Forthis evidence-based practice, the selected nursing journal is titled&quotEvidence-based practices to increase hand hygiene compliance inhealth care facilities: An integrated review written by Neo,Sagha-Zadeh, Vielemeyer, and Franklin. It acknowledges that thesurrounding environment in hospitals has disease causing pathogens.As a result, it recommends proper hand hygiene in health carefacilities as a technique of reducing pathogen transmission andnosocomial infections. The aim of the research was to provide acomprehensive summary about some of the latest evidence-basedfindings on hand hygiene interventions that can be used to improvecompliance and enable nurses, and other healthcare providers makeinformed decisions about patient`s safety.

Researchproblems that the journal is trying to address

Thisresearch journal is seeking to address the issue ofcross-contamination and hand hygiene compliance in health carefacilities. According to the authors, hospitals should encourageeveryone to practice proper hand washing techniques. The journaldefines hand hygiene as the act of hand-washing with water and soapor disinfection with an antiseptic agent. Health care has becomesophisticated and targeting specific areas will not yield positiveresults as far as disease control is concerned.

Significanceof the problem to nursing practice

Nursesinteract with many people within the course of their works. As aresult, they expose themselves and the patients to a lot of healthrisks. Proper care should be taken to ensure zero crosscontamination. One of the ways of ensuring that everyone is safewithin the health care facility is through practicing proper handhygiene techniques. This will be helpful in nursing because it willreduce incidences of disease spread since most germs are not visiblewith the naked eye.

of the journal

Thisjournal mainly used qualitative research methodology to prove itsfindings. Credible journals were retrieved from PubMed on handhygiene intervention and health care environment. According to theauthors, to enhance hand hygiene intervention, different medicalfacilities should make use of electronic monitoring and reminders toensure compliance (Neo, Sagha-Zadeh, Vielemeyer, &amp Franklin,2016). Additionally, the journal states that hand hygieneinterventions are useful tools for ensuring minimalcross-contamination in hospitals. For future research, the authorssuggest that the effectiveness of hand hygiene interventions shouldbe tested in other health care environments.

Recommendationfor nursing practice

Thejournal states that since behavior change processes are complicated,health care institutions should not target specific people topractice proper hand hygiene. Instead, everyone including family,friends, and relatives who come into contact with the sick should beencouraged to be conscious about his or her health. Althoughdifferent health care facilities have tried to emphasize on handwashing, compliance has always been a major issue. The journalrecommends the use of reminders to ensure that everyone complies withthe hand-washing policy. As a recommendation, it is evident thatthose in charge of policy making should address the different healthcare environment and their unique challenges and general policiesrelating to hand-washing. This will significantly help reducepossible infections and thus save lives.


Inconclusion, it is, therefore, evident that health care facilitiesneed to practice proper hand hygiene methods to preventcross-contamination between the patient and the nurse. This isbecause the immediate environment harbors several disease-causingorganisms. Hand washing with water and soap or disinfection with anantiseptic agent is the easiest way of preventing diseasetransmission, and everyone should adhere hospital policies relatingto the practice.


Neo,J. R. J., Sagha-Zadeh, R., Vielemeyer, O., &amp Franklin, E. (2016).Evidence-based practices to increase hand hygiene compliance inhealth care facilities: An integrated review.&nbspAmericanjournal of infection control,&nbsp44(6),691-704.

Hand washing



Nurses continue to have a fundamental role in ensuring that theyadopt the best methods of service delivery when caring for patients.Hand hygiene has been recognized to be of critical significance inpreventing infections. Unfortunately, most of the studies have shownthat nurses rarely practice hand washing as they deliver services tothe patients. It is critical that nurses adopt the practice as a wayof ensuring that they protect themselves and the patient fromdifferent infections. The World Health Organization has establishedguidelines regarding the concept of hand hygiene. However, no precisemethodology can be employed in assessing the adherence to handhygiene by nurses. Nevertheless, nurses need to embrace the conceptas a way of ensuring they realize the best patient outcomes byavoiding possibilities of infections as they are executing theirmandate. The implementation of the hand washing technique in healthcare institutions will be helpful in reducing infections of lack ofadherence to the technique.

