Development and appraisal of a hand hygiene teaching approach for medical students

C361 TASK 2 2

C361 TASK 2 2








C361 Task 2


Evidence-Based Practice and Applied Nursing Research


Eve Butler

July 28, 2019

Running head: C361 TASK 2 2







C361 Task 2

A.1 Healthcare problem

Worldwide estimates have shown that greater than 1.4 million patients have acquired nosocomial infections. Adherence to hand hygiene policies are shown to be the most effective way to help prevent these healthcare-associated infections; sadly research shows that healthcare workers have suboptimal compliance with their facilities hand hygiene policies due to lack of education and compliance monitoring. Patients in our healthcare settings are under the assumption that we are doing our best to promote their healing when in fact 7% of them will be subjected to a nosocomial infection with that rate climbing to 10% in developing countries (Finco et al., 2018).

A.2 Significance of the problem

The cost of care that is associated with nosocomial infections is estimated to be over ten billion dollars putting a burden on both patients and health organizations alike. It is estimated that 38% of all infections are caused by cross-contamination due to noncompliance with hand hygiene policies. These infections lead to approximately 99,000 deaths a year in the United States alone (Sickbert-Bennett et al., 2016).

A.3 Current healthcare practices related to the problem

Most healthcare facilities have an educational program that simply teaches how to achieve proper hand hygiene and use the WHO five moments of hand hygiene as their standard. However, this does not educate the healthcare workers on why it is important, nor does it address the far-reaching consequences for noncompliance. Along with the lack of foundational education, most facilities do not monitor for compliance.

A.4 How the problem affects the organization and patients’ cultural background

Inadequate hand hygiene leading to nosocomial infections can affect the organization’s cultural background by leading to dissatisfaction in the workplace as staff becomes frustrated by their feelings of inadequacy and helplessness in dealing with patients getting sicker instead of better. The staff may also be feeling stress in the burden of caring for sicker patients. The patient’s cultural background may be affected as they may be feeling despair or depression at their inability to get better, and some may feel it is punishment according to their cultural or religious beliefs.

B. Two research evidence sources and two non-research evidence sources considered

In searching for my research evidence sources, I start with the Western Governors University Library online. Once in the library, a boolean phrase was used, which allowed me to search for research articles that contain more than one topic in the same paper. Phrases I used in this search were “nosocomial infections,” “hand hygiene compliance,” and “ hand hygiene education.” With these phrases, thousands of articles were available to peruse.

One of the research evidence sources I considered was a qualitative paper that was done in Vietnam. This study showed that hand hygiene for healthcare workers was subpar due to the lack of education among the workers as to why hand hygiene was important for preventing infections. It also pointed out, that lack of resources made it impossible for the healthcare workers to adhere to the hand hygiene policies as at times there was no sink or hand sanitizer located near patients they were caring for (Salmon & McLaws, 2015).

A second research evidence source I looked at was a qualitative study on a hand hygiene teaching approach for medical students. The study looked at how to develop a teaching method that improved the knowledge concerning hand hygiene to medical students and the effectiveness of that teaching method. There was positive feedback from the medical students for the teaching method, but they felt the education should be mandatory to reinforce the need for proper hand hygiene as a way to prevent nosocomial infections and that the teaching should be repeated throughout their schooling (Kaur, Razee, & Seale, 2016).

To search for non-research evidence sources needed, I scrolled through the search results from my previous search and looked for keywords in the title such as quality improvement, editorial, expert opinion, commentary or consensus panel.

One of the non-research sources I looked at was a peer-reviewed editorial from India concerning nosocomial infections that represent a constant threat to patients. The authors surmised that the threat was not only to their health but finances as well since less than 15% of the people in India have medical insurance. Their paper used various strategies to help minimize nosocomial infections and the barriers that stand in the way of hand hygiene compliance (Saxena & Mani, 2014).

Another non-research source I read was concerning the compliance of hand hygiene with the healthcare workers at a hospital in Uganda. This paper discovered that low compliance could be linked to the fact that an established hand hygiene policy was not being used, there were no routine audits for hand hygiene compliance, and there was not an adequate resource to comply with hand hygiene (Niyonzima, Brennaman, & Beinempaka, 2018).

C. PICO question

What are the most effective interventions to improve hand hygiene compliance with healthcare workers in a healthcare setting to decrease nosocomial infections?

P-Healthcare personnel being noncompliant with handwashing policies resulting in nosocomial infections.

I-In depth hand hygiene education for healthcare workers and compliance monitoring.

C-Limited hand hygiene education with no monitoring of compliance.

O-Decrease in nosocomial infections.

D. Evidence Matrix-see attached file

E. Recommended practice change

The need for more in-depth education and monitoring of compliance was indicated in all five of the research articles. For us, as healthcare workers to see a significant decrease in nosocomial infections, we must improve our education, surrounding the need for hand hygiene. We must retool how we are teaching our staff, and also implement ongoing monitoring. With the increased education and monitoring of compliance, we will see a significant decrease in the number of nosocomial infections.

In the first article the medical students surveyed, felt that although they were vaguely familiar with proper hand hygiene policies, they did not feel the education provided had been effective in having them understand the true importance of hand hygiene, or the effects of not adhering to that policy (Kaur et al., 2016). The students also expressed that if the education regarding hand hygiene were ongoing with monitoring, then they would be more likely to comply, which would assist in the decrease of nosocomial infections.

