Recent orders
Table of Evidence
Table of Evidence
Katira Marshall, Sharun Manu, and Toyin Ajayi
Department of Nursing, West Chester University
NSG 313: Applied Nursing Research
Megan A. Infanti Mraz RN, PhD
6/26/2022
Theme Study #1 Study #2 Study #3
Purpose To determine the effectiveness of various hand washing methods in order to eliminate Escherichia coli and feline calicivirus (FCV) from fingernails, which is natural as well as artificial and are of different lengths (Lin et al., 2003). To compare the effectiveness of an antimicrobial soap and an alcohol-based hand cleansing gel on the colonization of fingernails, i.e., natural as well as artificial; determining the microflora differences in the healthcare worker’s nails (McNeil et al., 2001). To highlight the strategies for preventing healthcare- associated infections through the hand hygiene (Ellingson et al., 2014).
Design Bacterial inoculum preparation in which E. coli strain was added to the fresh grounded beef and was mixed with gloved hands; followed by the storage on ice before inoculating and immediately used after inoculating.
Tissue culturing and viral inoculum processing was done, collected and stored at -80◦ C, until the usage of viruses.
Accounting of virus populations and preparing viral inoculum.
Selection of human volunteers.
Inoculation of the fingernails using microbial sample.
Determining the microbial counts.
Evaluation of six hand washing methods. 21 volunteers were selected amongst the healthcare workers including inpatient and out patient care areas at University of Michigan and the Veterans Affairs Medical centers.
Cultured samples were obtained from the volunteers at different times during regular activities. Although cleaning of hands was not allowed just before the sampling, but they have cleansed their hands as usual.
Surfaces of the nails and subungual areas of all the five fingers of the most dominant hand were performed for culturing.
Different colonies were phenotypically quantified and identified S. aureus, enterococci, gram negative bacilli and yeasts. Hence, identification of all the organisms were done by the standard methods. Associating the hand hygiene improvisation as well as healthcare associated infection reduction (HAI).
Setting Laboratories. Medical Centers. Variety of settings (Healthcare settings or Hospitals; Medical centers; Laboratories).
Sample
Characteristics and Size Nonpathogenic E. coli JM 109 of 50 ml was used as bacterial indicators and feline calicivirus (FCV) strain F9 were used as viral indicators. Surfaces of the nails and subungual areas of healthcare workers.
Size- N/A. Pathogen specific- Clostridium difficile and norovirus.
Size- N/A.
Data Collection Data was collected from one of the involved volunteers for one hand washing method, which was considered as an experiment unit. 21 healthcare workers were wearing artificial nails and 20 healthcare workers was considered as control; i.e., before and after the usage of antimicrobial soap and alcohol-based gel. Direct observation.
Indirect volume.
Event count measurement.
Automated adherence monitoring by using advance technologies.
Data Measurement and Analysis Data analysis was done by performing statistical analysis, showing significant difference of P= 0.05 in E. coli or FCV counts amongst both the type of nails, which was determined by t test. Duncan’s test was then performed for multiple comparison for determining significant differences P= 0.05 of reduced microbial counts between hand was methods within same fingernail types and t test was done to determining significant differences P= 0.05 in microbial count reduction amongst natural and artificial nails with same hand wash method. Statistical analysis was overall done by the Statistical Analysis System program (SAS). Isolation frequency and organisms’ quantity were compared between the healthcare workers wearing artificial nails and the healthcare workers with native nails as the control.
Isolation frequency was done by X2 test and quantified differences of different organisms by Student’s t test.
Comparison of both the types of nails were done by the paired t test.
Statistical significance analyzed was as P≤ 0.05. Measured hand hygiene associated with the single measurement approach.
Direct observation helped in in-person monitoring of the behavior of hand hygiene.
Results (significant findings) Irrespective of the types of nails, long fingernails show to harbor more microbes when compared to the shorter nails.
When comparing natural and artificial nails in the same wash method, no significant reduction of E. coli JM 109 counts was found, except when soap and nailbrush both were used.
Average decrease of the FCV units, which is infectious, were found to be collected on the natural fingernails hand’s than the artificial nails. Hence, no statistically significant difference, P> 0.05. Significantly more cultures from the healthcare workers were found wearing artificial nails before cleaning of hands with soap or a gel; when compared to the healthcare workers as control had S. aureus, gram negative bacilli a well as yeasts isolated.
