Critical Appraisal of Practice Guidelines

Guideline Evaluation According to Agree II
Guideline In Question: WHO Guidelines on Hand Hygiene in Health Care. Geneva: WHO, 2009.
DOMAIN 1. SCOPE AND PURPOSE
The overall objective(s) of the guideline is (are) specifically described.
Strongly Disagree 12 3 4 5 6 7 Strongly Agree
Comments: Numerous sources and studies have demonstrated the importance of cleanliness of the hands, and that when hand hygiene is complete, patient outcomes are more positive and surgeries are safer. (Grol et al., 2003) (Sax et al., 2007) (O’Boyle, 2001)
2. The health question(s) covered by the guideline is (are) specifically described.
Strongly Disagree 2 3 4 5 6 7 Strongly Agree
Comments:
This guideline could be more specific in detailing all specific health questions this pertains to, though perhaps their lack of specificity was directly connected to the fact that hand hygiene impacts nearly every health condition.
3. The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments:
In this case, the population to whom this guideline is meant to apply is not specifically described, most likely because it applies to so many or nearly all populations.
DOMAIN 2. STAKEHOLDER INVOLVEMENT
4. The guideline development group includes individuals from all relevant professional groups. Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: There is clear mention that all participating members of the healthcare arena have a duty to participate in this guideline.
5. The views and preferences of the target population (patients, public, etc.) have been sought. Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: The implied target population in this case is largely everyone who receive professional healthcare in virtually any and every professional setting. Their goals aren’t explicitly stated as they are implied: they want to be healthy.
6. The target users of the guideline are clearly defined.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: All clinicians have a duty to participate in the highest and most comprehensive level of thorough hang hygiene that they are capable of.
DOMAIN 3. RIGOUR OF DEVELOPMENT
7. Systematic methods were used to search for evidence.
Strongly Disagree 12 3 4 5 6 7 Strongly Agree
Comments: Even the most cursory perusal of the evidence demonstrates the most systematic methods for researching the support of hand washing (Grol et al., 2003) (Sax et al., 2007) (O’Boyle, 2001).
8. The criteria for selecting the evidence are clearly described.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: The guideline makes a slight reference to the criteria for selecting evidence.
9. The strengths and limitations of the body of evidence are clearly described.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: There could have been more discussion regarding the strengths and limitations of the body of evidence.
10. The methods for formulating the recommendations are clearly described.
Strongly Disagree 12 3 4 5 6 7 Strongly Agree
Comments: The methods for formulating the recommendations based on the current evidence are described clearly and in detail.
11. The health benefits, side effects, and risks have been considered in formulating the recommendations.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: These aspects were described in detail and at length, as part of the support for hand washing.
12. There is an explicit link between the recommendations and the supporting evidence. Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: There is a clear and almost undebatable connection between the recommendations and the supporting evidence.
13. The guideline has been externally reviewed by experts prior to its publication. Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: There was no explicit mention of external review of this guideline, though given the source; one would assume there would be.
14. A procedure for updating the guidelines is provided.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: There is no mention of ever updating the guideline.
DOMAIN 4. CLARITY OF PRESENTATION
15. The recommendations are specific and unambiguous.
Strongly Disagree1 2 3 4 5 6 7 Strongly Agree
Comments: The guideline goes into specific detail about the importance and expectations of hand washing, long with when and how to do it.
16. The different options for management of the condition or health issue are clearly presented.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: When it comes to hand washing, there really aren’t a host of other options, though there is a cursory mention that hand sanitizer is important, and that certain hand wipes can help in sterilizing the hands.
17. Key recommendations are easily identifiable.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: There is much clarity surrounding the key recommendations and their importance, along with almost no ambiguity.
DOMAIN 5. APPLICABILITY
18. The guideline describes facilitators and barriers to its application.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: The guideline does allude to some of the barriers to its implication and to clinicians engaging in hand washing as often as they need to.
19. The guideline provides advice and/or tools on how the recommendations can be put into practice. Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: All relevant recommendations connected to hand washing are there, along with the importance of visual reminders in key places, along with hand-washing stations.
20. The potential resource implications of applying the recommendations have been considered. Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: There is a cursory mention of the potential resource implications that will connect to the application of the recommendations.
21. The guideline presents monitoring and/or auditing criteria.
Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: There is only a brief mention of monitoring or auditing criteria to ensure that clinicians are engaging in this crucial practice.
DOMAIN 6. EDITORIAL INDEPENDENCE
22. The views of the funding body have not influenced the content of the guideline.
Strongly Disagree 12 3 4 5 6 7 Strongly Agree
Comments: The WHO has a reputation of tirelessly trying to promote the greater good, and they have not influenced the content of the guideline.
23. Competing interests of guideline development group members have been recorded and addressed. Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree
Comments: Competing interests don’t appear to be relevant at this time, as hand hygiene is something that benefits all and is so simple to implement, if care is taken in regards to strategy.
OVERALL GUIDELINE ASSESSMENT
1. Rate the overall quality of this guideline.
Lowest possible quality 12 3 4 5 6 7 Highest possible quality
2. I would recommend this guideline for use
Yes
Yes, with modifications
No
Proper hand hygiene is essential for clinicians. These guidelines are instrumental as they provide clarity about how often clinicians need to engage in hand washing and why. The guidelines also offer helpful pointers regarding the practical implementation of this guideline and the importance of having things like hand-washing stations and hand-sanitizing stations. Another important detail that the guidelines recommend is the necessity of visual reminders for all healthcare professionals, such as signs. These healthcare professionals are so busy; it helps to have frequent visual reminders.
References
Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients' care. The lancet, 362(9391), 1225-1230.
O'boyle, C. A., Henly, S. J., & Larson, E. (2001). Understanding adherence to hand hygiene recommendations: the theory of planned behavior. American journal of infection control, 29(6), 352-360.
Pittet, D., Allegranzi, B., Boyce, J., & World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. (2009). The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infection Control & Hospital Epidemiology, 30(7), 611-622.
Sax, H., Allegranzi, B., Uckay, I., Larson, E., Boyce, J., & Pittet, D. (2007). ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection, 67(1), 9-21.