1. Evaluation Table
Use this document to complete the evaluation table requirement
of the Module 4 Assessment, Evidence-Based Project, Part 4A:
Critical Appraisal of Research
Full APA formatted citation of
selected article.
Article #1 Article #2 Article #3 Article #4
McCalla S, Reilly M,
Thomas R, McSpedon-
Rai D, McMahon LA,
Palumbo M. An
automated hand hygiene
compliance system is
associated with
decreased rates of
healthcare-associated
infections. Am J Infect
Control. 2018
Dec;46(12):1381-1386.
doi:
10.1016/j.ajic.2018.05.0
17. Epub 2018 Jul 6.
PMID: 30509358.
Wałaszek, M., Kołpa, M.,
Wolak, Z., Różańska, A.,
& Wójkowska-Mach, J.
(2018). Patient as a Partner
in Healthcare-Associated

2. Infection Prevention.
International Journal of
Environmental Research
and Public Health, 15(4),
624. MDPI AG. Retrieved
from
http://dx.doi.org/10.3390/ij
erph15040624
Hong, T. S., Bush,
E. C., Hauenstein,
M. F., Lafontant,
A., Li, C.,
Wanderer, J. P., &
Ehrenfeld, J. M.
(2015). A hand
hygiene compliance
check system: brief
communication on a
system to improve
hand hygiene
compliance in
hospitals and reduce
infection. Journal of
medical
systems, 39(6), 69.
Jenner EA, Watson
PW, Miller L, Jones
F, & Scott GM.
(2002). Explaining
hand hygiene practice:
an extended
application of the
Theory of Planned
Behaviour.

3. Psychology, Health &
Medicine, 7(3), 311–
326.
© 2018 Laureate Education Inc. 1
Mary Jane Heaney
Nilda,
well presented critical appraisal of the four peer-reviewed
articles and Evaluation Table within the Critical Appraisal Tool
Worksheet Template. Relevant examples and well stated
appraisal, with discussion and explanation of best practice
based on the research you reviewed.
Nice work overall.
Check format for references.
Include an introduction, purpose statement, and conclusion.
https://academicguides.waldenu.edu/writingcenter/apa/reference
s
https://academicguides.waldenu.edu/writingcenter/undergraduat
e/guidelines/purpose
https://academicguides.waldenu.edu/writingcenter/templates/gen
eral
Check journal format, include complete journal title. Incluude
doi for all research articles if available.
Mary Jane Heaney
Check caps in journal titles.
The response should fully integrate at least two outside
resources and two or three course-specific resources that fully
support the responses provided.
Evidence Level *
(I, II, or III)

4. This article is a level II This article is a level IV This article is
a level I This article is a level
V
Conceptual Framework
Describe the theoretical basis for
the study (If there is not one
mentioned in the article, say that
here).**
The aim of this
nonrandomized, pre–
post intervention
analysis was to see
whether introducing an
automated HHCS across
the hospital was linked
to a lower incidence of
HAIs.
Hand hygiene (HH)
activities may help
prevent health-care-
associated infections
(HAIs). Hand hygiene
enforcement systems
(HHCSs) have been seen
to properly evaluate HH
enforcement, there is
little proof on their
success in preventing
HAI rates.
The study's aim was to
learn about Polish patients'

5. and healthcare workers'
awareness and attitudes
about hand hygiene.
Partnership between
HCWs and patients is one
of the goals of HAI
prophylaxis, as is
cultivating successful hand
hygiene practices in
patients, which can be a
significant link in
achieving this purpose.
The experiment is based
on a prototype
framework that includes
enforcement rate
monitoring, real-time
sanitization notifications,
and a data repository for
future research.
The Health Belief
Model, the Theory of
Reasoned Action , and
the Theory of Planned
Behavior (TPB) are
among the theoretical
models built to
describe the influence
of beliefs on
individuals' behavior.
The importance of
using the TPB as a
foundation for

6. modeling hand
hygiene practice has
been demonstrated in
this report.
Design/Method
Describe the design and how the
study was carried out (In detail,
The design method used
in this study was a
nonrandomized, pre-post
intervention study.
The design method used
for this study was surveys
and interviews.
The design method used
in this study is
experimental design.
The design method
used in this study is
cross-sectional survey
.
© 2018 Laureate Education Inc. 2
including inclusion/exclusion
criteria).
Sample/Setting

