SECONDARY RESEARCH PROJECT
SYSTEMATIC APPRAISAL OF PUBLISHED RESEARCH
PROTOCOL DOCUMENT
Background of the Topic Area
COVID-19 is a communicable illness that in the past two years has proven to be a global menace to all people and healthcare industries. The virus is believed to have originated from Wuhan, a city in China, and later spread throughout the world. The virus is transmitted among human beings through touching, coughing, or sneezing and most people demonstrate respiratory symptoms such as shortness of breath, fever, and dry cough. The severity of COVID symptoms varies from one person to another although in serious cases, the disease leads to respiratory disease, organ failure, and eventually, death (Anser et al., 2020).
The spread of COVID-19 increased the burden experienced by healthcare systems since most symptomatic patients sought treatment in hospitals. High infection rates led to crowded hospitals and increased workloads for healthcare professionals. Nurses are always at the frontline during crises that increase the need for medical attention. The role of nurses during the pandemic entails triaging patients to determine those who require emergency treatment, especially respiratory support. Due to interactions with COVID patients, nurses, like other healthcare professionals, are at risk of being infected with the illness (Al Thobaity and Alshammari, 2020). As a result, hospitals implemented infection-prevention measures that entail the use of personal protective equipment (PPE) when working within the healthcare environment. Hospitals also emphasized the use of other COVID-19 prevention protocols such as handwashing and avoiding touching one’s face or eyes especially after being in contact with other people or touching any surfaces (Richterman et al., 2020). In Saudi Arabia, the Ministry of Health developed prevention protocols to be followed by hospitals including training workshops on the use of PPE, increased PPE supply, and sanitation protocols (Alarfaj et al., 2021).
Hospital-acquired infections are a menace in the healthcare system that increases the length of hospital stay and result in negative outcomes for patients. Examples of these infections include surgical site infections, pressure ulcers, catheter-associated urinary tract infections, and ventilator-associated pneumonia (Voidazan et al., 2020). Prevention protocols for healthcare-associated infections focus on hand hygiene and maintenance of a clean, safe, and hygienic hospital environment. Environmental hygiene is critical for the removal of any disease-causing micro-organisms on surfaces thus reducing the risk of contact with infectious germs (Haque et al., 2020).
Notably, COVID-19 prevention protocols, especially hand hygiene and environmental hygiene, align with the protocols for preventing hospital-acquired infections. However, according to Du et al. (2021) patients, like healthcare providers, are at high risk of acquiring COVID-19 in hospitals. Hu et al. (2020) add that regardless of the precautions taken, hospitalized patients, as well as healthcare workers, are at a higher risk of COVID-19 infections. Healthcare providers and patients can’t distance themselves from each other. Deressa et al. (2021) further explain that in intensive care units, the concern for patients is especially high because chronically-ill patients are at high risk of severe COVID-19 infections. Therefore, it is important to examine COVID-19 as a hospital-acquired infection that impacts patients in long-term and acute care settings to understand causes and determine preventive measures.
Research Aim(s)
The main purpose of the appraisal is to investigate literature on COVID-19 as a hospital-acquired infection to enhance knowledge on factors influencing coronavirus spread in hospitals and the possibility of preventing these infections now and in the future.
Research Question(s):
- What are the factors attributed to COVID-19 infections in hospitals?
- What are the impacts of hospital-acquired COVID-19 on patient health and outcomes?
- What measures can be taken to reduce COVID-19 spread in hospitals?
Scoping Exercise
Hospital-acquired infections
These are infections that patients acquire in the treatment process. They are also referred to as nosocomial or healthcare-associated infections and usually appear after 48 hours of admission or within 30 days after visiting a healthcare institution for treatment (Haque et al., 2018).
COVID-19
This term refers to a respiratory illness attributed to a new coronavirus called SARS-CoV-2 that was first detected in 2019. The illness is communicable since the virus is transmitted from an infected person to others via respiratory droplets when talking, sneezing, or coughing. The severity of illness ranges from one person to another although the elderly and chronically ill patients are at high risk of severe illness (Centers for Disease Control and Prevention, n.d.).
There is no universal definition of hospital-acquired COVID-19 infections based on uncertainties regarding the incubation period, the possibility of asymptomatic patients, and the possibility of transmission during the pre-symptomatic stage. Therefore, it is highly likely that some studies will overestimate the exact rate of hospital-acquired COVID-19 infections (Abbas et al., 2021).