A1 and A2



Shobowale, E. O., Adegunle, B., &amp Onyedibe, K. (2016). An assessment of hand hygiene practices of healthcare workers of a semi-urban teaching hospital using the five moments of hand hygiene. Nigerian Medical Journal : Journal of the Nigeria Medical Association, 57(3), 150–154. http://doi.org/10.4103/0300-1652.184058



From the article, it is evident that the researchers sought to evaluate the overall compliance of healthcare professionals when it came to the concept of hand washing. Notably, the researchers sought to identify the particular group of health care professionals who continually failed to adhere to the idea of hand washing while executing treatment for patients. The adherence to hand washing was conducted concerning the World Health Organization five guidelines. It was an observational study conducted in a period of sixty days from August 2015 to October 2015. The study was undertaken at Babcock University Teaching Hospital. Researchers conducted an observation on compliance to hand hygiene both at the outpatient and inpatient units and the intensive care unit. Participants of the study were selected randomly with one and seventy-six (176) observations being recorded for the healthcare personnel. The observations were made for personnel working in Surgery (40), Intensive care unit (34), Emergency Department (33) and Internal Medicine (32). Other observations were made in GOPD (21), Dental (17) and Pediatrics (10). Results indicated that 10 out of those observed were compliant with hand hygiene before touching the patient while 165 did not comply with the guidelines.



of Literature

Researchers adopt a variety of scholarly sources to help in facilitating their studies. Notably, they use a total of 20 literature sources in getting more information on the subject. The researchers adopt a broad range of scholarly articles with the oldest being a paper published in the year 1981 and the latest 2013. The choice of the academic papers was guided by the relevance of each article to the subject of discussion. The resources were helpful in providing more insight on the subject of discussion.

(A1) Discussion of Methodology

The study was observational, cross-sectional and quantitative. The researchers observed the health care personnel and recorded the patterns of adherence to hand hygiene concerning the tool provided by the World Health Organization. The focus of the study was to evaluate the compliance by healthcare personnel to the concept of hand hygiene using the tools provided by the World Health Organization. The observation was conducted for 60 days. The checklist used in the observation was presence or absence of hand washing facilities with the alcohol-based hand rubs. The researchers equally observed the nature and frequency of hand hygiene and used the same in conducting an analysis.

(A2) Data


Data analysis was conducted by use of EPI Info version 3.5.1 that was developed by the World Health Organization. Further, the researchers employed Chi-square test odds ratio and the risk ratio that were calculated with the significance of a P value being set at &lt0.05. The researchers set the confidence interval levels at 95%.

(A1) Researcher’s


The researchers concluded that the practice of hand hygiene was still low especially among the healthcare providers. However, the researchers noted that the healthcare workers paid attention to hand washing only in cases where it was determined that there was a direct observable threat to their individual wellbeing. Because of the same, the researchers point out the need to introduce educational measures aimed at addressing the issue of poor hand hygiene among the healthcare workers.

Analysisof the Five Areas

The study was a cross-sectional quantitative study focused onassessing the adherence of health care workers to hand hygiene atdifferent levels of provision of care to the patients. The studyadopted a reference tool provided by the World Health Organization. Amodel of the non-identified observer was adopted in conducting theobservation of the healthcare workers to get a broader perspective onthe concept. The researchers carried out the observation over aperiod of 60 days. A total of 176 observations were made during theperiod. At the time, the primary areas of concern as relates to handwashing was the presence or absence of facilities for hand washing atthe institution, nature, and frequency of hand hygiene. Also, theresearchers looked into compliance with hand hygiene before touchinga particular patient, after the contact with the surroundings of thepatient, after performing invasive procedures, after having contactwith the body fluids and after the removal of gloves. The factorswere recorded and used in conducting the analysis. Data analysis wascarried out through the use of Chi-square with the risk and oddsratio being calculated with the P value set at &gt0.05 and theconfidence interval measured at 95%. The results indicated that thenursing department recorded the highest number of those were observedwith 92 being the circulating nurses while 18 were the senior nurses.The researchers also observed 18 Anesthetists and doctors, 5post-operative nurses, 11 surgeons, 3 surgical technologists and 1medical student. Overall, the highest number of observations weremade in Surgery (40), ICU (34), Emergency Department (33), andinternal medicine (32), GOPD (21), Dental (17) and Pediatrics (10).Results indicated that only 10 healthcare personnel were observed asbeing compliant to hand hygiene.

