Critical Appraisal of article Titled


In the article Titled Health care worker hand contamination at critical moments in outpatient care setting published in American Journal of Infection Control, 44(11), 1198-1202, Bingham, J. et al. (2016)  expounds on the results of their research. Their research sought to quantify the presence of health care-associated pathogens on the hands of Health Care Workers at 2 of the key moments for hand hygiene in an outpatient care setting and to determine the influence of glove use. In addition, the study sought to clarify the distribution of hand contamination among Health Care Workers in outpatient care facilities. (2016).

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The results from the study led the authors to conclude that, Contamination of health care workers’ hands presents a significant risk of pathogen transmission in outpatient settings. In order to mitigate this, they suggested that gloving education, hand hygiene solutions at the point of care, and hand hygiene surveillance are important solutions for reducing transmission of pathogenic organisms.

 The findings of this results help me support my own research, in which I sought to establish how proper hand hygiene by healthcare workers and patients, compared to improper hand hygiene, affects the occurrence of hospital-acquired infections during hospital stay. 

I therefore seek to appraise Bingham’s research by supporting its findings and expounding on their authenticity and authority.

Why was the Study Done?

This study was conducted in consideration of the steady increase in the delivery of health care in outpatient settings over the years. The risk of infection in these settings was considered to be low but this has changed over the years and thus the study sought to reexamine the transmission of pathogens in this setting and give new evidence in this area.

Is this quantitative research report a case study, case control study, cohort study, randomized control trial or systematic review?

This research is a systematic review in form of a primary study that was etiological in nature. It addresses a focused, clearly formulated question whilst using a systematic and explicit cohort study to collect and analyze data from the studies. 

Hierarchy of Evidence

“Best available evidence” is used quite frequently and in order to fully understand this one needs to have a clear knowledge of the hierarchy of evidence and how the integration of this evidence can be used to formulate a grade of recommendation. (Atkins,2004.). The reason that studies are placed into a hierarchy is that those at the top are considered the “best evidence”. (Sackett, 1997). With this in mind, it is prudent to state that Bingham’s article lies top of the evidence hierarchy as it is a systematic review in form of a primary study that was etiological in nature. It addresses a focused, clearly formulated question whilst using a systematic and explicit cohort study to collect and analyze data from the studies. As such the research can be regarded as being factual and accurate.

Where the steps of the study clearly defined?

Bingham clearly defines the steps followed before and in the course of the study up until the results were obtained. The first step saw them obtain approval to conduct their study from the institutional review board of the wound care facilities they chose to participate in the study. 

Once approval was obtained, Health Care Workers were invited to participate on each day of sampling, which took place over two days at each facility. Participants were asked to undertake routine patient care activities, and hand hygiene, without deviating from their standard practices, except requiring hand hygiene before entering the examination room. Research staff  then monitored and recorded the application of hand hygiene before entering the examination room.

Sample Size?

The sample size of the Health care workers consisted of seventeen health care workers drawn out from four wound care facilities. This represented 85.0% of the eligible staff  found in the four facilities. This sample size represents a large enough population thus ensuring the results are fully justifiable.

Are the Measurements of Major Variables Reliable and Valid?

This study sought to give scientific evidence to support outpatient infection prevention practices increases. This was done by lab analysis to identify bacteria present on Health Cre Workers Tested. As such the results are very accurate and reliable for analysis leading to a conclusion. 

How was the Data Analyzed?

The results on hand contamination was analyzed by a mixed effects logistic regression model with random effects for date crossed with facility, and Health Care Workers nested in facility. The random effects accounted for the repeated measures taken from each Health Care Worker, date, and facility. 

Were they any untoward events during the conduct of the study?

From reading the research there was no reported untoward event during the conduct of the study. The study seemingly flowed smoothly with ease. This is likely as a result of proper planning before the research was conducted to ensure that all likely risks were mitigated.

How do the results fit with previous research in the area?

An observational study was conducted in 2015 with 200 nurses working in intensive care units in teaching hospitals of Tabriz, Iran. show that hand hygiene compliance before wearing gloves is poor among nurses who work in intensive care units (14.8%). Therefore, it is necessary to conduct effective interventions through continuing education programs to improve hand hygiene compliance. (Azam,2016). The finding of Azam’s research support the need for the research spoken of herein by emphasizing on the need to conduct effective interventions that would improve hygiene amongst Health Care Workers thereby resulting in reduced risk of pathogen transmission to patients in outpatient settings.

Conclusion: What Does This Research Mean to Clinical Practice?

The results of this research clearly show that bacteria causing infections are picked up by Health Care Workers in the course of giving care to patients. With this in mind,  the results give good case for  Infection prevention infrastructure to be put in place in order to reduce the Contamination of health care workers’ hands thus reducing the risk of pathogen transmission  to patients in outpatient settings.


 Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490.

 Azam G, Leila S, Akram S, Asghar M, et al. Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran. American Journal of Infection Control

Volume 44, Issue 11, 1 November 2016, Pages e279-e281.

Bingham, J., Abell, G., Kienast, L., Lerner, L., Matuschek, B., Mullins, W., Parker, A., Kirk, J. 

(2016). Health care worker hand contamination at critical moments in outpatient care settings. American Journal of Infection Control, 44(11), 1198-1202.

Sackett DL, Richardson WS, Rosenberg WM, Haynes RB. Evidence Based Medicine: How to practice and teach EBM. New York: Churchill Livingstone; 1997

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