What is the purpose of the integrative review?

Answer

Abstract

Aims and Objectives: This study aimed to establish whether the use of double-gloving as compared to single-gloving can result in significant reductions of the healthcare associated infections (HAIs) during neurosurgery and hernia repair.

Background: The risk of exposure of a patient to infections when surgical glove perforates is integral in the face of increasing cases of HAIs in the United States. Surgical patients must thus be protected from such a risk of infection.

Methods: This study uses integrative review to locate, analyze and appraise authentic past studies that report on the use of two pairs of gloves in surgical settings.

Results: All the six articles analyzed report on the efficacy of double-gloving in the prevention of glove perforations.

Conclusion: The use of two pairs of gloves significantly protects the patients undergoing neurosurgery and hernia repair from HAIs.

Relevance to clinical practice: The results of the study encourage health professionals to consistently use double-gloving during all their surgeries.

Integrative Review on Effectiveness of Double-Gloving in Healthcare Associated Infections (HAI) Prevention    

Purpose of the Integrative Review

The increasing complexity and amount of information in health care field require the development of scientific research techniques that enhance better use of evidence-based practice. This integrative review presents a methodology that utilizes knowledge synthesis and application of data from past studies to actual practice (Souza, Silva & Carvalho, 2010). Essentially, this integrative review encompasses clinical problem definition, identification of the necessary information, literature search of the relevant studies and evaluation of each resource to establish its results’ applicability and use on patients. This integrative review identifies, analyzes and synthesizes results gathered form independent studies on the subject of double-gloving, thus enhancing beneficial repercussion on care quality provided to patients.

Integrative review forms the most elaborate methodological technique of literature reviews. It allows for the use of both experimental and non-experimental research studies to fully conceptualize the topic being investigated. This research technique combines data from evidence, theories, and analysis of the methodological issues of a given topic. Therefore, integrative review involves a broad sample of evidence each having multiple proposals that when analyzed create a comprehensive and consistent results that are relevant to the nursing practice (Souza, Silva & Carvalho, 2010). This work follows the integrative review approach to propose a way in which the frequency of Healthcare Associated Infections (HAIs) in the United States can be reduced within the surgical setting.

Research Topic of Interest

HAIs, also known as nosocomial infections, occur in patients receiving medical care. HAIs occur both in developed and developing nations. The occurrence of the infections among inpatients can result to economic burden, disability and prolonged hospital stay (Makama, Okeme, Makama & Ameh, 2016). The nosocomial pathogens causing HAIs include fungal parasites, viruses and bacteria. Research indicates that HAIs affect fifteen percent of patients across the globe (Makama et al., 2016). Some of the most prevalent HAIs include bloodstream infection, pneumonia, surgical site infections and urinary tract infections. Patients are usually exposed to various pathogens through different sources such as the environment but majorly from healthcare staff. 

Problem Statement

Many efforts have been put in place through policy formulation to achieve aseptic conditions for surgical operations, yet the risk of cross-infection still persists. Although multiple causes of HAIs exist, the most frequent causal factors are the infections spreading from the surgical team such as surgeons and assistant surgeons to the patient (Lee et al., 2015). Over the years, surgical infections have been controlled by ensuring that all surgical operators undertake hand scrubbing using antiseptic agents and wearing of a surgical glove. These techniques aim at preventing potential infections to occur at the surgical site.

Even though surgical team scrubs before surgeries, their hands still normally possess pathogens and thus, if a surgical glove perforates, the infection control barrier collapses thereby allowing transfer of pathogens to the patient through the surgical site. The frequency of glove perforation during surgeries have been reported by many research to range between eight percent to slightly over fifty percent (Lee et al., 2015). Interestingly, the longer the surgery duration, the higher the rate of glove perforations. Neurosurgery and hernia repair at times require longer surgery period and complicated surgical operations that increases the risk of glove perforation. Addressing the problem of glove perforations in these types of surgeries can thus help to significantly reduce the rate of HAIs within the surgical setting.

Research Question of Study

The research question in this study is whether the use of double-gloving as compared to single-gloving can result in significant reduction of HAIs rates among inpatients during neurosurgeries and hernia repair. The study aims at showing that when double-gloving is used, glove leakage decreases to the minimum possible rate. Focusing on minimal glove leakage rates during surgeries infers a direct reduction in the frequency of HAIs among the inpatients undergoing hernia repair and neurosurgery. The objective of the research question is to utilize data from past studies to establish whether double-gloving can be applied to reduce the rate of puncture of the inner glove in addition to other fundamental benefits.

Variables of Interest

The study focusses on inpatients who are undergoing either neurosurgery or hernia repair. These patients usually experience high rates of HAIs and thus, finding a way of reducing transfer of pathogens from surgical team to surgical site is crucial for patient’s quality care (Mischke et al., 2014). The intervention that is proposed to minimize cases of HAIs is double-gloving. The premise of this concept is that double-gloving helps to significantly reduce inner glove perforations leading to minimized glove leakage and consequently reduced HAI rates. This integrative review will help to uncover the fundamental benefits that double-gloving has in relation to reduced rates of HAI among surgical inpatients.

