Importance of Hand Hygiene in Controlling Hospital Acquired Infections

This dissertation explores the importance of hand hygiene in controlling hospital acquired infections. It discusses the high morbidity and mortality rates associated with these infections and the role of hand hygiene in preventing their transmission. The research aims to evaluate the existing perception of hand hygiene among care professionals and investigate the effectiveness of an awareness workshop in changing their perceptions. The study also aims to assess the changes in perception and behavior after the training program on hand hygiene. The literature review section provides an overview of the existing research on hand hygiene and its implications for infection control.

Running head: DISSERTATION
DISSERTATION
Name of the Student:
Name of the University:
Author Note:

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CHAPTER 1:
Introduction:
1.0: Background:
According to the World Health Organization (2019), it has been mentioned that
approximately 1.4 million deaths are caused due to hospital acquired infection in Canada.
However, research studies also mention that the estimated figure could be incorrect due to the
lack of proper surveillance and estimation. It should be noted in this context that across a
healthcare setting, patients could be exposed to a number of infections that include blood
stream infections, surgical site infections, urinary infections, chest/respiratory infections or
gastrointestinal infections (Nabavi et al., 2015). It is extremely shocking to note that
healthcare workers are often responsible for the transmission of such infections. In this
context, it is important to note that most of the times care professionals cannot trace the
obvious symptoms or signs of carrying an infectious microbe and transmitting the infection to
a healthy patient (Megeus et al., 2015). This primarily leads to the dearth of hospital acquired
infections among the healthy patients.
1.1: Problem Statement:
The morbidity and mortality rate on account of hospital acquired infection is
sufficiently high and can be controlled with effective compliance with the hand hygiene
protocol (Kinston et al., 2016). Hand hygiene marks the safety of the patient and is a simple
and cost effective technique that could help in the prevention of infection transmission
(Megeus et al., 2015). It is important to note here that hand hygiene is not the only technique
that could help in ensuring infection control but it could help in significantly reduce the rate
of infection transmission and ensuring patient safety.
1.2: Research Rationale:

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A number of research studies have shown that compliance with effective hand
hygiene is considerably low on account of lack of education and awareness in relation to
infection control and hand hygiene (Hesselink et al., 2016; Hoogenboom et al., 2015).
Further, research studies also suggest that fostering effective strategies to improve hand
hygiene within the clinical setting could help in ensuring effective infection control. Also,
increased focus on hand hygiene could lead to an overall improvement in the organizational
performance and help in guaranteeing patient safety and at the same time could also help in
reducing medical expenses related to hospital acquired infection and disease burden.
1.3: Research Aim:
Therefore, based on the discussed background infection, the research aim of this
primary research study is to conduct an awareness workshop where education and awareness
would be disseminated in relation to hand hygiene to care professionals. The main purpose is
to change the perception of the care professionals in relation to hand hygiene and effectively
educate them in this regard so as to improve compliance with infection control policies.
1.4: Research Questions:
On the basis of the research rationale and the research aim, the following research
questions can be deduced:
RQ1: What is the existing perception in relation to hand hygiene among care professionals
working within a healthcare setting?
RQ2: Could an awareness workshop help in changing perceptions in relation to hand hygiene
among care professionals?
RQ3: What improvements can be observed in relation to the perception and attitude of care
professionals after conducting a training workshop on hand hygiene?

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1.5: Research Objectives:
The research objectives can therefore be summarized as under:
 To evaluate the existing perception and belief in relation to hand hygiene among care
professionals
 To investigate whether an awareness workshop could evoke a change in the existing
perception
 To evaluate what changes in perception or behaviour could be noticed after the
completion of the training program on hand hygiene

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CHAPTER 2:
Literature Review:
2.0: Introduction:
The literature review section forms an important section in a dissertation as in this
section researchers make use of the evidence base in order to develop an understanding about
what has already been done on the research topic. It can be mentioned in this context that the
Literature review helps in developing an insight into the available scholarly literatures that
are present on the area of research interest and accordingly helps the researcher in creating a
guideline to proceed with the research study.
2.1: Search Strategy:
Search strategy can be explained as the procedure that is used in order to search the
popular electronic databases and accordingly retrieve relevant research studies (Lampard &
Pole, 2015). In this case, the researchers conducted an exhaustive search on the popular
electronic databases that included Google Scholar, PubMeD, CINAHL and Medline. The
search was conducted with the use of key terms and specific inclusion and exclusion criteria
that helped in refining the search and retrieving the most relevant research studies.
2.2: Exclusion and Inclusion Criteria:
As stated by Lampard and Pole (2015), exclusion criteria refer to the set of
characteristics that are used to exclude research papers from a review. In this case, the set of
exclusion criteria comprised of the following characteristics:
 Research papers published in foreign languages
 Research papers published before 2013
 Research papers that were not accessible for full text

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On the other hand, inclusion criteria refer to the set of characteristics that are used by
the researchers to retrieve literatures on an electronic database. In this case, the set of
inclusion criteria included the following characteristics:
 Research papers published between 2013 till 2018
 Research papers published in English
 Research papers that were accessible for full-text
2.3: Key Words:
As stated by Leung (2015), key words can be defined as condensed terms or short
phrases that help in conducting a search over the electronic database and retrieving relevant
research papers. In order to conduct the search, the following key words were used:
Hand hygiene, compliance, infection control, health care setting, enhance compliance,
WHO interventions, Hand washing technique, Alcohol based hand rub, patient hygiene,
patient safety
In addition to this, it should further be noted that in order to refine the search, Boolean
operators were used that included the terms AND/ OR. The uses of Boolean terms help in
refining the search as long phrases are not properly retrieved on electronic databases.
Therefore two or more key terms were used in combination with a Boolean operator, like
Hand hygiene AND compliance AND patient safety OR Infection control.
2.4: Discussion:
Infections such as influenza, meningitis and the common cold have increased in
hospital settings as a result of unhygienic care environment and poor compliance with hand
hygiene routine (Kwok et al., 2016). Research studies indicate that the morbidity and
mortality due to healthcare associated infection is on the rise globally (Kingston et al., 2016).

