Patient Care

Week 3 paper

PICOT Statement Paper

Professor’s Name

Student’s Name

Course Title



Hand Hygiene (HH) is one of the most effective ways of reducing hospital transited infections (HTIs) in the healthcare setting. However, most healthcare professionals fail to comply with the international standard guidelines for hand hygiene negatively affecting the health and safety of patients. Poor HH of health workers has led to increased mortality rates among patients admitted in hospitals. More awareness needs to be created among the healthcare workers about the importance of HH to reduce the increased mortality rate. Healthcare agencies need to take the responsibility of ensuring their staffs are fully aware and adhere to World health Organization (WHO) guidelines for hand hygiene (Sadule-Rios & Aguilera, 2017).

PICOT Statement

For healthcare workers in Hospital does alcohol based solutions compared to hand washing protocol prevent hospital acquired infections during the period patients stay in healthcare facilities.

Evidence based solution

Alcohol based solutions have been used widely across the world. Studies show that this approach to HH irritates hands less often, removes germs effectively and requires less time as compared to hand washing. Alcohol based solutions are also more accessible as compared to sinks. This approach to HH is more effective when the hands are not soiled. However, in situations where dirt can be seen on the hands, health workers should clean their hands using water. Alcohol based solutions have good microbial activity against various bacteria and viruses. Multiple studies show that alcohol based solutions are more effective in the healthcare setting as compared to hand washing protocol (Lehotsky et al., 2017).

Nursing Intervention

Patients who have been admitted in the hospitals interact with nurses more often than any other healthcare professional. For this reason, nurses must take precautionary measure to ensure patient security and overall wellbeing. Nurse practitioners should use alcohol based solutions before and after interacting with patients. This will reduce the spread of infections in the healthcares setting. Nurses should also follow the WHO guidelines which require them to wear protective gear before interacting with patients. This will prevent them from acquiring infections from one patient and transmitting it to other patients within the hospital (Garus-Pakowska, Sobala & Szatko, 2013).

Patient Care

One of the most important goals for healthcare facilities is to provide quality services to patients. Without proper HH this goal cannot be achieved. Hospitals should create proper HH guidelines to be followed by all patients admitted in their facility. Healthcare providers should also ensure that their patients are fully aware of these guidelines and ensure they are followed to the latter. Enough alcohol based solutions should be provided to ensure patients adhere to the guidelines (Deochand & Deochand, 2016). The healthcare workers should also ensure that visitors clean their hands before visiting the patients and after leaving wards. This ensures visitors do not bring infections to the patients.

Health care agency

One of the main responsibilities of the healthcare agency is to provide enough alcohol based solutions to both patients and healthcare professionals. Without enough resources they will be unable to follow the WHO HH guidelines. The healthcare agency should also ensure it has enough sinks with running water to ensure that patients and healthcare professionals can clean their hand when they have less supply of alcohol based solutions. They should also ensure they create awareness among their healthcare professionals about the importance of HH. Occasional audits should also be conducted to ensure nurses comply with the set HH guidelines (Chatfield et al., 2016).

Nursing Practice

Most of the hospital acquired infections can be prevented by combining the alcohol based solutions and hand washing protocol. These techniques can complement one another increasing patient safety and care in hospitals. Nurses should comply with the WHO guidelines to reduce spread of infections in the healthcare setting (McLawsa et al., 2014). The implementation of standard HH guidelines will ensure a safe and secure healthcare environment. This will also improve patient outcomes and their overall well being. This can go a long way in reducing hospital stay as a result of hospital acquired infections. All hospital stakeholders need to take the necessary precautions to prevent the spread of these infections.



Chatfield, S. L., Nolan, R., Crawford, H.  and Hallam, J. S., (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE Open Medicine Volume 4: 1 –9

Deochand, N., & Deochand, M. E. (2016). Brief Report on Hand-Hygiene Monitoring Systems: A Pilot Study of a Computer-Assisted Image Analysis Technique. Journal of environmental health78(10). Journal of Hospital infection 97 (2017) 26-29

Garus-Pakowska, A., Sobala, W., Szatko. F. (2013).  Observance of hand washing procedures performed by the medical personnel before patient contact part 1.International journal of occupational medicine and environmental health 2013

Lehotsky, A., Szilagyi, L. , Szeremy, P., Weber, G., Haidegger, T. (2017). Towards objective hand hygiene technique assessment: validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure.