7. The number and characteristics of
patients, attrition rate, etc.
There were 14,297 and
36,890 patients in the
pre-intervention and
intervention years,
accordingly. This was
observed in two hospital
units. The research
included all patients who
were in units that used
the integrated HHCS
system. The automated
HHCS was needed for
all unit caregivers who
had direct patient
interaction. Nurses,
respiratory therapists,
care assistants, doctors,
dietary aides,
transporters, registrars,
physical therapists,
housekeeping workers,
and technicians were
among those who were
involved (radiology and
cardiology).
The survey study
comprised 459 respondents
who replied to the survey:
173 (37.6%) patients and
286 (62.3%)
A random sample of

8. patients and staff was
taken from the hospital's
electronic database. Two
samples of 300 subjects
each were taken from the
group of 629 patients and
846 HCWs.A standardized
table of random numbers is
used in the drawing. Every
patient and HCW had an
equal opportunity of being
selected. In the case of a
patient, the return sample
population was 58 percent
(173 questionnaires) and
95 percent in the case of
HCWs (286
questionnaires). 127 (42%)
of the patients did not
answer the questions.
Using a new
technological system A
doorway sensor is used
to keep track of who
enters the room A
BFlatback U-Ring, a
system developed to
house small IR beam
detectors, was installed
in the hospital's installed
hand sanitizing
stations.These are used
to see whether the hand
sanitizer was used
because the beam under

9. the nozzle was
penetrated by a
hand.The sensors are
connected to an Arduino
software, which.
transmits the data to the
hospital's wireless
network allowing the
data to be collected in
one convenient system
for review.
A total of 304
questionnaires were
given to the infection
control nurse and
ward manager who
agreed to distribute
them to workers who
were working in the
hospital
34% of the 101
questionnaires were
delivered to the
internal infection
control desk; there
were 76 registered
nurses, therapists, and
doctors who
participated in the
sample (in addition to
the other participants)
(3 percent ). Four
participants left the

10. job untracked. the
majority of
respondents were
female Only five
participants identified
themselves.
© 2018 Laureate Education Inc. 3
Major Variables Studied
List and define dependent and
independent variables
Catheter-associated
urinary tract infections
and central line-
associated bloodstream
infections were
observed. They were
observed by hand
hygiene compliance
systems (HHCS) that
include, human
observers, The biovigil
automated HHCS a
wearable tool that
prompts caregivers to
perform. Training was
provided on how to
insert and maintain a
Foley catheter, as well as
how to insert and
maintain a central line.

11. The diagnostic survey
approach was used to
conduct an observational
and descriptive analysis in
the Stukasz multi-profile
provincial hospital, which
has 713 beds and 22
departments (nine surgical,
12 non-surgical wards, and
one intensive care unit).
Structured interviews were
performed using a
specially designed survey
questionnaire
(Supplementary
Materials).
Scenario 1: The
customer can sanitize,
activating the dispenser's
infrared sensor, and then
walk through the door in
less than two seconds,
activating the door's
ultrasonic sensor. This is
a good scenario.
Scenario 2: After going
into the ultrasonic beam,
the person uses the hand
sanitizer in the patient's
room for two seconds.
Compliance is important
as well. If the hand
sanitizer doesn't work,

12. the room is bypassed
after two seconds.As
soon as you enter the
room, an alarm will go
off
Scenario 3: If all hands
sanitizing mechanisms
are active for two
seconds, no entry is
made.
A self-report
questionnaire was
developed to assess
perceptions,
subjective norms,
perceived behavioral
control, motive,
behavior, personal
responsibility, and
barriers.
Measurement In order to test this study The questionnaire In a
patient preoperative The questionnaire
© 2018 Laureate Education Inc. 4
Identify primary statistics used to
answer clinical questions (You
need to list the actual tests
done).
hand hygiene
compliance (HHC) was

13. assessed at two different
times: when entering and
leaving patient areas.
Each caregiver's
computer registered
hand hygiene (HH)
occasions and instances,
and data was created and
saved on cloud
computing-based
databases. Routine
hospital infection
monitoring obtained data
on the number of
CAUTIs and CLABSIs.
questions that were asked
include:
List all “5 moments for
hand hygiene.” Which are:
(1) before touching a
patient; (2) before
clean/aseptic procedure;
(3) after body fluids
exposure risk; (4) after
touching a patient; and (5)
after touching patient
surroundings.
Being at the hospital, were
you aware that the medical
staff were performing HH
in the course of the
activities associated with
medical procedures?