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Existing practices among the emergency medical service providers indicated that pre-hospital
service providers such as emergency medical technician had poor knowledge and awareness
in relation to hand hygiene (Benjamin, Hargrave & Nether, 2016). Also, a number of
researchers have emphasised on the need to devises interventions in order to compliance with
hand hygiene routine.
In accordance to the World Health Organization (2019), hospital acquired infections
have been discussed as the major causes that affect a large number of patients on a yearly
basis. Further, research studies also mention that healthcare associated infections are acquired
by the patients during their term of hospital stay (Ariyaratne et al., 2015; Benjamin et al.,
2016). The type of infections typically comprise of infections caused by Clostridium difficile
also known as CDI, methicillin resistant Staphylococcus aureus (MRSA), Carbapenemase
producing microbes also referred to as CPO and other bacterial pathogens and viruses (Carter
et al., 2016). Further, infections also occur on account of sharing contaminated instruments
such as catheters or ventilators. In addition to this, infections also spread also spread due to
cross contamination at the surgical sites. As suggested by Benjamin et al. (2016) hospital
acquired infections can potentially occur across any healthcare setting including, hospital care
units, surgical wards, ambulatory or outpatient clinics, long term care units as well as
rehabilitation centres.
Research studies suggest that nosocomial infections or the healthcare associated
infections are a major reason that elicit an economic burden within the healthcare system of
Canada. Within Canada, one out of every nine hospital patients report suffering from a
hospital acquired infection (Hesselink et al., 2016; Hoogenboom et al., 2015). Annually, it is
estimated that more than 220,000 cases of HAI are diagnosed which results in a minimum of
8000 deaths (Kingston, O'Connell & Dunne, 2016). In relation to the prevalent scenario,
researchers have urged upon stringently focusing upon strengthening the surveillance

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component within the healthcare environment so as to ensure effective infection control
(Kwok, Callard & McLaws, 2015). In this context, research studies suggest that the rise in the
prevalence of hospital acquired infection, is primarily due to poor compliance with hand
hygiene. As stated by Megeus et al. (2015), effective hand hygiene and stringent compliance
with the hand hygiene protocol can help in controlling the incidence of hospital acquired
infection and at the same time can help in alleviating the morbidity and disease burden in
relation to nosocomial infection or hospital acquired infection. As per Prabhakumar et al.
(2016), the significant rise in the incidence of hospital acquired infection is attributed to lack
of compliance with the hand hygiene protocol within a health care setting. Further, Benjamin,
Hargrave and Nether (2016), in their research paper suggested that poor hand hygiene is
tightly linked to transmission of nosocomial infections. Moreover, since stringent monitoring
of the emergency medical service has not been implemented across healthcare organizations
within Canada, there is poor compliance with infection control policies. Further, Nabavi et al.
(2015) has highlighted the need to commence effective hand hygiene training so as to
improve compliance with infection control guidelines and reduce the incidence of nosocomial
infections.
Researchers have typically identified hand hygiene as an effective tool that is
extremely helpful in controlling hospital acquired infections such as central line associated
bloodstream infection and catheter associated urinary tract infection (Titer, Millin & Bissel,
2015). Pathogenic microbial agents are more likely to be found on care professionals after
addressing activities such as offering wound care, handling biological fluid and handling
catheter (Prabhakumar et al., 2016). In addition to this, pathogenic microbes could also
traverse to care professionals while taking vital assessments such as measuring temperature,
blood pressure or cardiac output (Rahman et al., 2017).

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The most common microbial pathogens that were transmitted to patients from care
professionals include, Clostridium difficile, Staphylococcus aureus Klebsiella sp. and MRS
and the infection is transmitted either through direct contact or by touching contaminated
charts or progress notes handed over to nurses at the work station (Sakihama et al., 2016). As
per Wilson (2017), it was evaluated that the incidence of hospital acquired infection was
common among the patients placed within a care unit and was no different within the
advanced care unit. Further, the research conducted by Wilson (2017), revealed that the
incidence of HAI could be reduced by ensuring compliance with hand hygiene protocol. The
concept of effective hand hygiene refers to effective hand washing with soap and water or by
using Alcohol Based Hand Sanitizer. Research studies indicate that Ignaz Semmelweis was a
Hungarian physician who had first propounded the concept of effective hand washing so as to
improve health outcome within the maternity care unit and reduce postpartum deaths on
account of transmission of infection (Sansam et al., 2016; Sakihama et al., 2016). As per
Storr (2017), care professionals must adhere to the infection control guidelines and comply
with the five moments of hygiene which include, before touching a patient, after making
contact with a patient, before performing an aseptic task, after the end of contact with the
patient and after being exposed to biological fluid or making contact with the surrounding of
the patient.
A large number of research studies have stressed upon the reduction in the
transmission of infection on complying with the hand hygiene routine, however, the
compliance rate is significantly low, equivalent to only 50% to 60% (Tartari et al., 2015;
Taylor et al., 2015). Further, as per Nabavi et al. (2015), hand washing and use of hand
sanitizers could help in reducing infectious health outcome such as diarrhoea or allergies
within the care unit.
Hand-hygiene and implication on practice:

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As suggested by Carter et al. (2016), hand hygiene has been regarded as an
appropriate strategy that could help in controlling the transmission of infection and at the
same time reduce the number of microbes from the hands of the care professionals. As per
Benjamin et al. (2016), the transmission of microbial pathogens invariably occurs through
physical contact by means of touching the patients with hands. Further, Tartari et al. (2016)
has stressed upon hand washing with soap and water so as to sanitize the hands and prevent
the scope if transmitting infectious diseases.
Need to ensure stringent compliance with hand hygiene protocol:
A research study conducted by Sakihama et al. (2016) suggested that washing hands
under running water with an antimicrobial liquid soap for a period of 10 to 15 seconds could
help in getting rid of infectious pathogens. The researcher referred to Felman’s criteria that
suggested irrespective of the display of bubbles, washing hand for 10 to 15 seconds
effectively helped in diminishing the population of infectious microbes from the surface of
the hands (Sakihama et al., 2016). Also, researchers mention that the use of alcohol based
hand sanitizers could effectively help in getting rid of infectious pathogens from the surface
of the hands (Nabavi et al, 2015; Benjamin, Hargrave & Nether, 2016)
Promoting awareness about hand hygiene:
Research studies suggest that the compliance with effective hand hygiene technique
was compromised on account of the busy schedule of the care professionals (Megeus et al.
2015). A multitude of factors such as compelling correspondence and training about
contamination control, updates presented outwardly on advance great hand cleanliness,
strategically placed apportioning gear with hand sanitizers can help in improving compliance.
Further, as per Storr et al. (2017), effective hand hygiene is the most cost effective manner

