just nurses, and infection control concerns all members of the health and social care team (Saloojee and Steenhoff 2000). The necessity to make a comparative for effectiveness influenced the question being formed from ‘PICO.’ This involves patients/places, a new intervention, a comparison and an outcome that answers the original question. As CINAHL lists extensive articles looking at alternative treatments (McKibbon and Marks 1998), this influenced the decision to use this database.

Appendix 1 Shows a full extent of the search criteria and combinations before the article was selected. Specifically selecting the article and making sure the article was relevant for discussion for