14. Did you observe that
HCWs performed HH
before drawing your blood
for testing?
When you were in primary
and secondary school,
were there towels and soap
in the school bathrooms?
holding room.40
compliant and non-
noncompliant testing
were done in a single
patient room ahead of
time.
questions that were
asked include:
‘Washing my hands
before and after every
patient contact is …’
(1 =‘not important’,
7 =‘very important’).
‘I feel under social
pressure from other
health care workers to
wash my hands’
(1 = ‘strongly
disagree’, 7 = strongly
agree’)
‘If I wanted to, I could
easily wash my hands

15. before and after each
patient contact’ (1 =
unlikely’, 7 =
‘likely’).
‘I always intend to
wash my hands before
and after contact with
each patient’ ( 1 =
strongly disagree’, 7
=‘strongly agree’).
© 2018 Laureate Education Inc. 5
‘I always wash my
hands before and after
contact with each
patient’ (1= ‘strongly
disagree’, 7=‘strongly
agree’).
Data Analysis Statistical or
Qualitative findings
(You need to enter the actual
numbers determined by the
statistical tests or qualitative
data).
The rates of CAUTI and
CLABSI were expressed
as incidence rate ratios
of 95% confidence
intervals (CIs).

16. During the engagement
phase, the automated
HHCS reported the total
number of HH
opportunities per month.
The number of HH
opportunities increased
from 60,167 in March
2015, when the
automated HHCS was
only in use in the ICU
and ICU stepdown unit,
and 779,824 in July
2016, when the system
was completely
introduced in the
hospital.
The incidence of
192 (66.8%) of the 286
HCWs surveyed knew at
least one of the "5
moments for HH," but 94
(33%) had no idea what
they were. Medical
professionals with less
than six years of
experience and those with
more than twenty years of
experience were more
likely to correctly mention
the "5 moments for HH."
The patients said that the

17. staff disinfected their
hands "always" and
"sometimes" in about 40%
of the cases, but that it
occurred "rarely" in about
20% of the cases before
direct physical contact or
physical examination.
Majority of respondents
The method was
accurate in detecting
97.5% of the test
samples and 100% of the
non-compliant samples,
the total accuracy was
98.75%
The TPB predictors
successfully
developed a model
explaining intention to
practice hand hygiene,
correctly classifying
70% of cases.
Personal
accountability
contributed another
2% to the right
classification, and
obstacles contributed
another 7%.
Classification
accuracy rates were
71% for 'medium'

18. intenders and 84% for
'large' intenders. The
overall correct
classification rate was
79 percent, indicating
that the model
correctly predicted the
majority of variance
© 2018 Laureate Education Inc. 6
CAUTIs was 2.20 per
1,000 catheter days prior
to intervention. During
the intervention phase,
this rate dropped to 1.21
per 1,000 catheter days.
During the pre
intervention period,
there were 1.43
CLABSIs per 1,000
central line days; during
the intervention period,
there were 0.64
CLABSIs per 1,000
central line days.
(329)(71.2%) said their
school did not have such
supplies . Just 105 (22.7%)
of respondents said their
school had soap and
towels, while 28 (6.1%)
did not respond.

19. in hand hygiene
behavior purpose. As
a result, the model's
total predictive
validity was high.
Findings and Recommendations
General findings and
recommendations of the research
During the 32-month
HHCS intervention, the
relative risk of CAUTIs
was reduced by nearly
45 percent. During the
HHCS intervention,
researchers saw a nearly
55 percent reduction in
the relative risk of
CLABSIs.
There are limitations to
treating patients to
participate in hand
hygiene, and health care
workers failure to follow
the "5 moments for hand
hygiene" greatly decreases
patient safety.
Recommendations for this
study include: Education
about hand hygiene should
begin at a young age for

20. the entire society: a lack of
adequate supplies in school
Hand hygiene
compliance improves as
a result of the alarm
system. The system
produced an overall
accuracy of 98.75%
Attitudes were found
to be a major
predictor of hand
hygiene intention.
© 2018 Laureate Education Inc. 7
bathrooms impedes the
production of healthy hand
hygiene habits.
Appraisal and Study Quality
Describe the general worth of this
research to practice.
What are the strengths and
limitations of study?
What are the risks associated with
implementation of the suggested
practices or processes detailed in
the research?