McLawsa, M. L., Farahangizb, S., Palenikc, C. Askariand, M., (2014). Iranian healthcare workers’ perspective on hand hygiene: A qualitative study. Journal of Infection and Public Health (2015) 8, 72—79

Sadule-Rios , N., Aguilera, G. (2017). Nurses’ perception of reasons for persistent low rates in hand hygiene compliance. Intensive and Critical Care Nursing 42 (2017) 17-21



Literature Review

Professor’s Name

Student’s Name

Course Title



Most hospital acquired infections are as a result of human actions. Hand hygiene (HH) is a great way to prevent the spread of germs that cause these infections. However, studies show that nurse wash their hand less than they should contributing to the spread of these infections. This also puts patients at the risk of being infected during their stay in healthcare facilities. HH can prevent the spread of these infections and reduce hospital stay for patients. This paper aims to review various studies that are related to this topic and determine how they support the PICOT statement.

PICOT Statement

For healthcare workers in Hospital does alcohol based solutions compared to hand washing protocol prevent hospital acquired infections during the period patients stay in healthcare facilities.

Comparison of research Questions

A study conducted in 2015 aimed to establish whether technology can be used to do away with health acquired infections in hospitals (Al Salman et al., 2015). Another study conducted in 2017 aimed to establish whether HH is enough for the prevention of cross-contamination on hospital wards (Hor et al., 2017). A thirds study done in 2016 focused on assessing the knowledge and attitude of nursing staff and residents towards hand hygiene in relation to reducing hospital-acquired infections (Maheshwari, 2014). The fourth study reviewed in this paper was conducted in 2015 and aimed to assess the attitude, knowledge to HH guidelines of nursing students and final year medical students towards hand hygiene in relation to reducing hospital-acquired infections (Ariyaratne et al., 2015).

Another study conducted in 2019 aimed to explore the attitudes cleaning staff in hospitals as HH (Sendall, McCosker & Halton, 2019). In 2016, another research was conducted aiming to establish whether Hand-Hygiene Monitoring Systems are effective at reducing hospital acquired infections (Deochand & Deochand, 2016). Another study also conducted in the same year aimed to capture the experiences of HH among acute care nurses. This involved interviewing nurses to give their perceptions about HH (Chatfield et al., 2016). Finally, a study conducted in 2016 aimed to identify the knowledge of HH in the fight against HAI present in teaching hospitals affiliated to Zabol University (Sarani et al., 2016). All these research questions aimed to determine the effectiveness of HH in healthcare facilities.

Comparison of Sample Populations

The first study was carried out in carried out in Bahrain; a medical system in the nation was installed and observed for twenty-eight days. Over the twenty-eight days period, comments, suggestions, and remarks on the system were recorded and as a result improvements on the system were made on the course of the system trial. The second study was done in three hospitals in Australia. The specific areas of concern were the general surgical wards and the intensive care units. In order to examine if the infection prevention and control practices were influencing cross-contamination in hospitals, ethnography study was carried out (Hor et al.,  2017). The third study was done in Bhopal city and involved 160 respondents.

The fourth research was done at a university in Sri Lanka. There were 289 participants, of which ninety-three were nursing students and one hundred and ninety-six were medical students. The fifth study involved the use of focus groups where 12 cleaning staff participated. The sixth study looked at several implemented HH monitoring systems. In the other research, eight nurses in the US performing various roles were interviewed. The final study was conducted on 170 nurses of two teaching hospitals in Zabol (Sarani et al., 2016). All these studies had enough sample sizes that helped to bring out reliable findings.

Comparison of limitations

The methodology used in the first study was meant that the results could not be generalized for a wider population (Al Salman et al., 2015). The study is also time-consuming. In the second study, biasness on the part of the research could have significantly affected the findings of the study. The third study used a cross sectional approach and therefore could not be used to determine the behavior of healthcare professionals over a period of time. The fourth study used an approach that does not help to determine cause and effect of a phenomenon. The researchers experienced challenges in sampling the data that had been obtained compromising the reliability of the study.

The fifth study used explanatory design and therefore the interpretation of the information obtained was judgmental and biased.  The sixth study utilized observation as its method of study. This made it difficult for researchers to determine the behavior of interests of the participants. The next study was limited by the fact that participants could have provided biased information that could influence the final results. The approach also did not help to obtain all the information required from the respondents (Chatfield et al., 2016). The final study was limited by the fact that the problem of the study could not be tested statistically. Due to the observational nature of the study, the study is not repeatable.


