Evidence Based Study Use of Personal Protective Equipment for ICU Nur

Question: Discuss about theEvidence Based Studyfor Use of Personal Protective Equipment for ICU Nurses. Answer: Key words: PPE, ICU nurses, critical care, challenges, advantages, hand washing, ventilated patients, MRSA infections, hospital settings, responsibility of the nurses, comparison of PPE and hand washing, health hazards, risk factors, practices of PPE, transmission of infections, measures of prevention, infection prevention control, ineffective hand hygiene Introduction Personal Protective Equipment (PPE) must be availed by the nurses who work at the Intensive Care Unit (ICU). OSHA (Occupational Safety and Health Administration) defines PPE as equipment worn by an employee in order to protect oneself from infectious materials. Nurses in ICU work in hazardous situations involving patients with contagious and life threatening diseases such as influenza, Ebola, tuberculosis, anthrax, rabies, small pox, cholera (Tweedy, 2014). To prevent the nurses from contracting the diseases, proper safety based equipment is necessary. PPE protects the nurses from pathogens, which might spread through contact, aerosols and droplets. This essay aims to provide a background of the selected nursing issue, which is use of personal protective equipment for ICU nurses on ventilated patients. The essay will provide details of the search terms, source of evidence, and criteria of selection of each article. The essay aims at explaining the levels of evidence and critically analyzing the practice recommendations based on the level of evidence and the relevance to nursing practice in the healthcare settings of New Zealand. In addition, the essay will suggest the further areas of study based on the findings of the researched evidences. Background of the Nursing Issue Personal protective equipment refers to the specialized equipments or clothing that is utilized for protecting the healthcare professionals and the patients from pathogens (Gomersall et al., 2006). It plays a significant role in creating a barrier between the individuals and the microorganisms. It includes facemasks, goggles, gowns and gloves. The use of Personal protective equipment for ICU nurses on ventilated patients is essential and the nurses should be educated regarding it in every possible way as it is concerned with the health and safety of the patients (Santos et al., 2016). The PICOT question that has been developed for the nursing issue is: Does the proper use of Personal Protective Equipment by the ICU nurses minimize the risk of nosocomial infections in the ventilated patients, in comparison to Hand washing? P (Population) - ICU nurses I (Interventions) - Proper utilization of PPE for ICU nurses on ventilated patients C (Comparison) - Hand washing by nurses in the ICU for ventilated patients O (outcome) - Reduce spreading of nosocomial infections T (Time frame) Measuring outcome in 6 weeks The literature survey has been carried out by referring to the research articles that has been published from the year 2006-2016, which describes the use of personal protective equipment for ICU nurses on ventilated patients. These articles has been searched in PubMed, Medline, CINAHL, EMBASE, Cochrane Library, Science direct, Gideon, Google Scholar, Dopher, ELDIS, Health Evidence, HealthData.gov, Healthdirect, Medlineplus, Medscape, Ovid Nursing database, Oxford University Press Journals, PubMed Central databases. Critical Analysis of the Practice Based Recommendations Rozenbojm et al. (2015) (Level III- the evidence has been obtained from a controlled trial without involving randomization) has carried out a study in relation to the nurses using facial protective equipment. The suggestion has been made where the nurses should use FPE to protect themselves from contracting transmissible respiratory tract diseases while treating the patients. The higher level of evidence shows that the recommendation is applicable for nursing practice. Nichol et al. (2011) (Level IV- evidence has been obtained from a case control study) has carried out a similar study on FPE. Iten et al. (2015) (Level VI- evidence has been obtained from a single descriptive study) has carried out a study where Infection Control Specialists (ICS) have trained and supervised the nurses and staff in using PPE while handling patients with Ebola Virus disease and how to dispose off their waste without causing an outbreak, in an European setting. The evidence is low which shows that few su ch studies has been carried out in respect to Ebola virus. Beam et al. (2014) (Level IV) has carried out the study where the patients make basic mistakes while handling patients who are suffering from contagious diseases. Guidelines have been suggested for the nurses working in such a setting to use PPE measures in order not to contract the diseases. The high level of evidencing shows that the error study among the nursing practices still requires a detailed study as it is for their own safety. Jain et al. (2013) carried out a similar study (Level VI) where they have studied the factors that are responsible for limiting the use of PPE in respect to a tertiary care hospital. The nurses must be careful and alert and take it into their stride of using PPE as it is a matter of their health. The low level of evidence shows the lack of in depth study in this context and it can mistly be furthered by carrying out a population-based study. Shrestha (2014) (Level IV) has carried out a study on the impact that educational based intervention has on the nurses to inspire them to follow universally followed practices in respect to personal precautions. The low level of evidence shows that the study still has a lot of room for further exploration. Leonard and Timmins (2013) (Level VII- evidence has been obtained from expert communities) had carried out a study that involved the precautionary measures that has to be followed in order to safe guard the patients as well as the nurses from contracting blood-borne infections. PPE based guidelines must be followed and the low level of evidence shows that the sufficient information has not been collected from an in detailed study. Thorough research has to be carried out in order to validate the recommendations. Verbeek et al. (2016) (Level II) has carried out a study where stress has been laid on the usage of PPE by the nurses in order to