I agree with the fact that the study adopted a broad variety ofopinion when it came to getting more information on the topic. Theresearchers adopted a total of 20 scholarly articles aimed at seekingthe ideas of other investigators on the subject. Indeed, articlespresented by the researchers were helpful in arriving at theconclusion that was made by the researchers. For example, Albert andCondie (1981) made an observation that healthcare workers do notadhere to hand hygiene practices. The findings are consistent withobservations made by the researchers since put of the 176 personnelobserved only 10 were identified as being compliant. Similarly,Erasmus et al. (2010) indicate that hand washing compliance even atcritical care units is dismal. The observation is a confirmation ofthe fact that there is an agreement on the fact that health careproviders do not observe hand hygiene, especially when caring for thepatients. However, the researchers ought to have used many of currentresearch articles. It was evident that a greater percentage of thearticles used were more than 30 years old. Many changes have beenwitnessed since then negating the need to use current papers.

The primary strength of the study relies on the number ofparticipants in the study. The researchers used a total of onehundred and seventy-six participants as the sample size. It surpassedthe recommended minimum sample of thirty. Because of the same,observations made by the researchers could be relied upon. The randomselection of participants equally eliminated the chance of biasoccurring further enhancing the validity of the study. The choice ofthe data analysis methods was also efficient in improving theconclusions made by the researchers since it was a reliable and validmethod that has been used by other researchers.


The process of data collection was confidential. At the time theresearchers were making the observations, the participants were notinformed of the entire process. The researchers adopted thenon-identified observer framework to ensure that the aspect ofconfidentiality was maintained. The researchers, however, fail tohighlight the point of ethical approval by an established ethicsreview committee.

Strengthsand Limitations of the Study

The strength of the study lies on various factors. The large samplesize that they adopted is instrumental in promoting the reliabilityof the study. The researchers observed a total of one hundred andseventy-six personnel, a number that exceeded the recommended thirty.The findings of the study could be used in guiding practice. Further,the methods of data analysis were instrumental in helping theresearchers get reliable and valid results. For example, they usedrecommended statistical parameters in conducting the assessment.Amongst the tools used was the EPI Info version 3.5.1 that wasdeveloped by the World Health Organization. The limitation of thestudy could be that the researchers did not have to fund. Theinadequate funds could have significantly affected the overall mannerin which they carried out the study. For example, it could limit thenumber of analyses they would wish to conduct in addition to areduction in the number of participants.

Howthe Evidence Informs Practice

The evidence presented by the researchers is instrumental in guidingnursing practice at a greater perspective. Notably, the researchersreiterate the important role played by healthcare professionals,particularly the nurses when it comes to the provision of care byreduction of infection to patients. is of criticalsignificance considering the effect it has when it comes to theentire process of transmission of infections. Healthcareprofessionals come into contact with a variety of pathogenicsubstances. The failure to adhere to hand hygiene means that theyrisk infecting themselves or in worst case scenarios, transfer ofthese components to other medical staff. The evidence presented bythe researchers is a confirmation of the fact that there isreluctance among the health care professionals to observe handwashing practices. The researchers suggest the introduction of aneducational program that aims at informing health care professionalson the need to adhere to hand washing guidelines as stated by theWorld Health Organization. The evidence will be instrumental in theintroduction of policies that seek to improve the overall manner inwhich the healthcare providers execute their mandate.



