Quantitative Research Critique and Ethical Considerations Part II

My PICOT question focuses on hospitalized patients suffering from surgical site infections and generating a comparison of different interventions (including training and reducing stressors upon staff) to reduce the likelihood of such infections occurring post-surgery. This paper reviews the previous literature on attempts to better understand why such preventable infections occur and how to address their root causes.

Background of Study

The study of Teshager, Engada, & Worku (2015) focuses on human-related factors associated with increased risks of surgical infection in Amhara, Ethiopia. The study focused on nursing personnel specifically. Associated demographic factors with lower risk included greater knowledge of preventative factors, increased age of the nurse, increased practice experience, male gender, past training, and higher education level. The study encompassed 423 nurses, and more experienced male nurses with higher levels of training and education had the greatest knowledge of infection preventative practices. Male nurses may have been more aware of preventative factors may have to do with access to education.

The studys findings support the idea that proactive approaches could reduce infection rates by increasing providers knowledge. This includes supporting nurses continuing education, support for obtaining graduate degrees, as well as providing on-the-job training. Results made a strong case for educational interventions, given that nurses that had taken preventative coursework were two times as likely to be knowledgeable of best practices in infection prevention versus those nurses who did not. It should be noted, however, that the study merely surveyed the level of nurse knowledge versus actual infection rates at the hospitals where the nurses were in practice.

While this particular study focused upon nurse knowledge, as measured by researchers, in another study of Ethiopian hospitals by Awoke, Arba, & Girma (2019), the focus was on the prevalence of such infections and how to prevent their occurrence from an institutional perspective. Surgical site infections were found to be a significant risk in the hospitals studied, meriting aggressive preventative interventions. Shortening preoperative stays, pre-surgical intravenous antimicrobial prophylaxis, and ensuring wound care was immediately given as orders were all suggested as ways to reduce infection, based upon a random sampling of 261 patient charts in a study of a 268-bed hospital, with a focus on medical, pediatrics, surgical, gynecology, and obstetrics wards.

How Do These Two Studies Support the PICOT Question

These two studies support an answer to the PICOT question because they focus on two different dynamics that simultaneously affect the likelihood of infection. In the case...

…levels of knowledge of how to prevent surgical site infections were manifest in the Teshager (et al., 2015) study. However, both studies did offer some hope in the sense that it was possible to reduce risk, both on an individual level in terms of improving levels of provider education in the case of Teshager (et al., 2015), and addressing institutional practices such as reducing the length of patient stays in the hospital and being more diligent in the use of prophylactic on-site antibiotic treatment (Awoke et al., 2019).

Ethical Considerations

The subjects of both studies were anonymous, so providers and patients identities were protected from institutional repercussions. Of course, the question might arise if the level of risk evidenced at both institutions to future patients undergoing surgery warranted a more immediate and aggressive intervention, such as an education and training program for providers, or a review of best practices.

Conclusion

Both studies support the severity and urgency of addressing the problem of surgical site infection. They also suggest a multifactorial approach to doing so, both from institutions and also from a provider standpoint, in seeking out continuing education. But ultimately, it is institutions that must support the time and financial requirements for such initiatives, as well as to allow…