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that could help in reducing the disease burden associated with nosocomial infection summing
up to an expenditure of $ 45 billion (Teter, Millin & Bissell, 2015).
Compliance with hand washing technique and infection control:
On the basis of the research studies covered in the literature review, it can be
suggested that the most effective procedure to control nosocomial infection within health care
environment is the use of hand hygiene technique (White et al., 2015). There is a significant
need to include appropriate infection control policies and at the same time ensure strict
surveillance so as to reduce the incidence of healthcare associated infection within the care
environment and promote positive patient outcome.
2.5: Literature Gap:
Therefore, on the basis of the exhaustive literature review, it can be mentioned that
the research studies included in the review have primarily suggested that the incidence of
hospital acquired infection could be controlled with the implementation and monitoring of
effective hand hygiene routine (Kingston, O'Connell & Dunne, 2016). A number of research
studies effectively highlighted that despite the remarkable benefit that could be ensured on
compliance with activities such as hand washing, the compliance with the hand hygiene
protocol is low within a care environment (Hoogenboom et al., 2015). However, none of the
research studies included within the review have discussed about the requisite and objectives
of a training program within a care environment that would help in reducing the incidence of
nosocomial infection, so as to promote positive health outcome. Therefore, this primary
research study intends to work on the identified research gap and conduct an awareness
training workshop on effective hand hygiene technique so as to improve compliance among
care professionals and achieve positive patient outcome.
2.6: Summary:

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Therefore, to summarize, the findings of the literature review, it can be mentioned that
effective hand hygiene is one of the effective tool that has been reported to prevent the
transmission of healthcare associated infection within a care environment. Research studies
have critically stated that poor compliance with hand hygiene protocol among care
professionals promote the transmission of infectious microbes such as Clostridium difficile,
Staphylococcus aureus Klebsiella spp and MRS (Teter et al., 2015). Further, research studies
have also revealed that despite a large number of research studies focusing on the importance
of complying with hand hygiene protocol, the compliance percentage is as low as 50% to
60% within the care environment (Wilson, 2017; Taylor et al., 2015). This suggests that there
is an increased need to conduct hand hygiene awareness workshop within a care environment
so as to impart education and disseminate awareness in relation to infection control and hand
hygiene within a care environment.

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CHAPTER 3:
Methodology:
3.0: Introduction:
Methodology forms an important section of a research paper. According to Birley and
Moreland (2014), the methods section critically describes the actions that need to be taken in
order to critically investigate a research problem and at the same time devise rationales for
the application of specific procedures in order to carry out the process of identification,
selection, process as well as analysis of a specific problem. It should be noted in this context
that the application of the set of information to the research problem allows the researcher to
evaluate the overall validity as well as reliability of the study (Punch, 2013; Birley &
Moreland, 2014). As stated by Fassinger and Marrow (2014), the methodology section of a
research paper critically answers two important research based questions that include
answering the question, how the data was collected or generated and how it was analysed. In
this context it should be noted that the researcher would conduct a training workshop on hand
hygiene in order to ensure increased compliance to hand hygiene routine and prevent the
progression of the hospital acquired hand hygiene infection within the hospital environment.
3.1: Research Design:
According to Punch (2013), research design can be defined as a key plan to answer a
specific research question. It should be noted in this context that a research method is
basically a tool that is used to address a research question and defined research objectives. It
should be note din this context that a research design can either be qualitative or quantitative
or mixed (Walliman, 2017). As stated by quantitative research method deals with the analysis
of numerical data and is analysed with the help of analysis tools (Leung, 2015). On the other

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hand, qualitative methods help in evaluating qualitative responses such as interview
responses (Punch, 2013). It should be noted in this context that the purpose of this research is
to conduct a hand hygiene workshop in order to improve compliance and prevent the
prevalence and incidence rate of the hospital acquired infections (HAI). The researcher would
evaluate the extent of compliance and positive difference made on the basis of conducting a
pre-training questionnaire which would evaluate the perception of the nurses prior to
attending the workshop and evaluate the responses of the post-training questionnaire in order
to estimate the difference in the knowledge and attitude of the nurses in relation to hand
hygiene. The research design for the research study would thus comprise of conducting a
exploratory quantitative study. As stated by Hirschi and Selvin (2017), exploratory research
study can be defined as a research study design that helps to investigate a problem which is
not clearly defined. The study design typically helps in acquiring a better understanding of
the existing issue and helps in exploring issues that could be the area of primary focus for
future research studies (Davis & Hughes, 2014). It can be mentioned in this context, that the
researcher is conducting the training on the basis of the belief that the training on hand
hygiene would help in improving hand hygiene compliance and at the same time would also
help in reducing the transmission of hospital acquired infection.
3.2: Research Method:
In the words of Berger (2013), while conducting a research, it is extremely important
to choose a clear methodology that would best define the research objectives. Typically,
research methods aids researchers in choosing an appropriate methodology in order analyse
the collected data (Lampard & Pole, 2015). The most popular research methods can be
mentioned as interviews and surveys (Davies & Hughes, 2014). It should be noted in this
context that the choice of research method majorly depends on the type of data to be analysed
and the classified parameters that are to be kept in mind while analysing the set of collected

