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Review questions for article : Chhapola, V., & Brar, R. (2015). Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit. International Journal Of Nursing Practice, 21(5), 486-492. doi:10.1111/ijn.12283 1.) What type of sample was utilized for this study? 2.) The study states it has a quasi-experimental design. Why is this not a randomized control trial? 3.) During the study, no other new infection control procedures were implemented. How would this impact the validity of the study? 4.) If a new antibiotic policy were started before this study how might a carry over effect impact your results? 5.) In this study, data for each observed opportunity for handwashing was recorded as correctly performed or not (yes/no). What level of measurement is this variable? 6.) If instead the data were collected as the number of errors made while hand washing, the variable would be at what level of measurement? 7.) Look at table 1. What was the rate of HCW’s performing correct hand washing techniques between patient encounters before and after the intervention? 8.) Look at table 1. A chi-square test is completed to determine if there is an increase in correct hand washing technique between patient encounters. Was there a significantly significant relationship between the variables? Why? 9.) Look at table 1. Interpret the RR that HCW correctly wash their hands between patient encounters. 10.) Look at table 1. Were HCW’s significantly more likely to wash their hands correctly after leaving the patient? 11.) Look at table 1. After the intervention were the HCW’s significantly more likely to wash their hands correctly after removing gloves? 12.) Look at table 2. Which types of HCW had a significant increase in correct hand washing after the intervention? 13.) Look at table 2 where the incidence rates for nosocomial infections per 100 neonatal admissions were calculated. What percentage developed a nosocomial infection in this unit before and after the hand washing intervention? 14.) Look at table 2 where the incidence rates for nosocomial infections per 100 neonatal admissions were calculated. If an infant were admitted to the NICU after the intervention what would be the RR of developing a nosocomial infection when compared to admission before the intervention? 15.) The authors indicate there may have been a Hawthorne Effect in this study because the participants knew they were being observed after phase 1. If that is true, what might happen to correct hand washing once the observers are no longer at the site? 16.) If these studies were replicated in other developing nations and was simple and inexpensive to implement, would you recommend this intervention? Why or why not? 17.) What might you suggest to measure any Hawthorn Effect that is occurring in the study?

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