Squires, J. E., Suh, K. N., Linklater, S., Bruce, N., Gartke, K., Graham, I. D., … Grimshaw, J. M. (2013). Improving physician hand hygiene compliance using behavioural theories: a study protocol. Implementation Science : IS, 8, 16. http://doi.org/10.1186/1748-5908-8-16



The researchers acknowledge the increase in cases of healthcare related infections with 10% of the patients in the Canadian acute-care hospital suffering from the same. According to the researchers, the increased cases of such infections are equally caused by the inability of healthcare professionals to adhere to the concept of hand hygiene. The research seeks to evaluate the factors barring healthcare professionals from adhering to hand hygiene while also explaining the possible remedies toward the problem. Notably, researchers develop a knowledge base intervention in addressing the problem to help physicians adhere to the issue. The researchers adopt the behavioral approach to gain a broader understanding of the subject. They first identify the barriers and enablers, develop interventions and implement and pilot the knowledge translation intervention.



of Literature

The researchers adopt the use of a variety of resources to help in gaining a better understanding of the subject matter. They include a total of 60 scholarly articles that aim at expanding on knowledge on the concept of hand washing. The researchers have adopted the use of both old and new resources that seek to explain the topic in detail. Notably, the earliest source used is that published in 1985 but some of the most current sources are dated 2012. The scholarly articles are relevant to the topic of discussion as they all illustrate the concept of hand washing among health care professionals.

(B1) Discussion of Methodology

The researchers adopted a semi-structured interview with the physicians and residents to understand the concept in detail. Participants were selected from a Canadian urban hospital. Eligible physicians and residents included physicians in the medicine campus in two groups, physicians in surgery campus also divided into two, and residents both in medicine and surgery. A total of six groups of individuals were selected to participate in the study. The researchers adopted the use of a quasi-experimental sampling design to select the informants for the study. They chose the first key informant randomly while the rest were chosen based on a regular interval called the periods. A period was derived by dividing the population size (N) with the sample size (n). Informants were informed through email by the Associate Director of Infection Prevention and Control of the hospital. Informants selected for participation in the study were expected to contact the study assistant (SL) who would provide more details regarding the study.

(B2) Data


The researchers opted to combine the process of interviewing, transcription and analysis to be conducted at the same time. Verbatim would be used for the transcription and verification would be done by the interviewer before the analysis. Data analysis would be done by the use of NVivo 9. The researchers opted to use three steps in the analysis of the transcripts. They included coding for the interview transcripts, generation of specific beliefs and the identification of relevant theoretical domains.

(B1) Researcher’s


The researchers identify the need to address physician behaviors in the healthcare setting. The introduction of appropriate interventions aimed at enhancing the understanding of the concept of hand hygiene is essential in reducing the detrimental effects associated with the infections emanating from such conditions. The researchers conclude that the adoption of behavior based approaches is instrumental in transforming the conduct of physicians as pertains to hand hygiene practice.

Literature Search

Identification ofa Nursing Problem

Healthcare professionals have been mandated to ensure that theyreduce cases of infections in hospitals. hygiene hasbeen identified as one of the crucial ways through which theinfections can be prevented. However, a greater number of healthcareprofessionals have failed to adhere to the hand washing practice,exposing themselves and their patients to a variety of pathogenicdiseases. The failure by healthcare professionals to adhere to suchpractices is a significant nursing problem that needs to beaddressed. The adoption of hand hygiene practices suggested by theWorld Health Organization is essential in helping reduce theinfections that are likely to occur.

Helder et al. (2012) identify good hand washing hygiene as beingfundamental in the prevention of nosocomial infections in a typicalhealthcare setting. In a study involving all of the healthcareworkers, the researchers were able to determine that indeed, thepractice of hand washing among the hospital staff is essential inreducing infections. The researchers reiterated the need forhealthcare professionals to adopt the practice of hand washing as anintervention against diseases that are likely to be transmitted. Theresearchers observe staff who engage in hand washing hygiene andcompare the same with the number of infections that occur in shifts.Indeed, they can confirm that hand washing is essential in helpingreduce infections.