21. What is the feasibility of use in
your practice?
This study was intended
to decrease the incidence
of CAUTI and CLABSI
and it did just that. The
strengths of this study is
that it utilized
preintervention and
intervention periods The
lack of randomization in
this study's
quasiexperimental nature
is a disadvantage. The
risks associated with this
study is the invasion of
privacy of healthcare
workers and patients.
This study is feasible to
my practice because
in the current research,
where the use of the
HHCS was expanded to
all hospital units and the
follow-up period for
evaluating HAI rates
was increased,
substantial reductions in
the rate of CAUTIs and
CLABSIs were observed
This research practice was
intended to determine if
the partnership with
patients and healthcare

22. workers was feasible in
accomplishing HAI.
The strengths in this study
is that they engage patients
of different cultures,
gender, and economical
status, and participate in a
worldwide struggle in
healthcare. Limitations are
that not all patients and
HCWs were supportive in
achieving the same goal
and will fail to answer the
questionnaires. also that
this study has only been
conducted in Poland. I do
not think there are any
risks in the implementation
of this study. This study
would be feasible in my
practice because it would
make patients aware of
their importance in hand
hygiene in regards to
This experiment was
designed to promote the
use of this Alarm
system. The Strengths of
this experiment is that
Variables are under
better control. It's easier
to make a comment
about cause and effect.
Limitations ate the
experiment was

23. conducted in one
hospital setting. The
risks of this system is if
it crashes and the data is
not transmitted to the
hospitals database
causing failure to receive
results of compliance.
This experiment would
be feasible in the use of
my practice because it
would allow for better
recording the
compliance of hand
hygiene.
This study was
designed to illustrate
how the attitudes of
people were found to
be a major predictor
of hand hygiene
intention. The
strengths of this study
is that Multiple
outcomes by the series
of questions were
addressed. The
limitations were that
with this study you
weren't able to
actually see if the
attitudes impacted
hand hygiene it was
solely based on
answers. I do not see

24. there being any risks
associated with this
study and this
research is feasible
because it allows for a
wider view on how
attitudes can impact
whether hands will
© 2018 Laureate Education Inc. 8
reminding healthcare
workers to wash their
hands.
washed or not be
washed
Key findings
Hand hygiene
compliance systems can
improve HAI
The partnership of patient
and healthcare workers is
encouraged however
education is needed.
Utilizing alarm systems
can promote hand
hygiene compliance.
Attitude towards hand

25. hygiene.
Outcomes
There is a decrease in
CAUTIs and CLABSIs
when HH is utilized
patients and healthcare
workers working together
emphasize the practice of
hand hygiene and decrease
HAIs
Decrease in HAIs Attitudes can have an
impact on hand
hygiene.
General Notes/Comments
* These levels are from the Johns Hopkins Nursing Evidence-
Based Practice: Evidence Level and Quality Guide
● Level I
Experimental, randomized controlled trial (RCT), systematic
review RTCs with or without meta-analysis
● Level II
Quasi-experimental studies, systematic review of a combination
of RCTs and quasi-experimental studies, or quasi-experimental
studies only, with or without meta-analysis
● Level III
© 2018 Laureate Education Inc. 9

26. Nonexperimental, systematic review of RCTs, quasi-
experimental with/without meta-analysis, qualitative,
qualitative systematic review with/without meta-synthesis
● Level IV
Respected authorities’ opinions, nationally recognized expert
committee/consensus panel reports based on scientific evidence
● Level V
Literature reviews, quality improvement, program evaluation,
financial evaluation, case reports, nationally recognized
expert(s) opinion based on experiential evidence
**Note on Conceptual Framework
● The following information is from Walden academic guides
which helps explain conceptual frameworks and the reasons
they are used in research. Here is the link
https://academicguides.waldenu.edu/library/conceptualframewor
k
● Researchers create theoretical and conceptual frameworks that
include a philosophical and methodological model to help
design their work. A formal theory provides context
for the outcome of the events conducted in the research. The
data collection and analysis are also based on the theoretical
and conceptual framework.
● As stated by Grant and Osanloo (2014), “Without a
theoretical framework, the structure and vision for a study is
unclear, much like a house that cannot be constructed
without a blueprint. By contrast, a research plan that contains a
theoretical framework allows the dissertation study to be strong
and structured with an organized flow from