The second article showed that health care workers did not even understand that “duty of care” included hand hygiene, and they failed to see their role in the transmission of infections. Once the healthcare workers were educated on their responsibility for preventing nosocomial infections, and the results of these infections, they were more likely to comply with hand hygiene protocols (Salmon & McLaws, 2015). The researchers concluded that for there to be improved compliance with a decrease in infection rates, then an in-depth educational program must be implemented and monitored.

The third article was an observational study to determine the amount of compliance in regards to hand hygiene among healthcare workers and the factors that affect compliance. Of all the hand hygiene moments observed, in this study, only 38.9% were appropriate. They also noted no strong evidence between different categories of workers at the hospital and compliance among them (Nicholson et al., 2016). It was also noted that compliance was improved once workers were aware of observation, and the improvement resulted in lower rates of nosocomial infections. The research concluded that there needed to be a more in-depth ongoing educational program in place to decrease the number of nosocomial infections.

The fourth article showed that hand hygiene was the key intervention in decreasing the number of nosocomial infections, but that maintaining compliance was very difficult. The research team developed a novel approach to assist in compliance, which engaged the entire hospital staff. This approach including educating all staff as to the importance of hand hygiene in preventing nosocomial infections, and also had them be the ones to monitor that all staff was engaging in the proper hand hygiene policy, and then giving instant feedback if a break in protocol was observed (Sickbert-Bennett et al., 2016). The researchers concluded that this approach not only increased the amount of hand hygiene compliance, but they saw a reduction of nosocomial infections.

The fifth article addressed the number of nosocomial infections in three ICUs in Italy. They monitored to see if there was a change in the trend of nosocomial infections once a specific hand hygiene policy was implemented. All the staff in the ICUs were given education on hand hygiene, and then the staff was observed for compliance. Throughout the study, ongoing education and monitoring of compliance with the staff was tracked. During the study, compliance was up to 83% with a reduction of nosocomial infections of 53% (Finco et al., 2018).

F. Process for implementing the needed practice change

F.1 Key stakeholders

To implement the needed practice changes, I would begin by doing a thorough assessment of the current hand hygiene policies in my facility. Once the assessment was done, I would do a research article search to find which practices have been proven to be “ best practice,” and the most effective ways of implementing and monitoring them. Three key stakeholders I would want to involve in the decision to implement the new recommendations would be the nurse educator, unit manager, and chief nursing officer. I would carefully collect all the research to back the practice changes I wish to make and have a meeting with them to go over the pros and cons of implemented the changes. All of the research and data would be given to them to analyze, and together we would come up with the new practice change that will benefit our patients and our facility by decreasing the number of nosocomial infections.

F.2 Two barriers in the nursing practice setting

One of the barriers that may be encountered would be staff that is resistant to the new hand hygiene policy. Another barrier may be getting staff to engage in the new education, that is needed, for a greater understanding of our responsibility for proper hand hygiene, and the far-reaching results of noncompliance not only for the patient but the organization as well.

F.3 Two strategies to overcome barriers

By offering an education that not only teaches proper hand hygiene but why it is so important, and how not participating in the new process affects not only the patient but them as well, may increase the staff’s willingness to get on board with the new practice changes. A way to overcome staff not wanting to engage in the new practice education would be to use motivation. Give away gift cards, food items, or give tickets for a raffle to all staff that participates in the new education, and offer the education on all shifts, with additional staff to cover while the education is going on.

F.4 Indicator to measure the outcome of the recommended change

An indicator to measure the outcome of the recommended change would be a collection of data that measured the number of nosocomial infections before the practice change, and after the practice change.






Finco, G., Musu, M., Landoni, G., Campagna, M., Lai, A., Cabrini, L., … Galletta, M. (2018). Healthcare-associated respiratory infections in intensive care unit can be reduced by a hand hygiene program: A multicenter study. [Article]. Australian Critical Care31(6), 340-346.

Kaur, R., Razee, H., & Seale, H. (2016, March 27). Development and appraisal of a hand hygiene teaching approach for medical students: a qualitative study [Article]. Journal of Infection Prevention17(4), 162-168. 10.1177/1757177416645345

Nicholson, A., Tennant, I., Martin, A., Ehikhametalor, K., Reynolds, G., Thoms-Rodriquez, C., … Crandon, I. (2016, February 10). Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica [Article]. JIDC.

Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018, Spring). Practice and compliance of essential handwashing among healthcare workers at a regional referral hospital in Uganda: A quality improvement and evidence-based practice [Article]. Canadian Journal of Infection Control33(1), 33-38. Retrieved from

Salmon, S., & McLaws, M. (2015). Qualitative findings from focus group discussions on hand hygiene compliance among health care workers in Vietnam [Article]. American Journal of Infection Control43(10), 1086-1091.

Saxena, P., & Mani, R. (2014). Preventing hospital acquired infections: A challenge we must accept [Editorial]. Indian Journal of Critical Care Medicine18(3), 125-126. 10.4103/0972-5229.128699

Sickbert-Bennett, E., DiBiase, L., Schade Willis, T., Wolak, E., Weber, D., & Rutala, W. (2016). Reducing healthcare-associated infections by implementing a novel all hands on deck approach for hand hygiene compliance [Article]. American Journal of Infection Control44, e13-e16.

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