The inability of healthcare workers to strictly adhere to the conceptof hand hygiene could be attributed to lack of knowledge on aspectsof occupational safety. Notably, hand washing is an activity thataims at protecting not only the transmission of infections from onegroup to the other, but it is safer for the healthcare workers.According to Schönrock et al. (2015), a small percentage of workerswere well informed on the concept of modes of transmissions ofinfections. It could be a confirmation of the fact that some of thehealthcare workers fail to adhere to hand washing hygiene becausethey are not aware that it is a factor contributing to transmissionof infections. Musuuza et al. (2016) postulate that hand hygieneamong healthcare workers is essential and compliance to the practiceis fundamental in the prevention of infections. However, theresearchers equally identify the challenges that are associated withthe inability to sustain the practice. Many of the interventions thathave been introduced have not been adhered to by the workers makingit difficult to uphold the practice. Ciofi et al. (2011) investigatedthe perception of both the parents and healthcare workers when itcame to the concept of handwashing. According to the researchers,parents and healthcare workers were of a common opinion that indeed,hand washing was essential and ought to be upheld at all times.However, Ciofi et al. (2011) indicate factors such as years ofpractice, formal training on hand hygiene and type of ward asdeterminant factors when it came to the practice.

Stewardson et al.(2014) postulate that hand hygiene is essential when it comes to thecontrol of infections. The researchers draw their argument from theWHO recommendation on the concept of hand washing based on thepractice of SureWash (Glanta Ltd, Dublin, Ireland). Findings by theresearchers indicated that the adoption of SureWash was essential inincreasing the number of poses needed per hand hygiene among thehealthcare workers. Li et al. (2015) state that it was mandatory tohave an educational training among healthcare workers to inform themon the practice of hand washing.

However, it is essential to get the perception of healthcare workerswhen it comes to the overall concept of hand washing. Sessa et al.(2011) investigate the knowledge, attitudes, and practice of handwashing among healthcare nurses. According to the researchers,knowledge on the concept of hand washing was higher in nurses withthe highest level of education. Notably, Sessa et al. (2011) indicatethat nurses who were highly educated and operated in a departmentperceived to be at a risk of transmission of infectious diseasesstrictly adhered to hand washing techniques. Mathur (2011) agree withthe fact that hand washing is a vital component of infection control.The researcher acknowledges the efforts presented by the healthcareworkers when it came to the reversal back to basics of prevention ofinfections. Mathur (2011) states that health care workers haveembraced the practice of hand washing as a way of reducing suchinfections.

Healthcare professionals must ensure that they comply with theestablished standards of practice. According to Karaaslan et al.(2014), few healthcare workers adhered to the concept of hand hygienepractice and the utilization of alcohol-based disinfectants. Theresearchers report that it could be mandatory to introduce educationprograms that seek to enhance the aspect of compliance from thehealthcare professionals. According to Huis et al. (2012), factorssuch as knowledge and the facilitation of behavior among healthcareprofessionals was instrumental in improving the overall state ofcompliance toward hand hygiene. Additionally, Huis et al. (2012)indicate that it would be essential to seek alternatives such asattitude and self-efficacy in addressing the problem.

B 2. Matrix

Evidence-Based Practice Matrix of Primary Research on one Topic related to Nursing



Year of publication

Research Type

Population/ Sample Size

Outcome Variables Measured

Pertinent data from results

Author’s suggested conclusions


Ciofi degli Atti, M. L., Tozzi, A. E., Ciliento, G., Pomponi, M., Rinaldi, S., &amp Raponi, M.

BMC Public Health


Cross-sectional study

139 HCWs and 236 parents

Perceptions of the healthcare workers and parents regarding hand hygiene and effectiveness of measures for increasing hand hygiene adherence

Availability of alcohol-based hand rub was perceived as the most useful action for improving adherence to hand hygiene (scores ≥ 6 on a 7-point Likert-type scale: 84.8% [CI95%78.0-90.1] for HCWs and 87.9% [CI95% 83.3-91.7] for parents)

Formal training among healthcare workers essential and should be adopted

The paper is informative on the subject of study.

Helder, O. K., van Goudoever, J. B., Hop, W. C. J., Brug, J., &amp Kornelisse, R. F.

BMC Infectious Diseases


Observational study

All healthcare workers employed at the NICU participated in the study

. Investigate alcohol-based hand rub dispensers and determine compliance with hand hygiene protocols

65.8% of 1,168 observations of patient contacts requiring hand hygiene, healthcare workers complied protocol

Electronic devices provide information on frequency, time, and location of its use, while also revealing the trends in hand disinfection events

The article is informative on an aspect of hand washing among HCW.