27. one chapter to the next.”
● Theoretical and conceptual frameworks provide evidence of
academic standards and procedure. They also offer an
explanation of why the study is pertinent and how the
researcher expects to fill the gap in the literature.
● Literature does not always clearly delineate between a
theoretical or conceptual framework. With that being said, there
are slight differences between the two.
© 2018 Laureate Education Inc. 10
References
The Johns Hopkins Hospital/Johns Hopkins University (n.d.).
Johns Hopkins nursing dvidence-based practice: appendix C:
evidence level and quality
guide. Retrieved October 23, 2019 from
https://www.hopkinsmedicine.org/evidence-based-
practice/_docs/appendix_c_evidence_level_quality_guide.pdf
Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and
Integrating a Theoretical Framework in Dissertation Research:
Creating the Blueprint
for Your" House". Administrative Issues Journal: Education,
Practice, and Research, 4(2), 12-26.
Walden University Academic Guides (n.d.). Conceptual &
theoretical frameworks overview. Retrieved October 23, 2019
from
https://academicguides.waldenu.edu/library/conceptualframewor

28. k
© 2018 Laureate Education Inc. 11
Part 3B of Evidence-Based Project.
It is estimated that approximately 30% of hospital infections
could be avoided if medical staff followed the recommendations
on
hand hygiene. (Jenner.EA et al., 2002) This sought to be true
based on a system of things including participation of
healthcare workers,
patients, utilizing a theoretical approach such as a hand hygiene
compliance system. Hand hygiene is essentially the root of the
cause of
many HAIs that can be prevented if all healthcare worker, and
patients in the hospital wash their hands. Compliance with hand
hygiene is
described as proper washing of hands before and after all
patients or patient environments, using soap and water or the
antiseptic agent.
(Hong, T. S. et al, 2015)
Evidence based practices demonstrate that utilizing hand
hygiene systems to record the compliance of healthcare
workers hand
hygiene decreases the rates of HAIs. In a study of hand hygiene
compliance monitoring, the use of a prototype device that

29. includes a
doorway sensor, two sanitizer dispenser sensors, a
microprocessor, and an alarm is decreasing HAIs. It allows for
hospitals to educate
staff based on the data retrieved from the device.(Hong, T. S. et
al, 2015) In addition to other infection prevention steps,
tracking hand
hygiene activities via an automated system such as Biovigil
may be an efficient way to reduce HAIs. The Biovigil is an
automated
machine that reminds health care professionals to apply hand
hygiene.The device's light flashes yellow, then red, before hand
hygiene is
completed, at which point the light flashes green, assuring
patients and everyone at the bedside that HHC was
completed.(McCalla S., et
al, 2018) Attitudes were found to be a major predictor of hand
hygiene intention. (Jenner.EA et al., 2002) In order to
implement the
© 2018 Laureate Education Inc. 12
importance of hand hygiene education about hand hygiene
should begin at a young age for the entire society: a lack of
adequate supplies in
school bathrooms impedes the production of healthy hand
hygiene habits. (Wałaszek, M., 2018)

30. As we advance in this world many studies have proven the use
of hand hygiene compliance in the reduction of hospital
acquired
infections. Emphasizing the importance of hand hygiene can be
implemented by everyone it is standard for the prevention of
transmission of bacteria.
© 2018 Laureate Education Inc. 13
References
Hong, T. S., Bush, E. C., Hauenstein, M. F., Lafontant, A., Li,
C., Wanderer, J. P., & Ehrenfeld, J. M.(2015). A hand hygiene
compliance
check system: brief communication on a system to improve
hand hygiene compliance in hospitals and reduce infection.
Journal
of medical systems, 39(6), 69.
Jenner EA, Watson PW, Miller L, Jones F, & Scott GM. (2002).
Explaining hand hygiene practice: an extended application of
the
Theory of Planned Behaviour. Psychology, Health & Medicine,
7(3), 311–326.
McCalla S, Reilly M, Thomas R, McSpedon-Rai D, McMahon
LA, Palumbo M. An automated hand hygiene compliance system
is
associated with decreased rates of healthcare-associated
infections. Am J Infect Control. 2018 Dec;46(12):1381-1386.
doi:

31. 10.1016/j.ajic.2018.05.017. Epub 2018 Jul 6. PMID: 30509358
Wałaszek, M., Kołpa, M., Wolak, Z., Różańska, A., &
Wójkowska-Mach, J. (2018). Patient as a Partner in Healthcare-
Associated
Infection Prevention. International Journal of Environmental
Research and Public Health, 15(4), 624. MDPI AG. Retrieved
from http://dx.doi.org/10.3390/ijerph15040624
© 2018 Laureate Education Inc. 14