Background and Significance of the Problem to Nursing

Initially, gloves were used by surgeons to protect themselves from infections but it later gained momentum in ensuring that the patient also remained protected during surgeries. Since then, surgical gloves have been used to offer a mechanical barrier against bacterial and viral infections. According to Mischke et al. (2014), gloves prevent transmission of pathogens in both directions; from the patient to the surgeons hand and vice versa. When the glove barrier gets breached, exposure risk of the patient and the surgical team certainly increases.

The use of double-gloving is linked to reduced number of perforations by at least seventy one percent as compared to the use of a single-pair of glove (Mischke et al., 2014). Additionally, research has established that wearing two pairs of gloves results in reduced blood stain on the hands of the surgical team by sixty five percent. The use of two pairs of glove provides an infection barrier thus, reducing the risk of cross-infections. According to Inam, Shah, MCPS and Jan (2017), the use of double-gloving is safer than the application of one pair of gloves during surgeries.

Nurses have a role in preventing the occurrence of HAIs through research, patient education and evidence-based practice. Nurses act as patient advocates and thus, they are uniquely placed to implement changes that improve the care standards of the patients (Souza, Silva & Carvalho, 2010). The evidence presented by the studies reviewed informs on nursing practice in a number of ways. First, nurses can use the study results as a basis for advocating for the consistent use of double-gloving among all members of the surgical team. Secondly, the evidence presented by the study can motivate the nurses continue using two pairs of gloves during surgeries given the practical results accrued from the approach. Additionally, nurses can use the study as a means to educate patients on the importance of gloving, particularly, double-gloving among the medical practitioners. Lastly, the study enhances nursing practice by supporting nurse leaders in advocating for methods of reducing HAIs within the hospital.

Literature Search Methods

Search Strategies

Here, the search terms were combined and phrased to form a combination of words that together provides the basis of the search, for instance, ‘double-gloving.’ The phrased words were used to find alternative terms such as multiple gloving. This helped to broaden my search (Bell, 2015). Additionally, brackets were applied around the search terms; (double-gloving or multiple-gloving), for ease of identification. Thereafter, the word “AND” was used to combine search concepts. For instance, “double-gloving AND efficacy.” This helped to link different concepts together thus narrowing my search.

Finding the Research Databases

The second step in the research involved finding of debases with authentic and reliable sources. Focus was especially on ebscohost.com and googlescholar databases since they provide a wide range of sources from multiple disciplines. The Cochrane review database also provided a reliable source that was used in the study. Identifying the right databases to use is essential since it provides a guarantee of reliability of the sources at the early stages of research (Bell, 2015).

Planning of Research

Prior to the commencement of the actual search of the articles, planning of the research was first carried out by formulation of key terms from the already formed PICOT question. After analyzing and synthesizing the key terms, key words were formed to help yield the most reliable and relevant sources of the study. The planning stage was crucial since it allowed for isolation of the most important search terms that guaranteed acquisition of the most appropriate resources.

Inclusion/Exclusion Criteria for the Sample of Research Reports

The first search yielded a mixture of resources, some current and some older than twenty years. Therefore, the search was regulated using the publication date to only focus on those references published within the last five years. The search was further limited by the article type, specifically, peer-reviewed documents. The study then proceeded to use the synthesized key words to search for the most relevant resource to the research topic.

Choosing the Resources

Depending on the number of keywords contained in the articles displayed, they were classified as highly-related or closely related to the PICO (T) question (Bell, 2015). The articles falling within the high related category were then chosen for the analysis. By sticking to the widely known and highly rated scholarly debases, the study managed to access many articles that touched on HAIs, single and double-gloving, in addition to other techniques such as frequent change in gloves to prevent cross-infections within the hospital.

Data Analysis and Critical Appraisal

Quality of Each Study, their Strengths and Limitations

The study conducted by Lee, Cho, Lee, Choi, and Lee (2015) focused on assessing the frequencies and sites of glove perforations during fracture surgeries. The problem and the scope of the study were well captured thus directly informing the reader of the article’s objective. The authors used a relevant method, biogel, to assess the sites of perforations of surgical glove thereby informing on the frequency of the incidence during surgeries. The research also uses many past studies to explain and support its finding and thus it makes use of an understanding of the related studies. The results of the study affirm that glove perforations are more frequent among chief operators than scrub nurses or assistant doctors and they mostly occur at the second digit of left hand thus informing on the nursing practice. The strength of the study is that it comprehensively covered the objective of the research and it recommended that surgeons should use double-gloving as a safety approach. Its limitation is that it does not provide the scope within which the results gathered can be applied.

The article by Makama, Okeme, Makama and Ameh (2016) clearly outlines the study’s purpose and the problem addressed through research. The problem indicated by the authors is the perforation rates of gloves during surgeries and the authors sorted to determine whether double-gloving could yield better results when compared to single pairs of gloves. The method used by the authors, cohort study, provides the primary evidence of the effectiveness of double-gloving and thus it is appropriately used. The study approach was well executed by making use of random selection of the surgeons involved in the research. Providing evidence of the efficacy of the use of two pairs of glove in reduction of glove perforations helps nurses to adhere to the practice and advocate its usage across board. The strength of the study is that it provides rich knowledge of the methodology that can effectively be applied in a similar research. Its limitation is that the authors failed to propose the need for further research on the topic.