Huis, A., van Achterberg, T., de Bruin, M., Grol, R., Schoonhoven, L., &amp Hulscher, M.

BioMed Central


Systematic searches of experimental and quasi-experimental research

Medline, Embase, CINAHL, and Cochrane databases from January 2000 to November 2009

Hand hygiene improvement strategies were conducted

Fewer studies evaluated aspects of social influence, attitude, self-efficacy, and intention

Focus on behavior changes instrumental on hand hygiene improvement strategies

Article essential in expanding knowledge on subject

Karaaslan, A., Kepenekli Kadayifci, E., Atıcı, S., Sili, U., Soysal, A., Çulha, G., … Bakır, M.

Interdisciplinary Perspectives on Infectious Diseases



Doctors in two wards including a pediatric intensive care unit and a neonatal intensive care unit

Compliance with the hand hygiene (HH) of healthcare workers in neonatal and pediatric intensive care unit

The compliance differed by role where nurses recorded (41.4%) and doctors (31.9%)

Adherence to hand hygiene practice and utilization of alcohol-based disinfectant was very low

HCW do not comply with hand hygiene practices.

Li, Y., Wang, Y., Yan, D., &amp Rao, C. Y.

The Journal of Hospital Infection



369 participants

assess the feasibility and acceptability of sanitizing hands with alcohol-based hand rubs

84.5% of the ABHR recipients agreed that receiving the ABHR improved hand hygiene practice

Hand hygiene education and training are essential

.The paper is instrumental in guiding practice

Martín-Madrazo, C., Cañada-Dorado, A., Salinero- Fort, M. A., Abanades-Herranz, J. C., Arnal-Selfa, R., García-Ferradal, I., … Soto-Diaz, S.

BMC Public Health


Experimental study

A multicenter study of 21 health centers in north-eastern Madrid from Spain

Determine the prevalence of hand hygiene noncompliance, and improve healthcare

Non-compliance is evident in several studies in hospitals

Most healthcare workers fail to comply with hand washing practices.

Article is informative

Fuller, C., Michie, S., Savage, J., McAteer, J., Besser, S., Charlett, A., … Stone, S.



Stepped wedge cluster randomized controlled design

16 Intensive Therapy Units [ITU] 44 Acute Care of the Elderly [ACE] wards

Investigate sustained improvement in hand-hygiene compliance

All 16 trusts (60 wards) randomized, 33 departments implemented intervention

An intervention coupling feedback to personalized action planning produced moderate but significant sustained improvements in hand hygiene compliance

Some HCW adheres to guidelines by the WHO

Schönrock, S., Schablon, A., Nienhaus, A., &amp Peters, C.

Journal of Occupational Medicine and Toxicology (London, England)


Explorative survey

Four hundred and seventy-three HCW

Knowledge of healthcare workers in elderly cares about occupational health and safety

74&nbsp% of HCW felt well informed

Employees in elderly care are well informed about the range of precautionary occupational medical examinations

Some health care workers are well informed.

Sessa, A., Di Giuseppe, G., Albano, L., &amp Angelillo, I. F.

BMC Infectious Diseases


Cross-sectional study

Eight acute general public hospitals were randomly selected

Evaluation of Nurses` Knowledge, Attitudes, and Practices Regarding Disinfection Procedures

Nurses with high educational levels and exposed to a risk of transmitting an infectious disease more likely to perform appropriate antisepsis of the surgical wound and handwashing before and after medication.

Education and introduction of more preventive measures needed.

Further education vital.