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data (McNabb, 2015) Since, in this research, the researcher is trying to study and establish the
difference in the level of education and perception after conducting the training workshop on
hand hygiene and compliance, the research method that has been chosen includes a survey of
the questionnaire (Yilmaz, 2013). It should further be noted in this regard that the researcher
would conduct the questionnaire in two sets, the first would comprise of evaluating the level
of pre-existing awareness in relation to hand hygiene and prevention of hospital acquired
infections (Hartas, 2015). On the other hand, the second questionnaire response would
comprise of evaluating the level of change in clinical perception and hand hygiene
compliance so as improve the cumulative patient outcome.
3.3: Data collection:
According to Hartas (2018), data collection can be defined as the process of gathering
as well as measuring information on the variables of research interest. It should be mentioned
in this context that typically, the data collection method enables researchers to answer
research question, test hypothesis as well as evaluate outcomes (Creswell & Creswell, 2017).
Further, it should also be noted that the data collection method is integral for both qualitative
as well as quantitative research studies and it helps in the maintenance of the integrity of
research (Nardi, 2018). Further, the selection of the proper data collection instrument as well
as clear delineated instructions help in the reducing the probability of encountering errors in
the future (Lampard & Pole, 2015).
In order to justify the objectives of the research, the data collection method that would
be chosen would comprise of conducting survey questionnaires. It should be typically noted
in this context that the primary agenda of the research is to compare and contrast the level of
education and awareness among the nursing professionals about the hand hygiene routine and

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compliance after the completion of the training workshop and compare it with the perception
retrieved from the nurses prior to the training.
Dependent Variable:
As stated by Creswell and Creswell (2017), a dependent variable can be defined as a
variable which is dependent upon other factors for its validity. In this case, the dependent
variable is hospital acquired infection which is caused on account of non-compliance with
hand hygiene method.
Independent Variable:
According to Brannen (2017), an independent variable can be defined as the variable
that is not dependent upon other factors for its validity. In this case, the independent variable
can be defined as hand hygiene. It should be noted that compliance with hand hygiene helps
in the prevention of infection occurrence and helps in the promotion of positive patient
outcome.
3.4: Data analysis:
The collected data in the form of questionnaire responses collected from the 80
nursing professionals would be evaluated on the basis of the statistical analysis using the
SPSS software. The SPSS software can be defined as a statistical tool that provides assistance
with statistical analysis and helps in analysing the existing ratio statistics between a set of two
data sets (Neuman & Robson, 2014). In addition to this, the statistical data analysis tool also
helps in the process of cross tabulation and correlating between the two different data sets. In
this case, the SPSS tool would be used to carry out a statistical data analysis in order to
conduct a sample t-test (Srigley et al., 2015). It should be noted in this context that the
independent sample t-Test, compares and contrasts the mean of two independent groups to
evaluate two sets of data and establish statistically if there is an existing relationship between

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the two sets of data (Choy, 2014). In this case, the research method employed to extract
responses from the participants would comprise of two sets of questions which would be
evaluated prior to the training and after conducting the training (Neuman & Robson, 2014). It
should be noted in this context that the questionnaire that would be distributed to the
participants prior to the training would comprise of two sets of questions that would evaluate
the response of the nurses on the basis of perception of the nurses towards hand hygiene and
experience of the nurses in relation to patient outcome and hand hygiene. On the other hand,
the second questionnaire would comprise of one set of question that would be based upon the
evaluation of the change in perception after conducting the training workshop on hand
hygiene. It should be typically noted in this context that the relation between the perception
levels of the pre and post questionnaire would be evaluated on the basis of T-test. Whereas, in
case of the pre-questionnaire form the relation between the perception level of the nurses and
experience would be evaluated on the basis of the regression ANOVA test (Creswell &
Creswell, 2017).
3.5: Evaluation:
It is integral to note in this context that while conducting a training workshop, it is
extremely important to conduct continuous evaluation. In this case, the data evaluation would
be conducted on the basis of the findings of data analysis (Yilmaz, 2013). Further, on the
basis of the success rate of the findings retrieved from the survey responses, further action
would be taken to incorporate modifications in the training program so as to improve the
level of clinical compliance at the end of the nursing professionals (Nardi, 2018).
3.6: Validity:
According to Hartas (2018), validity refers to the indication that helps in determining
the authenticity of the research. It should be typically noted in this regard that validity holds

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true in case of both the research design as well as the research methods. Validity in the
process of data collection refers to the extent to which the findings help in establishing that to
what extent the findings justify the phenomenon that is being measured in the research study
(Brannen, 2017). Validity claims are solid claims and are often measured on the basis of
external or internal validity. In this case, the validity of the training program on the
performance output of the care professionals would be tested on the basis of the findings
accumulated from the evidence base (McNabb, 2015).
3.7: Material and Methods:
Material and methods refer to the instruments that are required to conduct a research
(Berger, 2018). In this case, the research study includes conducting a training workshop to
educate the nurses about hand hygiene and at the same time improve compliance so as to
prevent the incidence rate of hospital acquired infection and promote wellness of the patients.
The materials would therefore comprise of the inclusion of a rented room, a projector to
display the presentation, a power point presentation and two questionnaire forms, one that
would be distributed to the nurses prior to the workshop and the second that would be
conducted after the completion of the program. In addition to this, the other materials would
comprise of seating arrangement, PEP equipment as well as alcohol rub and hand washing
soap which would be used to demonstrate the correct hand washing technique to the nurses.
3.8: Subjects:
The subjects would comprise of 80 nursing professionals. The criteria of the choice of
the nursing professionals would comprise of selection of one nurse from each shift from each
station. The nurses would be imparted with the training of correct hand hygiene protocol in
order to prevent the incidence of hospital acquired infection and promote positive patient
outcome.

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3.9: Ethical Considerations:
As stated by Leung (2015), ethical considerations form an integral aspect of
conducting a primary research study. As has already been mentioned that a total of 80 nursing
professionals would be chosen from each shift working across the different stations within a
healthcare setting. Prior to conducting the workshop, an ethical approval would be obtained
from the hospital authorities (Hirschi & Selvin, 2017). This would be done by briefing the
authorities about the purpose and significance of the research. In addition to this, the research
objectives would also be mentioned to the authorities and the training protocol would also be
discussed. After obtaining the ethical approval from the hospital authorities, posters would be
displayed within the hospital and flyers would be distributed to the nurses working within the
hospital. The nursing professionals that display interest would be recruited as participants
within the training program (Davies & Hughes, 2015). The recruited nurses would be
contacted personally through email and would be briefed about the purpose as well as the
significance of the research. Additionally, the participants would be asked to revert to the
email by sending an acceptance of the consent form via email (McNabb, 2018). Upon
obtaining the consent forms, the participants would be recruited to participate in the training
workshop (Yilmaz, 2013) .
3.10: Preparations:
Prior to conducting the workshop, an introductory session would be held where the
researcher would greet the participants and would introduce himself to the participants. After
the same, the researcher would discuss the objectives and the purpose of the research and at
each stage ask the participants if they are clear with the purpose of the research. This would
help in maintaining an effective flow of communication between the researcher as well as the
participants and ensure that the training is conducted in an effective manner (Leung, 2015).