The research conducted by Inam, Shah, MCPS, and Jan (2017) articulates the purpose of the study as a comparison of the effectiveness of single vs. double-gloving practices on protection against needle injuries. The authors have thus expressed the problem and the study purpose clearly. The use of randomized controlled trials provide first hand evidence of the effectiveness of double-gloving thus informing on the nursing practice. The strength of the study is that the authors used scientific standards of study as evident by the use of appropriate methods and materials in the research.

The study carried out by Mischke, Verbeek, Saarto, Lavoie, Pahwa and Ijaz (2014) accurately presented the problem and purpose of the research. Specifically, the authors report the benefits and harms that extra gloving has regarding the prevention of glove leakage during surgeries. The authors have clearly outlined their research approach by indicating search methods, selection criteria and data collection and analysis. The review used data from several past studies to arrive at their conclusion. The study also informs on the nursing practice since it provides them with evidence of the benefits of using double-gloving during operations. The strength of the study is that it used reputable sites to find sources for the systematic review. Its limitation is that it may exhibit biasness in reporting of the studies that support the double-gloving intervention.

The article by Ali, Chandra, Patil, and Tahasildar (2016) presents an argument that the risk of infection during dental surgery can be minimized by using two pairs of gloves. The study problem and purpose is thus well presented. The study approach used by the authors was a comprehensive systematic review that gathered adequate evidence to help them arrive at the conclusion that wearing two pairs of glove reduces cross-infection. The authors also used a wide base of past studies to support the argument put forth by the authors. The article proposes potential solutions that can be used to reduce HAIs thus it informs on the nursing practice. Its limitation however, is that the authors failed to indicate the shortcomings they might have experienced during their study.

The study conducted by Arowolo, Agbakwuru, Obonna, Onyia, Akinkuolie, and Olaogun (2014) aimed to determine whether the use of two pairs of gloves would protect surgeons from infections such as HIV, thus clearly presenting the study problem and purpose. The authors made use of more than a thousand surgical procedures to establish that using two pairs of gloves significantly reduces glove perforations. This forms the strength of the study. The results gathered informs on the nursing practice in that nurses can encourage the use of the technique among surgical staff for their protection. The authors, however, failed to indicate grounds for further studies on this topic.

Gaps and Similarities in the Identified Literature

Most of the studies presented only touched on the benefits of extra gloving but failed to indicate if there are negative consequences of the practice on either the surgical team or the patient. The studies also fail to provide mechanisms with which a new change policy can be implemented to increase adherence to double-gloving by the health professionals. The studies however, are consistent in their reports for the superiority of double-gloving against single-gloving with regards to reducing the rates of HAIs.

Synthesis, Interpretation and Presentation of Results

Major Trends in the Research Reviewed, Generalizations and Conclusions

All the reviewed research report on the effectiveness of using two pairs of gloving to increase the pathogen barrier between the patient and the surgeon. Most of the research used randomized controlled trials to arrive at the conclusion, thus making the data clinically viable to use in hospitals. All the studies reviewed supported the use of two pairs of gloving to reduce cases of HAIs within the surgical setting.  For instance, Lee et al. (2016) asserts that surgeons should use double-gloving regularly to prevent risk of perforations, Ali et al. (2016) report that using two pairs of glove significantly reduce exposure to pathogens, and Inam et al. (2017) confirm that double gloving is safer as compared to single gloving. The use of double-gloving thus significantly reduces the rate of HAIs due to minimized glove perforations. In summary, the use of two pairs of glove increases protection against HAIs by preventing the perforation of the inner gloves, thus preventing the transfer of pathogens from the hands of the surgical team to the patient’s surgical site.

Recommendations

The surgical team should adhere to the practice of double-gloving as a means of protecting themselves and the patients from blood borne pathogens. The reviewed literature report close to ninety percent protection rates when the practice is implemented (Mischke et al., 2014). The nurses should advocate for the use of double-gloving both at the policy and the practice levels. This will directly improve the quality of care that patients receive from many surgical settings. Additionally, nurses should educate the patients on the importance of double-gloving to enable them remain alert and remind the care givers to always use two pairs of glove while operating on them.

Conclusion

The literature review focused on sources that reported the effectiveness of using two pairs of gloves during surgery. However, it made limited inquiry into the negative consequences of using double-gloving within the surgical setting. The results of this review affects clinical practice in that health professionals such as surgeons will become enlightened and stick to the use of double-gloving during all their surgeries. The recommended practice change impacts on future nursing in that nurses can use the study results as a basis to advocate for the consistent use of double-gloving among all members of the surgical team. Also, the evidence presented by the study can motivate the nurses continue using two pairs of gloves during surgeries given the practical results accrued from the approach.