reduce the prevalence of infection among the nurses. From the aspect of contaminated body fluids has been used to discuss the importance of PPE usage among the nurses. The high level of evidence shows that a thorough study has been carried out with the use of RCT and the values obtained show a high level of significance. Practice Recommendations in Relation to the Healthcare Settings of New Zealand Pesiridis et al. (2014) (Level II- evidence has been obtained from a randomized controlled trial) has carried out a study which has aimed at explaining the guidelines and safe practices for the nurses to follow during a disease related disaster. The high level of evidence shows that it can be applied in the New Zealand setting. de Carvalho Nagliate et al. (2013) (Level IV evidence has been obtained from a case control study) has also suggested standard precautionary measures which must be followed by the nurses while working with patients who are infected with contagious diseases and it is definitely more effective than hand washing. The evidence level is not exactly low and it can be applied in the New Zealand setting. Bin-Reza et al. (2012) (Level I- evidence has been obtained from systematic review of a RCT) has carried out a study where he has discussed the use of masks as well as respirators in order to prevent the transmission of influenza in the nurses working with them. The high level of evidence makes it eligible to be applied in the nursing setting of New Zealand. Eskander, Morsy Elfeky (2013) (Level VI) has carried out a study involving nurses in ICU and the knowledge and practices in regard to the infection control standard based precautions in an Egyptian Cancer Hospital setting. The low level of evidence shows that thorough research still needs to be carried out to be applied as a recommendation in respect to New Zealand nursing setting. Abad et al. (2014) (Level IV) has carried out a study basically to reduce the transmission of MRSA (Methicillin Resistant Staphylococcus aueus) and VRE (Vancomycin Resistant Enterococcus) among ICU patients by making sure the nurses follow proper PPE usage guidelines to prevent infection. Mitchell et al. (2013) (Level IV) has carried out studies in a Canadian setting where they have considered hospitals and has referred to the data collected from the Canadian Nosocomial Infection Surveillance Program. The high level of evidence shows that there is still a scope of research that needs to be carried out. Schwartz, Shapira Bar-Dayan (2014) (Level II) has carried out a study where the knowledge and confidence of the nurses in respect to PPE was evaluated in an Israeli setting during the H1N1 pandemic. The level of evidence is high and it can use in the nursing setting of New Zealand. Such a pandemic can hit New Zealand and during such a situation, the nurses must use PPE to reduce their chances of contracting the disease and be in a condition where they are abel to provide care and service to the patients. Valdez (2014)(Level VI) has carried out a study where he has recommended the safe practices that are adhered to PPE. The study that has been carried out has a low level of incidence because it neither targeted a particular population nor did it consider a particular setting where the guidelines could have been applied. The evidence is simply a single descriptive work considering the safe practices in respect to PPE have been outlined. Hence, this evidence cannot be used as a recomme ndation in respect to the nursing setting of New Zealand. Loveday et al. (2014 (Level VII) had carried out a study where they have outlined the National Evidence Based guidelines which has been used in preventing the Healthcare associated infections at NHS hospitals, part of the England setting. the lower level of evidence is very low and it is mostly because the study is limited in England only. However, the guidelines are quite applicable to nursing practice in any setting. Hence, they can be recommended for the nursing practice in New Zealand setting. Butt et al. (2016) (Level II) has carried out a study where prevention practices for infection by MERS (Middle- East Respiratory Syndrome) has been suggested in respect to the Saudi Arabian setting. The guidelines have been suggested in order to prevent the patient and the nurses from contracting the disease. The guidelines suggested can be applied to nursing setting in New Zealand since the level of evidence is high. Most of the guidelines have suggested that PPE is a better method than hand washing. Hence, the recommendations were suggested which are inclined more towards the usage of PPE as the best measure for preventing the infection among the nurses. Further Areas of Study Based on the findings of the evidence search, the further areas of study include the development of novel methods for maintaining hand hygiene by using PPE by ICU nurses for the ventilated patients. Since, the patients that are admitted have critical condition and they require appropriate and care for recovering their health effectively (Hickman, 2015). The traditional and the current methods practiced by the nurses and the other healthcare professionals, sometimes fail to accomplish the goal of maintaining the health and safety of the patients. Therefore, the new methods will be more accurate and will help the nurses and the other healthcare professionals in an efficient manner. Conclusion The analysis of all the chosen articles has illustrated all the levels of evidence and has provided information regarding the comparison of hand washing and PPE by the ICU nurses for the ventilated patients. The evaluation regarding the adequacy of the information provided has been carried out for allowing the computation of comparable dimensions of outcome across studies. Additionally for the potential risk factors, it has been noted that a preponderance of the studies have demonstrated a significant correlation concerning the assessment of appropriate utilization of hand washing and PPE for ICU nurses on ventilated patients and only some of the studies have not revealed such significant relationship between these two. References: Abad, C. L., Pulia, M. S., Krupp, A., Safdar, N. (2014). Reducing Transmission of Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus in the ICUAn Update on Prevention and Infection Control Practices.JCOM,21(5). 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