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3.11: Protocol Design:
The protocol design would comprise of conducting an awareness session where the
care professionals would be educated about hospital acquired infections and nosocomial
infections and then the next step would comprise of demonstrating effective hand hygiene
technique and the correct procedure of donning PEP so that the progression of nosocomial
infection is reduced and positive patient outcome is promoted.
3.12: Summary:
Therefore, to summarize, it can be mentioned that methodology forms an integral
aspect of a research study. In this case, the study design adapted by the researcher is
quantitative and the research method that would be used is conducting questionnaire survey
prior to conducting the training and after conducting the training workshop on hand hygiene
(Nardi, 2018). The responses obtained would be evaluated with the help of SPSS software
and ANOVA test where the existing relationship between the independent variable (hand
hygiene) and dependent variable (hospital acquired infection) would be measured (Lampard
& Pole, 2015).

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Chapter 4:
Results and Analysis:
4.0: Descriptive Study
Profession
Number out of 80 Percentage
Nurse 45 56
Midwife 35 44
Nurse Midwife
0
10
20
30
40
50
60
Percentage
Experience
Number out of 80 Percentage
Intern 20 25
Less than 1 year 12 15
1 to 5 years 20 25
5 to 10 years 11 14
More than 10 years 17 21
Intern Less than
1 year 1 to 5
years 5 to 10
years More
than 10
years
0
5
10
15
20
25
30
Percentage

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Department
Number out of 80 Percentage
Emergency 40 50
Maternal 16 20
Surgical 10 13
Medical 7 9
ICU 7 9
Emergency Maternal Surgical Medical ICU
0
10
20
30
40
50
60
Percentage
Training in last three years
Number out of 80 Percentage
Never 37 46
Once 24 30
More than once 19 24
Never Once More than once
0
5
10
15
20
25
30
35
40
45
50
Percentage
Suggestion from supervisor regarding hand hygiene

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Number out of 80 Percentage
None 12 15
Rarely 27 34
Sometimes 28 35
Often 9 11
Always 4 5
None Rarely Sometimes Often Always
0
5
10
15
20
25
30
35
40
Percentage
How beneficial was the hand hygiene training
Number out of 80 Percentage
Very low 3 4
Low 11 14
Moderate 28 35
High 28 35
Very high 11 13
Very low Low Moderate High Very high
0
5
10
15
20
25
30
35
40
Percentage
Further training required

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Number out of 80 Percentage
Very low 10 13
Low 25 31
Moderate 31 39
High 4 6
Very high 8 10
Very low Low Moderate High Very high
0
5
10
15
20
25
30
35
40
45
Percentage
4.1: Findings from descriptive study:
 Most of the participants are nurse.
 Most of them work in emergency care unit.
 A large number of caregivers including nurses and midwifes have not received any
hand hygiene training.
 Most of the participants rarely receive suggestion from their supervisors regarding
hand hygiene.
 Most of the caregivers including nurses and midwifes think that the provided training
regarding hand hygiene is very beneficial for the professional improvement
 Most of them have moderate level urge to get further training on hand hygiene
4.2: Hypothesis testing hand hygiene and infectious disease through ANOVA and
regression
Model Summary
Model R R Square
Adjusted R
Square
Std. Error of
the Estimate

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1 .918a .843 .833 .517
a. Predictors: (Constant), Pre_priority_handhygiene,
Pre_essentiality_Training, Pre_Detoriation,
Pre_essentiality_handhygiene, Pre_frequency

26DISSERTATION
Model Summary
Model R R Square
Adjusted R
Square
Std. Error of
the Estimate
1 .924a .854 .844 .539
a. Predictors: (Constant), Pre_priority_handhygiene,
Pre_essentiality_Training, Pre_Detoriation,
Pre_essentiality_handhygiene, Pre_frequency
Regression data is 85% (0.85) correct and hence the following results are valid and
acceptable
ANOVAa
Model
Sum of
Squares df Mean Square F Sig.
1 Regression 106.673 5 21.335 79.679 .000b
Residual 19.814 74 .268
Total 126.488 79
a. Dependent Variable: Treatability_infectious_disease
b. Predictors: (Constant), Pre_priority_handhygiene, Pre_essentiality_Training,
Pre_Detoriation, Pre_essentiality_handhygiene, Pre_frequency
ANOVAa
Model
Sum of
Squares df Mean Square F Sig.
1 Regression 125.479 5 25.096 86.292 .000b
Residual 21.521 74 .291
Total 147.000 79
a. Dependent Variable: Success_rate
b. Predictors: (Constant), Pre_priority_handhygiene, Pre_essentiality_Training,
Pre_Detoriation, Pre_essentiality_handhygiene, Pre_frequency

27DISSERTATION
The significance value is less than 0.05 and hence both treatability and success rate is
dependent on the independent variables of nursing practice
Coefficientsa
Model
Unstandardized
Coefficients
Standardized
Coefficients
t Sig.B Std. Error Beta
1 (Constant) -.271 .163 -1.657 .102
Pre_frequency .020 .101 .022 .202 .841
Pre_essentiality_handhy
giene .414 .106 .390 3.898 .000
Pre_Detoriation .347 .079 .326 4.383 .000
Pre_essentiality_Trainin
g .087 .094 .081 .923 .359
Pre_priority_handhygien
e .212 .087 .204 2.435 .017
a. Dependent Variable: Treatability_infectious_disease
Coefficientsa
Model
Unstandardized
Coefficients
Standardized
Coefficients
t Sig.B Std. Error Beta
1 (Constant) -.068 .170 -.399 .691
Pre_frequency .648 .105 .656 6.149 .000
Pre_essentiality_handhy
giene .270 .111 .235 2.433 .017
Pre_Detoriation .155 .082 .135 1.878 .064
Pre_essentiality_Trainin
g -.057 .098 -.049 -.583 .561
Pre_priority_handhygien
e -.009 .091 -.008 -.101 .920
a. Dependent Variable: Success_rate