Search Strategy
The research articles for the systematic appraisal will include scientific studies that focus on COVID-19 infections in healthcare institutions including hospitals and other long-term or acute care institutions but excluding nursing homes and other facilities that provide residential care. Other inclusion criteria for the articles will include research articles published in the years 2020 and 2021 since this is the period within which most COVID-19 cases were detected all over the world. The research articles must also be peer-reviewed and only those published in English will be included in the systematic appraisal. Only primary research studies will be included in the appraisal and any systematic reviews and meta-analyses will be excluded.
The main databases where the search will be conducted include PUBMED, EBSCO Host, EMBASE, psychINFO, CINAHL, and MEDLINE. The search formula will include keywords such as “coronavirus”, “COVID-19”, “SARS-COV-2”, “healthcare-related infections”, “nosocomial infections”, and “hospital-acquired infections”. These words will be combined to form phrases that will be searched in the above databases. Other platforms such as Google Scholar and SSRN will also be considered to ensure that more research articles on the study title are identified.
After identifying the articles that meet the criteria, the abstracts will be analyzed to determine their relevance to the study title, and only those that directly examine COVID-19 as a healthcare-acquired infection will be included in the appraisal. The full text for the selected articles will then be thoroughly reviewed to further ascertain relevance to the study title. A summary of the selected articles will be developed and the information obtained from the articles will be categorized according to the three research questions. Factors such as study limitations, presence of bias, the strength of research evidence, and implications for nursing practice and healthcare will be considered to determine the validity and reliability of the findings and to assess relevance to the nursing profession.
References
Abbas, M., Robalo Nunes, T., Martischang, R., Zingg, W., Iten, A., Pittet, D. and Harbarth, S. (2021). Nosocomial transmission and outbreaks of coronavirus disease 2019: the need to protect both patients and healthcare workers. Antimicrobial Resistance & Infection Control, 10(1).
Al Thobaity, A. and Alshammari, F. (2020). Nurses on the Frontline against the COVID-19 Pandemic: An Integrative Review. Dubai Medical Journal, 3(3), pp.87-92.
Alarfaj, M., Foula, M., Alshammary, S., Nwesar, F., Eldamati, A., Alomar, A., Abdulmomen, A., Alarfaj, L., Almulhim, A., Alarfaj, O. and Zakaria, H. (2021). Impact of wearing personal protective equipment on the performance and decision-making of surgeons during the COVID-19 pandemic. Medicine, 100(37), p.e27240.
Anser, M., Yousaf, Z., Khan, M., Nassani, A., Alotaibi, S., Qazi Abro, M., Vo, X., and Zaman, K. (2020). Do communicable diseases (including COVID-19) may increase global poverty risk? A cloud on the horizon. Environmental Research, 187, p.109668.
Centers for Disease Control and Prevention, n.d. Disease of the Week – COVID-19. [online] Available at: https://www.cdc.gov/dotw/covid-19/index.html
Deressa, W., Worku, A., Abebe, W., Gizaw, M. and Amogne, W. (2021). Risk perceptions and preventive practices of COVID-19 among healthcare professionals in public hospitals in Addis Ababa, Ethiopia. PLOS ONE, 16(6), p.e0242471.
Du, Q., Zhang, D., Hu, W., Li, X., Xia, Q., Wen, T. and Jia, H. (2021). Nosocomial infection of COVID‑19: A new challenge for healthcare professionals (Review). International Journal of Molecular Medicine, 47(4).
Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F., Islam, S., Jahan, D., Nusrat, T., Chowdhury, T., Coccolini, F., Iskandar, K., Catena, F. and Charan, J. (2020). Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview. Risk Management and Healthcare Policy, Volume 13, pp.1765-1780.
Haque, M., Sartelli, M., McKimm, J. and Abu Bakar, M. (2018). Healthcare Associated infections; an overview. Infection and Drug Resistance, Volume 11, pp.2321-2333.
Hu, L., Wang, J., Huang, A., Wang, D. and Wang, J. (2020). COVID-19 and improved prevention of hospital-acquired infection. British Journal of Anaesthesia, 125(3), pp.e318-e319.
Richterman, A., Meyerowitz, E. and Cevik, M. (2020). Hospital-Acquired SARS-CoV-2 Infection. JAMA, 324(21), p.2155.
Voidazan, S., Albu, S., Toth, R., Grigorescu, B., Rachita, A. and Moldovan, I. (2020). Healthcare Associated Infections—A New Pathology in Medical Practice? International Journal of Environmental Research and Public Health, 17(3), p.760.