No healthcare workers with the native nails had gram negative bacilli, which was isolated after cleaning hands with the alcohol gel.
Therefore, alcohol-based gel was found to be more effective for elimination of pathogens when compared to antimicrobial soap. Performance measures are based on the internal reporting, which includes quality improvement, feedback, longitudinal assessment, improvisation through measurement and intervention strategies in individual facilities as well as different group of facilities in the same healthcare system.
Based on external reporting, hand hygiene metrics suffers from the non-trusted data, implies of misaligned incentives.
Limitations N/A Time constraints.
Cleaning of hands of the healthcare workers.
Improper usage of gloves. Lack of combined approach to explore further studies of feasibility and acceptability in order to refine the methods.
References
Ellingson, K., Haas, J., Aiello, A., Kusek, L., Maragakis, L., Olmsted, R. & Yokoe, D. (2014). Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infection Control & Hospital Epidemiology, 35(S2), S155-S178. doi:10.1017/S0899823X00193900
Lin, C. M., Wu, F. M., Kim, H. K., Doyle, M. P., Michaels, B. S., & Williams, L. K. (2003). A comparison of hand washing techniques to remove Escherichia coli and caliciviruses under natural or artificial fingernails. Journal of Food Protection, 66(12), 2296-2301. https://doi.org/10.4315/0362-028X-66.12.2296McNeil, S. A., Foster, C. L., Hedderwick, S. A., & Kauffman, C. A. (2001). Effect of hand cleansing with antimicrobial soap or alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers. Clinical Infectious Diseases, 32(3), 367-372. https://doi.org/10.1086/318488
Diego.
& Brunkal
The effect of environments on the Indian Culture during the Pre
The effect of environments on the Indian Culture during the Pre-Columbian Period
The Pre-Columbian era is the period before the voyages of 1942 by Christopher Columbus arrived to America. During the era, the development of cultures was based on the region where the community lived, environment shaped the peoples culture. North American Indians Had a hunting culture where the used Clovis points, a fluted stone which was used as a spear for hunting. Other hunting cultures by the Indian people include the Folsom tradition, where they used Folsom points for hunting; Folsom points were an advancement of Clovis points such that they were thinner and smaller. The Hohokam people who settled in the present day Arizona practiced desert farming, in Southwestern America they were the first to grow cotton, and living in a fertile environment enabled them to practice farming. Indians who lived around the Ohio valley and Illinois River valley practiced both hunting and gathering alongside farming, those in the valleys practiced hunting and gathering while those along the rivers practiced farming as the environment favored farming.
Though in the Pre-Columbian era Indians occupied different regions of America, their cultures had similar elements like the use of Stone tools to practice hunting also settling along rivers to practice farming.
The European Exploration
The Europeans set out to explore beyond their borders for many reasons, they were looking for a different trade route to Asia where they got their spices, and they also set out of their countries in search of gold, silver and other precious stones, while some European rulers sent out explorers who were to help them expand their empires. The European explores were also missionaries who wanted to spread Christianity to other parts of the world. While others wanted to expand their knowledge about the world, to explore and discover regions beyond Europe.
As they explored their aim was to find new areas to settle, to find new trade partners and also new sea routes to their trade destinations. As they explored Europeans interacted with the natives from the new regions and made many exchanges. Knowledge exchange that occurred, explorers from Spain had never seen Turkeys, rattlesnakes and llamas, they also learnt about new foods like corn, chocolate, tobacco, beans and pineapples, the American natives got to learn about coffee, wheat, sugar cane and bananas also animals like horses, sheep and pigs were introduced to them.
Disease was also exchanged during the interactions; Europeans came with influenza, smallpox and whooping cough which affected the natives severely, some of which reduced the natives population due to lack of cure.
The natives were affected majorly by the diseases that came with the Europeans as Europeans got somewhere to settle and enriched themselves from the raw materials they got from America.References
King, Heidi, Ma. Mercedes Pérez, and N.Y. York. Peruvian featherworks: art of the Precolumbian era. New York: Metropolitan Museum of Art ;, 2012. Print.
Morison, Samuel Eliot. The European discovery of America. New York: Oxford University Press, 197174. Print.
Kupperman, Karen Ordahl. America in European consciousness, 1493 – 1750. Chapel Hill [u.a.: Univ. of North Carolina Press, 1995. Print.