Hand Hygiene and Respiratory Infections in Long-Term Care

Introduction to the Evidence-Based Practice Project

A literature review conducted by Rabie and Curtis (2006) aimed at establishing the effects of handwashing in reducing respiratory infections. The literature was obtained by searching CAB Abstracts, PubMed, Embase, Cochrane, and the Web of Science library. The inclusion criteria for the review required that studies report on the impact of handwashing in reducing respiratory infections, and all articles included were published before June 2004. This was a quantitative systematic review, which made it an effective method for analyzing and evaluating the selected studies. After searching for relevant articles, the researchers found 395 articles; however, only 61 were selected after review of their abstracts (Rabie & Curtis, 2006). The review and selection process continued, and the final review included only eight articles, which the researchers determined were most relevant to their study. By eliminating articles that focused on children with disabilities, microbiology, and hospital settings, the researchers ensured that their review would demonstrate the effects of handwashing under normal conditions.

Handwashing and Respiratory Infection Risk: Systematic Review

The studies reviewed were all conducted in developed countries, which was a notable limitation, as the researchers could not establish whether the same findings would apply in developing countries. Nevertheless, it was found that there is a possibility of reducing respiratory infection risks by 16% simply by washing hands. The evidence found is therefore only directly applicable to developed countries, and replication in developing-country contexts is needed. The researchers acknowledged that their review is only indicative due to its limitations (Rabie & Curtis, 2006). The studies reviewed were few, of poor quality, and subject to geographical limitations. The exclusion of major studies due to methodological flaws was also noted. These factors make it difficult to determine whether the results are fully reliable. The exclusion of eligible studies suggests the review could have produced different results; however, including methodologically flawed studies would risk introducing bias.

This was a multiple-center cohort study conducted over three years, aimed at establishing the prevalence of respiratory tract infections in nursing home residents. The researchers sought to determine whether these infections had any impact on the functional status and clinical course of patients (Loeb, McGeer, McArthur, Walter, & Simor, 1999). The study included 475 residents across five nursing homes located in metropolitan Toronto, Ontario, and was conducted from July 1993 to June 1996. The study comprised 192 women, and the mean age of participants was 85 years (Loeb et al., 1999). The results demonstrated no significant difference from other reports in the literature. The researchers found that surrogate markers were associated with the development of pneumonia. A diagnosis of pneumonia was made when patients exhibited difficulty breathing. Respiratory tract infections are common among elderly patients, and understanding their causes and effects is vital for formulating effective treatment. Participants who had received an influenza vaccination were least likely to develop pneumonia or other respiratory infections, demonstrating the effectiveness of influenza vaccination for elderly people.

The evidence presented by the researchers is strong, and a clear indication is offered that, to prevent the development of pneumonia, yearly vaccinations should be administered. The study results may not be fully applicable to Veterans Affairs facilities (Loeb et al., 1999). The study also found that the development of pneumonia does not necessarily result in a decline in functional status, as had been suggested by earlier research. This is a valuable study that provides a positive foundation for advancing this line of inquiry. The researchers noted that viral respiratory infections were common and that these most often led to the development of pneumonia in elderly patients. The limited availability of prior research focused on this phenomenon makes it difficult to confirm this finding definitively, and future research would help clarify the issue.

Conclusion