Stewardson, A. J., Iten, A., Camus, V., Gayet-Ageron, A., Caulfield, D., Lacey, G., &amp Pittet, D.



controlled before-after study

Sixty-three healthcare workers were recruited, 34 in Group A and 29 in Group B

Evaluating the impact of self-directed SureWash use on healthcare worker hand hygiene technique

Group A participant and none of the Group B participants performed a complete action

no healthcare workers were able to carry out a complete hand hygiene action

Non-compliance still common

B3. Review ofLiterature

B3a. AnnotatedBibliography

Ciofi degliAtti, M. L., Tozzi, A. E., Ciliento, G., Pomponi, M., Rinaldi, S., &ampRaponi, M. (2011). Healthcare workers’ and parents’ perceptionsof measures for improving adherence to hand-hygiene. BMCPublic Health, 11, 466.http://doi.org/10.1186/1471-2458-11-466

The focus of thestudy is to evaluate the perception of parents and healthcare workerswhen it comes to the aspect of improvement of adherence to handhygiene practices. The article is essential in guiding practice sinceit reiterates the need to ensure that there is a focus on adoption ofthe concept of hand washing.

Fuller, C.,Michie, S., Savage, J., McAteer, J., Besser, S., Charlett, A., …Stone, S. (2012). The Feedback Intervention Trial (FIT) — ImprovingHand-Hygiene Compliance in UK Healthcare Workers: A Stepped WedgeCluster Randomised Controlled Trial. PLoS ONE,7(10), e41617.http://doi.org/10.1371/journal.pone.0041617

The researchlooks into the improvement of compliance with hand hygiene by thehealthcare workers. A total of 60 wards is selected to take part inthe study. The article is essential since it looks into the aspect ofthe need to have healthcare professionals to stick to hand hygiene.The article is critical in adding knowledge to the subject ofdiscussion.

Helder, O. K.,van Goudoever, J. B., Hop, W. C. J., Brug, J., &amp Kornelisse, R.F. (2012). Hand disinfection in a neonatal intensive care unit:continuous electronic monitoring over a one-year period. BMCInfectious Diseases, 12, 248.http://doi.org/10.1186/1471-2334-12-248

The articleillustrates an observational study that focused on the investigationof the aspect of hand disinfection in the neonatal intensive careunit. The study that incorporated all healthcare workers in the unitwas instrumental in providing information on the research question.Findings of the study help in guiding practice.

Huis, A., vanAchterberg, T., de Bruin, M., Grol, R., Schoonhoven, L., &ampHulscher, M. (2012). A systematic review of hand hygiene improvementstrategies: a behavioural approach. ImplementationScience : IS, 7, 92.http://doi.org/10.1186/1748-5908-7-92

The article whichis a systematic search of the experimental and quasi-experimentalresearch illustrates that different strategies have been introducedthat aim at improving the practice of hand hygiene. The use of thearticle is essential in guiding practice since it provides measuresthrough which healthcare workers can improve on hand hygiene.

Karaaslan, A.,Kepenekli Kadayifci, E., Atıcı, S., Sili, U., Soysal, A., Çulha,G., … Bakır, M. (2014). Compliance of Healthcare Workers with HandHygiene Practices in Neonatal and Pediatric Intensive Care Units:Overt Observation. Interdisciplinary Perspectives onInfectious Diseases, 2014, 306478.http://doi.org/10.1155/2014/306478

The article is anobservational study seeking to evaluate the degree of compliance ofthe healthcare workers when it comes to the aspect of hand hygiene.The study that incorporated doctors from two wards provided insightinto the concept of adherence to hand hygiene. Findings are essentialin guiding practice.

Li, Y., Wang,Y., Yan, D., &amp Rao, C. Y. (2015). Self-reported hand hygienepractices, and feasibility and acceptability of alcohol-based handrubs among village healthcare workers in Inner Mongolia, China. TheJournal of Hospital Infection, 90(4),338–343. http://doi.org/10.1016/j.jhin.2015.04.006

The article seeksto understand the degree of acceptability of the use of alcohol-basedhand rubs among the healthcare workers. The qualitative study thatincorporated a total of 369 participants revealed that there was anoverall acceptance of the concept of hand washing. Insights presentedin the study is essential in guiding practice.