In conclusion, the studies that have been reviewed in this paper support the PICOT Statement. A threat to the credibility that might have been present to most of these studies was selection bias. The monitoring technology was not put all over the complex rather it was only installed in the coronary care unit. It was recommended that the systems should be tested in other sections of hospitals. HH training needs to be emphasized in order to bring improvement in healthcare system. Infection prevention management needs to come up with proper training programs for HH for hospital acquired infections to be done away with. There is a need for the study to be conducted in the real world for a valid conclusion on the subject matter to be done.



Al Salman, J. M., Hani, S., de Marcellis-Warin, N., & Isa, S. F. (2015). Effectiveness of an electronic hand hygiene monitoring system on healthcare workers’ compliance to guidelines. Journal of infection and public health8(2), 117-126.

Hor, S. Y., Hooker, C., Iedema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O’Sullivan, M. V. N. (2017). Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ Qual Saf26(7), 552-558.

Maheshwari, V. (2014). A study to assess knowledge and attitude regarding hand hygiene amongst residents and nursing staff in a tertiary health care setting of Bhopal City. Journal of clinical and diagnostic research: JCDR8(8), DC04.

Ariyaratne, M. H. J. D., Gunasekara, T. D. C. P., Weerasekara, M. M., Kottahachchi, J., Kudavidanage, B. P., & Fernando, S. S. N. (2015). Knowledge, attitudes and practices of hand hygiene among final year medical and nursing students at the University of Sri Jayewardenepura.

Sendall, M. C., McCosker, L. K., & Halton, K. (2019). Cleaning staff’s attitudes about hand hygiene in a metropolitan hospital in Australia: A qualitative study. International journal of environmental research and public health16(6), 1067.

Deochand, N., & Deochand, M. E. (2016). Brief report on hand-hygiene monitoring systems: A pilot study of a computer-assisted image analysis technique. Journal of environmental health78(10), 14-21.

Chatfield, S. L., Nolan, R., Crawford, H., & Hallam, J. S. (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE open medicine4, 2050312116675098.

Sarani, H., Balouchi, A., Masinaeinezhad, N., & Ebrahimitabs, E. (2016). Knowledge, attitude and practice of nurses about standard precautions for hospital-acquired infection in teaching hospitals affiliated to Zabol University of Medical Sciences (2014). Global journal of health

science8(3), 193



DQ . Barriers to EBP project implementation

The ultimate aim of change projects is to effect continuous improvements in healthcare organizations for subsequent improvements in patient care and organizational management. One way of creating lasting change is through collaborating with the employees to ensure that the new change is accepted and accommodated by the professionals. This creates a space for joint implementation of the change where the employees own the project. Another approach is through educating the staff and the community on the need for the change and how it is going to benefit them. However, there exists several challenges against the attainment of this objective including resistance to change and the depletion of resources.

Resistance to change is a common challenge in the healthcare sector especially when the staff are not transformative and have no desire for change. This normally occurs where the leadership promotes a feeling of comfortability on present dynamics instead of advocating for continued quality improvements (Jordan, Bowers, & Morton, 2016). To overcome this barrier, I will educate the staff on the need for implementing this change and the expected benefits. It is also essential to educate the patients, their families, and communities on the importance of engaging in constant exercises and healthy dieting to control blood sugar among diabetes patients. The education sessions should focus on the role of the interventions in mitigating the cost of care, reducing the burden of diseases, and improving the quality of life.

Another barrier likely lower the efficacy of my project in attaining the intended objectives is the depletion of the resources necessary to complete this change. Key resources needed to support the implementation of this project include finances and human resources to promote regular exercises and healthy dieting as better strategies of promoting long-term stability among patients. To mitigate this challenge, I will partner with healthcare organizations, community members, adjacent healthcare organizations, and community-based organizations to provide financial and intellectual resources for the project’s completion. Another strategy is utilizing the six sigma resource management approach to avoid resource wastage (Koeijer, Paauwe, & Huijsman, 2014).






Jordan, P., Bowers, C., & Morton, D. (2016). Barriers to implementing evidence-based practice in a private intensive care unit on the EAstern Cape. South African Journal of Critical Care, 32(2), 50-54. doi:10.7196/SAJCC.2016.v32i2.253

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