28DISSERTATION
Further ANOVA test is required for Pre_frequency, Pre_essentiality_Training,
Pre_Detoriation, Pre_priority_handhygiene because, significant probability values are not
lower than 0.05, where for other independent variables the values are lower than 0.05.
ANOVAa
Model
Sum of
Squares df Mean Square F Sig.
1 Regression 85.266 1 85.266 161.343 .000b
Residual 41.221 78 .528
Total 126.488 79
a. Dependent Variable: Treatability_infectious_disease
b. Predictors: (Constant), Pre_frequency
ANOVAa
Model
Sum of
Squares df Mean Square F Sig.
1 Regression 69.952 1 69.952 96.510 .000b
Residual 56.535 78 .725
Total 126.488 79
a. Dependent Variable: Treatability_infectious_disease
b. Predictors: (Constant), Pre_essentiality_Training
ANOVAa
Model
Sum of
Squares df Mean Square F Sig.
1 Regression 82.798 1 82.798 100.593 .000b
Residual 64.202 78 .823
Total 147.000 79
a. Dependent Variable: Success_rate
b. Predictors: (Constant), Pre_Detoriation
ANOVAa

29DISSERTATION
Model
Sum of
Squares df Mean Square F Sig.
1 Regression 84.396 1 84.396 105.150 .000b
Residual 62.604 78 .803
Total 147.000 79
a. Dependent Variable: Success_rate
b. Predictors: (Constant), Pre_essentiality_Training
ANOVAa
Model
Sum of
Squares df Mean Square F Sig.
1 Regression 82.537 1 82.537 99.870 .000b
Residual 64.463 78 .826
Total 147.000 79
a. Dependent Variable: Success_rate
b. Predictors: (Constant), Pre_priority_handhygiene
Hence both regression and ANOVA test suggest that the significant probability value is lower
than 0.05, hence the dependency of dependent variables on independent variables is
undeniable.
4.3: Findings from regression and ANOVA test
Hypothesis is statistically valid that emphasises that the efficiency or effectiveness of
nursing treatment for infectious disease significantly depends on Hand Hygiene. Hence
improved hand hygiene can increase the efficiency or effectiveness of nursing treatment for
infectious disease.

30DISSERTATION
4.4: Effectiveness of training through T test:
Paired Samples Test
Paired Differences
t df
Sig. (2-
tailed)Mean
Std.
Deviation
Std.
Error
Mean
95% Confidence
Interval of the
Difference
Lower Upper
Pair 1 Pre_essentiality_handhygie
ne -
Post_essentiality_handhygi
ene
-.038 .191 .021 -.080 .005 -1.754 79 .083
Pair 2 Pre_Detoriation -
Post_Detoriation -.825 1.261 .141 -1.106 -.544 -5.853 79 .000
Pair 3 Pre_frequency -
Post_frequency -.587 1.299 .145 -.877 -.298 -4.044 79 .000
Pair 4 Pre_essentiality_Training -
Post_essentiality_Training -.512 1.180 .132 -.775 -.250 -3.885 79 .000
Pair 5 Pre_priority_handhygiene -
Post_priority_handhygiene -.787 1.309 .146 -1.079 -.496 -5.380 79 .000
4.5: Findings from regression and ANOVA test
Most of the paired variables have the significant value lower than 0.05, which
indicates that there is a significant difference of recomposes between before and after the
hand hygiene training or course. The negative t values suggested that the importance of hand
hygiene among caregivers before the training was lower than after providing the training.
Hence, after training participants are washing their hand more frequently and prioritising the
hand hygiene while assessing patients while becoming more confidence to treat the patients
with infectious disease successfully.

31DISSERTATION
Chapter 5:
Discussion
5.1: Overview:
Discussion forms an important section of a dissertation or a thesis, wherein the results
and findings are broadly discussed and evaluated (Neuman & Robson, 2014). It should be
noted in this context, that the discussion section presents the key findings of the research
conducted and helps in estimating the authenticity and validity by comparing the findings
with the available scholarly evidences (Choy, 2014). It should be noted in this context that
the researcher conducted a training workshop on effective hand hygiene so as to improve
compliance with hand hygiene routine and at the same time reduce the incidences of hospital
acquired infections (Srigley et al., 2015). The training workshop comprised a total of 80
participants who were imparted training. A total of 56% of the participants were nurses and
44% of the participants were Midwives. This was almost equivalent to a total of 45 nursing
professionals and 35 midwives who were included in the training workshop. A total of 20%
of the participants were interns which was equivalent to a total of 25% of the participants
being interns. 12 of the participants had less than a year of experience, which could be
compared to a total of 15% of the total participants. Further, 20 of the total participants had
an experience between 1 to 5 years which could be considered equivalent to 25%. 11 out of
8o participants had an experience between 5 to 10 years which could be considered
equivalent to 14% and 17 out of 80 participants had an experience of more than 17 years,
which could be considered equivalent to 21%.
40 out of 80 participants worked at the emergency unit which can be estimated to be
equivalent to 50%. Further, 16 out of the 80 participants worked at the maternal unit which
could be considered equivalent to 20%. 10 out of 80 participants worked at the surgical unit

32DISSERTATION
which could be considered equivalent to 9% and 7 out of the 80 participants worked at the
Intensive Care Unit which could be compared equivalent to 9%.
Upon comparing and contrasting the level of training acquired by the care
professionals in the last three years, it can be mentioned that 37 of the participants, equivalent
to 46% had never received a formal training. 24 of the participants out of 80 participants,
equivalent to 30% of the care professionals had received a training on hand hygiene only
once in the course of their professional tenure. 19 participants out of the 80 participants
which could be compared equivalent to 24% of the participants had received a formal training
on hand hygiene routine more than once. Further, upon evaluating that whether the care
professionals had ever been suggested by their supervisors to obtain training on effective
hand hygiene protocol, 12 out of 80 participants, equivalent to 15% reported in negative. 27
participants out of 80 participants mentioned they had rarely acquired training which could be
compared equivalent to 34%. Further, 28 participants said that they has been recommended
sometimes casually by their supervisors which could be considered equivalent to 35%.
Further, 9% of the participants mentioned that they had often been recommended and the
percentage was considered equivalent to 11%. In addition to this, 4 out of 80 participants
mentioned that they were always recommended to obtain a formal training on effective hand
hygiene by their supervisors which could be considered equivalent to only 5%.
5.2: Interpretation and evaluation of findings:
Upon evaluating the extent to which a training on hand hygiene was effective for care
professionals, 3 care professionals out of 80, equivalent to 4% reported in negation. On the
other hand, 11 participants out of the 80 participants, equivalent to 14% mentioned responses
that revealed ‘low significance’. Further, 28 participants out of the 80 participants, equivalent
to 35% of the participants mentioned responses worth ‘moderate significance’. In addition to

