Healthy People 2020 serves as a framework to assist communities in preventing disease
and promoting health. Search the scientific literature and find a research study related
to one of the focus areas identified by Healthy People 2020. Refer to the Module 7
In a narrative format, critically appraise the study by answering each of the following

  1. What is the study question and is it relevant?
  2. Does the study add anything new?
  3. What type of research question is being asked?
  4. Was the study design appropriate for the research question?
  5. Did the study methods address the most important potential sources of bias?
  6. Was the study performed according to the original protocol?
  7. Does the study test a stated hypothesis? If so, what is it?
  8. Does the data justify the conclusions?
  9. Are there any conflicts of interest?
  10. There are methodological points to consider in appraising literature that are specific
    to cross-sectional, cohort, case-control, clinical trials, and case studies. Based on the
    design of this study, what are the key methodical points to consider?
    APA format is not required, but solid academic writing is expected


The Healthy People 2020 is a document that has been in circulation for 3 decades
from the US Department Of Health And Human Services (HHS). Since 1980, this department
has published the comprehensive document on a ten-year basis outlining the government’s
decade-long health targets, reporting on impact of prevention, drawing different health
sectors together, and giving general guidance on making health choices (“Healthy people
2020 framework,” 2009). The aim of this paper is to identify the focus areas of Healthy
People 2020 and compare one of these areas with a study that has been conducted. The paper
will then critically appraise the identified study by answering a number of questions given.

Epidemiology 2

Some of the focus areas include Adolescent Health, Blood Disorders and Blood
Safety, Healthcare-Associated Infections, Early and Middle Childhood, and Quality Of Life
and Wellbeing. This paper focuses on healthcare-related infections with the understanding
that healthcare-associated infections (HAIs) are a major cause of preventable deaths in the
United States (“Healthy people 2020 framework,” 2009). Several settings tend to contribute
to HAIs including long-term care facilities, same-day surgical centers, and acute care within
hospitals (“Healthy people 2020 framework,” 2009).
Specifically, the paper analyses a recent research that found that towels in the
hospitals could be cause certain infections to those seeking medical attention. The study titled
“Hospital Laundering Practices May Expose Patients To Infection-Causing Bacteria” was
conducted by a team from University of Arizona, comprising of Professor Charles Gerba,
Kmberley-Clark among others (Ga, 2013). The question of this study was whether towel use
has any effect on hospital-grade disinfectant.
The relevance of this study is drawn from the fact that handling of nosocomial
infections in the hospital involves hospital-cleaning methods. Towels soaked in disinfectant
are a critical part of these cleaning processes. This study was important in the sense that it
would help determine if reusing towels in the hospital setting leads to the spread of disease-
causing pathogens.
The research questions for this study fall under the relationship/existence category,
which defines a question. It seeks to establish whether the use of towels correlates with the
occurrence of diseases caused pathogens in the hospital. This study added something new to
research because it fulfilled its objectives of establishing whether towels used for
disinfectants in the hospital rooms contain microbial contaminants. However, there was a

Epidemiology 3

possibility of biasness in this research. Young and Solomon identify the sources of bias in
research as either random or systematic (Solomon & Young, 2009). The research involved
the use of towels that had been soaked in disinfectant to clean patients’ rooms in the hospital.
After the cleaning exercise, the housekeeping staff laundered the towels and reused them in
the same manner (Ga, 2013). It would suffice it to say that this was a source of systematic
bias, given that the housekeeping staff, probably being hospital employees, would be tempted
to influence the research results to a particular direction. Random bias was minimal if any.
The researchers focused on 10 Arizona hospitals, this being a random selection. (Ga, 2013)
This study design was the most appropriate for the research question, as it replayed the real
scenario in the hospital. Furthermore, the researchers reduced the likelihood of bias by
selecting the study hospitals randomly.
Young and Solomon point out that deviating from the planned protocol is a source of
invalidity and irrelevance of research (Solomon & Young, 2009). The study in question did
not have such problems because it stuck to the same exclusion and exclusion criteria all
through. Only specific hospitals in the Arizona are were surveyed in this study. Using the
same staff in the study further ensured that there would be no deviation from the planned
This study had a stated hypothesis and the professor and his team were well aware of
what they were finding from the onset of the exercise. The research “Hospital Laundering
Practices May Expose Patients To Infection-Causing Bacteria” looked into the contribution
of towels the prevalence of disease causing bacteria. The stated hypothesis was that
laundering towels used in hospitals contribute to the spread of infection-causing bacteria (Ga,

Epidemiology 4

Results from this study indicated that laundering towels in hospitals in the Arizona
area were not sufficient to remove all the disease-causing bacteria. Specifically, the team
from the University of Arizona found out that; the laundry practices used on microfiber
towels and reusable cloth were insufficient in removal of bacteria, 67 percent of the soak
buckets used in the study contained harmful viable bacteria, including those that cause
tetanus and botulism (Ga, 2013). Another find was that 93 percent of the towels used in the
study contained E Coli, Klebsiela and total coliforms bacteria (Ga, 2013). This data justifies
the conclusion of the study that the methods used to clean laundry in hospitals are poor in
removing contaminants and may even add contaminants to the rooms. This kind of
conclusion is also reasonable considering that the sample size was big enough to eliminate
any statistical misconceptions.
Critical appraisal of any research work is very important as this outlines the strengths
and drawbacks of the research. In the study presented in this paper, the focus would be on
relevance study design. The methodological features of the design are also very critical.
These and other criteria would help clinicians decide whether this study is suitable for
guidance in the practice.
One major challenge of any clinical study is the presence of conflict of interest.
According to young and Solomon, conflict of interest personal factors have the potential to
influence professional roles or responsibilities (Solomon & Young, 2009). The research may
have been affected by this problem, given that the researchers relied on the services of
housekeeping staff. However, if the researchers had engaged in full disclosure prior to the
exercise, this source of conflict of interest could be eliminated.

Epidemiology 5

The relevance of a research question is very important in appraisal of this study
because without it, all the other aspects of a good research meaningless. However, the
research questions are not the only means appraising a clinical research. In addition, the type
of research question used in research forms a strong basis on which to appraise the study. In
this study, an investigation about healthcare quality is the focus. It is on this basis that this
study forms a strong basis for further studies on better laundering practices in the hospitals.


Healthcare-Associated Infections. (2013, April 10).
Healthy People 2020 Framework. (2009, October 29).