Martín-Madrazo,C., Cañada-Dorado, A., Salinero- Fort, M. A., Abanades-Herranz, J.C., Arnal-Selfa, R., García-Ferradal, I., … Soto-Diaz, S. (2009).Effectiveness of a training program to improve hand hygienecompliance in primary healthcare. BMC Public Health,9, 469. http://doi.org/10.1186/1471-2458-9-469

The authors seekto evaluate the impact of a training program when it comes to theimprovement of hand hygiene compliance by the healthcare workers. Thestudy which incorporated 21 healthcare centers in Madrid. Theexperiment study is essential in guiding practice as pertains to handhygiene. The article indicates that most of the healthcare workers donot comply with hand hygiene.

Schönrock,S., Schablon, A., Nienhaus, A., &amp Peters, C. (2015). What dohealthcare workers in elderly care know about occupational health andsafety? An explorative survey. Journal of OccupationalMedicine and Toxicology (London, England), 10,36. http://doi.org/10.1186/s12995-015-0079-0

The articlesought to find out the knowledge of healthcare workers on aspects ofoccupational health and safety. Particularly, reference is made tothe hand hygiene. The explorative survey indicated that most of thehealthcare workers are informed on issues of occupational safety. Thearticle is essential and could be adopted for guiding practice.

Sessa, A., DiGiuseppe, G., Albano, L., &amp Angelillo, I. F. (2011). AnInvestigation of Nurses’ Knowledge, Attitudes, and PracticesRegarding Disinfection Procedures in Italy. BMC InfectiousDiseases, 11, 148.http://doi.org/10.1186/1471-2334-11-148

The researchersaim at investigating the knowledge of nurses and their attitudestowards disinfection activities. The cross-sectional study conductedin eight different hospitals indicated that nurses who were highlyeducated knew much about the concept of hand washing hygiene.However, it is unfortunate that the practice of hand washing was onlydone in environments that were perceived as being risky about thetransmission of infections.

Stewardson, A.J., Iten, A., Camus, V., Gayet-Ageron, A., Caulfield, D., Lacey, G.,&amp Pittet, D. (2014). Efficacy of a New Educational Tool toImprove Handrubbing Technique amongst Healthcare Workers: AControlled, Before-After Study. PLoS ONE, 9(9),e105866. http://doi.org/10.1371/journal.pone.0105866

The articlesought to illustrate the application of a hand washing tool when itcomes to the improvement of such a practice among the health careworkers. The study that incorporated a total of 63 participants wasessential illustrating the lack of compliance by healthcare workersto complete the hand washing techniques. The paper could be adoptedfor practice by providing interventions on how to help healthcareworks adhere to hand washing.

B3 Efficacy

The articlesreviewed indicate that overall, there is a lack of compliance withthe part of healthcare workers in hand hygiene practices. However,multiple interventions have been introduced that seek to change thestatus quo. Notably, the introduction of education and trainingprograms have been suggested as an alternative into encouraging handwashing among the healthcare workers. Further, change of attitude isessential in ensuring that health care workers adhere to handhygiene. Through the same, it would be essential in preventinginfections in hospitals.

B3 Tools

Different toolswere adopted by researchers in getting a broader understanding of thesubject matter. Notably, interviews, observations and surveys wereused. The tools were instrumental in providing more information onthe subject. Questionnaire surveys were equally used in the studies.

B3d. Effect onresults

The tools adoptedwere instrumental in obtaining the results. Notably, the observationsmade, and survey questionnaires influenced the results obtained. Thetools used were essential since they were valid and could be reliedupon.

B4. EvidenceSummary

Differentfactors came up in the study. Notably, there is the aspect ofcompliance and knowledge of healthcare workers when it came to theaspect of hand hygiene. Studies indicate that some healthcare workersare knowledgeable on aspects of hand washing hygiene. However, thedegree of compliance is minimal, negating the need to address theissue.


Theincreased chances of transmission of infections in the hospitalsnegate the need to enhance awareness on hand washing among healthcare workers. Educational training should be increased to enhance thepractice. Further, it is vital that protocols are introduced aimed atencouraging compliance on hand washing.

B6.Theoretical Models

The applicationof theory has become a common practice in nursing. Insights presentedin these studies are essential to improving practice. Findings can beused to improve the practice of hand washing in hospitals to preventinfections. The increase in knowledge-based theories on the aspect isessential in improving practice.


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