33DISSERTATION
this, 28 participants equivalent to 35% mentioned responses that suggested effective training
on hand hygiene was ‘highly beneficial’. Also, 11 participants out of a total 80 participants,
equivalent to 13 % of the participants said that effective training on hand hygiene was
‘extremely- beneficial’ for care professionals working within a hospital environment. Further,
upon evaluating the responses of the participants in relation to whether or not a further
training on effective hand hygiene was required, 10 out of the 80 participants, equivalent to
13% reported in negation. 25 participants were also of a similar opinion and mentioned that
further training was led likely required. 31 participants equivalent to 39% mentioned that
further training was moderately required. 4 out of 80 participants equivalent to 6% said that
subsequent training on effective hand hygiene was highly required. On the other hand 8 out
of the 80 participants equivalent to 10% of the care professionals mentioned that further
training on effective hand hygiene was highly required within a care setting.
It can hence be mentioned on the basis of the responses acquired from the care
professionals that most of the participants of the training program were nurses and worked
within the emergency care unit. Further, a large number of the care professionals included a
significant proportion of the nurses as well as midwives who had not received any formal
training on effective hand hygiene and were not aware about the positive implication of hand
hygiene on the clinical outcome. Further, it should also be mentioned in this context that a
number of participants of the training workshop had rarely received any suggestion from the
preceptors or supervisors about the positive implication of hand hygiene on the overall
clinical outcome of the patients. Further, a major proportion of the caregivers comprising of
the nursing professionals as well as the midwives felt that an effective training on hand
hygiene could prove to be extremely beneficial for the career development and would
contribute directly to the improvement of professional performance. Further, it should also be

34DISSERTATION
noted that a significant proportion of the care professionals felt that there was a moderate
need to receive further training of effective hand hygiene protocol.
Further, through the ANOVA test it was estimated that the regression data was
equivalent to 85% which means that the obtained results were correct and could be validated.
In addition to this, it should be noted that the significance value was retrieved to be less than
0.05 and hence it could be mentioned that both the treatability as well as the success rate were
dependent on the independent variables of hand hygiene, training, deterioration and quality of
infection control. However, it should be noted in this regard that further ANOVA test is
required to evaluate parameters of frequency, training, deterioration and priority hand
hygiene prior to conducting the training workshop, This is because the significant probability
value estimated is less than 0.,05 and for other independent variables the values are much
lower than 0.05.
Further, it should also be mentioned in this context that both the regression test as wll
as ANOVA test suggested that the significant probability values was lower than 0.05, which
suggests that the dependency of the dependent variables that is the success rate and
prevention of infectious diseases are tightly dependent on the independent variable of
effective training on infection control and hand hygiene routine.
In order to test the relationship in between the difference of perception level among
the nursing professionals before and after conducting the training workshop, paired sample t-
test was conducted. The paired t-test was conducted for 5 pairs of parameters. The first pair
comprised of pre-essential hand hygiene and post essential hand hygiene perception, the
second pair comprised of evaluating pre-deterioration of infection control routine and post
deterioration of infection control routine. The third pair comprised of the pair of pre and post
frequency. The fourth pair comprised of pre-essential training and post essential training and

35DISSERTATION
the fifth pair comprised of pre-priority hand hygiene and post-priority hand hygiene.
Typically it was found that most of the paired variables showed the significant value lower
than 0.05 which indicated that a significant difference exists between the before and after
impact of conducting the training workshop. Further, the negative t values suggest that the
importance of hand hygiene routine among the care professionals prior to conducting the
workshop was lower than after conducting the training. Overall it can be mentioned that after
the completion of the training, the care professionals washed their hands frequently and
prioritized the importance of hand hygiene during assessing patient. Also, care professionals
acquired more confidence while treating the patients and believed that effective hand hygiene
helped in reducing the transmission of infections.
5.3: Validating findings:
On the basis of the key findings retrieved, it can be said that after conducting the
training workshop on effective hand hygiene, the level of perception related to hand hygiene
among the care professionals changed significantly (Larson, 2013). The findings can be co-
related with a number of research findings which suggest that effective training on hand
hygiene can help in improving clinical outcome (Huis et al., 2013; Marra & Edmond, 2014).
As suggested by Pan et al. (2013), effective training program on hand hygiene helped in
improving compliance and improving clinical performance. The researchers conducted a
cohort study that extended for a period of one year and imparted effective training on hand
hygiene routine. After the completion of the program, the researchers validated and
determined the WHO indications for hand hygiene through observation. It should be noted in
this case that the training program comprised of a total number of eleven infection control
nurses and two unit HH ambassadors across 83 wards (Pan et al., 2013). Typically a number
of research studies findings revealed that the training program increased awareness among
the care professionals and at of the same time also increased compliance with the

