Clinical Guidelines How can we link research and practice

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Clinical Guidelines How can we link research
and practice

• Preben Ulrich Pedersen,RN, P.HD.
• Associate professor
• Centre for Clinical Guidelines National Danish
  Clearinghouse for Nursing

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Components in High Quality Care

• Accessibility
• Acceptability
• Efficient
• Effective
• Appropriate

(Sidani Brade, 1998)
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Evidence-based Practice

• Evidence-based practice is an approach that
  enables clinicians to provide the highest quality
  of care in meeting the multifaceted needs of
  their patients and families.

Melnyk et al, 2005
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Obstacles to use research

• Number of articles
• Difficulties of accessing journals
• Skills to determine the quality and validity of
  research
• Read literature in English
• Be able to synthesise evidence into explicit
  recommendation
• Have the time to do all this

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Clinical guidelines

• Systematically developed statements to assist
  practitioner and patients decisions about
  appropriate health care for specific clinical
  circumstances

www.clinicalguidelines.dk
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Clinical guidelines contribution to quality
improvements

• Provide knowledge about care options
• Outline a course of intervention
• Providing indicators for measuring quality and
  cost

Thomson et al, 2002 Pedersen, 2009
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Develop a clinical guideline

• Ask the burning clinical question
• Collect the most relevant and best evidence
• Critical appraise the evidence make an résumé
  of the findings
• Make recommendation for clinical practice
• Make suggestions to methods for monitoring the
  quality of care.

Melnyk et al., 2005 Pedersen, 2009
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The burning clinical questions

• What is the evidence that contaminated hands are
  a cause of hospital acquired infections?
• Which hand cleaning agents are the most effective
  at removing/-reducing potential pathogenic
  bacteria?
• When must hands be cleaned in relation to patient
  care activities?
• What is the most effective hand
  washing/handrubbing technique for
  removal/reducing microorganisms on hands?

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Continued

• Which hand cleaning agents are least toxic to
  hospital staff hands
• How can contamination of hands be prevented?
• When and how should gloves be used?
• What are the prerequisites for performing correct
  hand hygiene?

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Collect the best evidence

• Develop a search strategy
• Search in databases
• Search terms
• Criteria for in- and exclusion of literature
• Validation for literature
• Strategy for selections of papers

www.clinicalguidelines.dk, Laustsen et al, 2009
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Search terms

• Infection control, cross infection, hand hygiene,
  hand rub, hand-rubbing, alcohol-based hand-rub ,
  hand wash, hand washing (MESH), non-sterile
  gloves, hand cream, hand emollient, nails, skin
  and corresponding Danish searching terms.

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Collect the best evidence

• Develop a search strategy
• Search in databases
• Search terms
• Criteria for in- and exclusion of literature
• Validation for literature
• Strategy for selections of papers

www.clinicalguidelines.dk, Laustsen et al, 2009
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Resumé of findings

• Handwashing RCTs demonstrated that handwashing
  is significantly more effective to remove visible
  dirt on hands than alcohol-based handrubbing.
  (1539-41). RCTs documented how handwashing
  should be performed (3942). There is
  inconsistency and lacking evidence on how to dry
  hands after handwashing. But it seems important
  to press hands into the single use paper towel
  instead of rubbing to reduce friction of the skin
  (3243). Controlled studies confirm that
  handwashing always should be followed by
  alcohol-based handrubbing since handwashing dries
  out the skin and thus risking contamination and
  possible colonisation of the skin on hands
  (4445).

www.clinicalguideline.dk, Laustsen et al, 2009
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Make recommendation for clinical practice

• Indications for hand-washing
• - when hands are visibly soiled or at risk of
  being soiled with blood, secretion, excretions or
  other biological materials (1539-41)(A)
• Hand-washing should always be followed by
  alcohol-based hand-rubbing (4445)(B)

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Recommendation

• Hand-washing technique
• wet hands and wrists with water (cold or
  lukewarm)
• apply 1-2 pump pushes of soap (39)(A)
• rub mechanically the water and soap palm to palm,
  around the fingertips and thumbs, around the
  wrists and on the back of the hands, and between
  fingers for about 15 seconds. Rinse thoroughly
  with water (3942)(A)
• hands and wrists should be carefully pressed dry
  with a single use paper towel (3243)(D)

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Monitoring the quality of care

• Indicators (standards )
• Proportion of performed alcohol-based
  hand-rubbing before clean procedures (85)
• Proportion of performed alcohol-based
  hand-rubbing after unclean procedures (85)

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Centre for Clinical Guidelines

• To insure high quality of developed clinical
  guidelines by peer viewing the guidelines
  before publication
• To maintain a data based of all reviewed

www.clinicalguidelines.dk
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High quality of a clinical guidelines

• Cclinicians can have the confidence to the
  recommendations
• Peer-review in and external
• Validated instrument (The AGREE-Instrument)

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Centre of Clinical Guidelines

• Bridges the gab between research and clinical
  practice by providing
• Clinical guidelines based on a critical appraisal
  of the existing research
• Trustworthy clinical guidelines as they are peer
  reviewed internal and external
• Research based indicators for measuring the
  quality of care.

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Thank you for your attentionThis presentation
and the clinical guidelines can be found
atwww.clinicalguidelines.dk