36DISSERTATION
recommended hand hygiene protocol by the World Health Organization (Luangasanatip et
al., 2015; Ellingson et al., 2014). Another research study conducted by Chassin et al. (2015),
mentioned about the effectiveness of training workshops upon improving the level of clinical
performance and improves compliance among the care professionals. Healthcare
organizations across the world have aimed at incorporating infection prevention policies so as
to reduce the incidence rate of hospital acquired infection and improve compliance of care
professionals to the recommended hand hygiene routine (Gould et al., 2017; Su et al., 2015;
Neo et al., 2016). However, the continuous endeavour of the healthcare organizations and the
infection control policies has had little or no effect till the last decade (White et al., 2015;
Brahona-Guzman et al., 2014). In order to improve awareness and enhance clinical outcome,
the Joint Commission Center for Transforming Healthcare employed teams of experts for
improving the performance outcome against infectious diseases (Chassin et al., 2015). The
team of professionals were incorporated among eight hospitals for the purpose if improving
hand hygiene and the project was conducted from December 2008 to September 2010
(Chassin et al., 2015). Quality improvement tools such as Lean, Six Sigma and Change
management methods were used in order to evaluate the effectiveness of the hand hygiene
program and test the impact of applied interventions on the target audience (Chassin et al.,
2015; Allegranzi et al., 2014). Typically, it was observed that the compliance with hand
hygiene protocol exceeded 70.5% (Chassin et al., 2015; Mahfouz et al., 2013). Also, the
project was implemented across 8 hospitals and the results typically showed that the rate of
compliance increased from 47.5% to 81.0% (Chassin et al., 2015). The research study
therefore suggests that the implementation of effective awareness program and the use of
quality improvement tools can enhance the quality of compliance with the hand hygiene
routine. Further, Szilagyi et al. (2013) stated that awareness and training helped in improving
adherence to the WHO five moments and at the same time also helped in the incidence rate of

37DISSERTATION
nosocomial infections across health settings. The researcher typically conducted an education
and awareness program that included a total of 52000 clinical care professionals and the
program was conducted for a week (Szilagyi et al., 2013). Typically, it was seen that after the
completion of the training program, the compliance to hand hygiene routine significantly
improved and that led to improved quality of hand hygiene and effective patient care
(Ariyaratne et al., 2015; Tschudin-Sutter et al., 2015; Rosenthal et al., 2013). Therefore,
overall it can be mentioned that the findings of the primary research conducted to address the
research objectives could be validated and it can be said that the findings revealed improved
clinical outcome and effective compliance with the hand hygiene routine.
According to Lee et al. (2014) hand hygiene compliance has been studied to
significantly improve clinical performance. In this paper, the authors mentioned that
implementation of poster campaign and stringent monitoring of performance and feedback
could help in improving compliance with hand hygiene routine. In this study the researchers
critically investigated that whether hand hygiene training could help in changing perception
among care professionals in relation to hand hygiene and infection control. Lee et al. (2014)
compared and evaluated the change in perception in relation to hand hygiene and compared
the data collected between the second quarter of 2009 when the hand hygiene program was
commenced and the second quarter of 2012 that marked the completion of the training
program. Adherence of the care professional was tested in accordance to the WHO
recommended method for direct observation and at the same time the researchers also made
use of a self-reported questionnaire in order to collect and interpret the perception data in
relation to hand hygiene and infection control. The findings of the research study conducted
by Lee et al. (2014) revealed that the hand hygiene compliance improved significantly among
nursing professionals from 19.0% in the year 2009 to a total of 74.5% as reported at the end
of the year 2012. Further, it was also observed that compliance to hand hygiene routine had

38DISSERTATION
improved significantly since the year 2009 (Lee et al., 2014). Also, the perception of the care
professionals towards hand hygiene had improved since the year 2009 (Lee et al., 2014). This
suggests that perception related to the importance of maintaining hand hygiene within the
care environment strikingly improved (Lee et al., 2014). Also, effective improvements were
noticed in relation to adherence to hand hygiene, improved knowledge about hand hygiene
techniques as well as motivation to comply with the routine and positively tackle obstacles
that hinder compliance with hand hygiene. Another research study conducted by Ethan et al.
(2013) mentioned that hand hygiene typically occurs at the intersection of culture as well as
habit. The researcher typically shed light on the fact that psychological as well as social
principles in relation to operant conditioning in combination with peer pressure could lead to
a behavioural change (Ethan et al., 2014). It should be noted in this context that
demonstrating the correct procedure of hand hygiene and organising an intra team or inter
team hand hygiene workshop could help in bringing out a cumulative behavioural change
among the care professionals.
On the other hand Davey et al. (2015) were of the opinion that self monitoring as well
as constructive feedback could help in making important behavioural changes and at the same
time employ a range of appropriate interventions to facilitate a change within the care
environment. This can directly be correlated to the purpose of the research that conducting a
workshop on hand hygiene can help in improving compliance with hand hygiene and at the
same reduce the proportion of infection control. It should be noted in this context that a
number of research studies have stated that healthcare associated infection has emerged to be
a major cause of mortality and morbidity within a care environment (Davey et al., 2015). In
addition to this, research studies have also indicated that hand hygiene is an effective
preventive measure and it helps in improving clinical outcome and provision of effective care
delivery. A research study conducted by Gould et al. (2017), investigated the evidence base

39DISSERTATION
to critically identify the long and short term strategies so as to improve compliance with hand
hygiene and at the same time establish that whether or not compliance with hand hygiene
could help in the reduction of hospital acquired infection. On the basis of the findings of the
literature it was found that an increased supply of Alcohol Based Hand Rub (ABHR) as well
as hand washing soap and training programs that disseminated awareness in relation to
effective hand hygiene among the care professionals could help in improving compliance
with hand hygiene and at the same time prevent infection control (Davey et al., 2015). In
addition to this, the results also revealed that education and awareness along with
performance feedback helped in improving compliance with infection control. Therefore, on
the basis of the findings of Gould et al. (2017), it can be mentioned that the most feasible
method used by the researchers to improve compliance with the hand hygiene is with the use
of awareness workshops and training.
In this regard, it should further be stated that compliance with hand hygiene and using
soap and water to wash hands helps in the prevention of infection outbreak and reduces the
incidence rate of hospital acquired infection. Research studies suggest that compliance with
hand hygiene at the five moments of hand hygiene can help in preventing the transmission of
infection to a healthy individual within a care environment. According to the report published
by the WHO (2019), it has been stated that care professionals must adhere to the five
moments of hygiene so as to ensure a secure and hygienic care environment. The five
moments of hand hygiene, typically include the moments prior to touching a patient, before
cleaning a wound or performing any aseptic procedures, after being exposed to body fluid,
after touching a patient and after touching the surrounding of the patient’s surroundings.
Further, it has also been stated that following the hand hygiene on a daily basis could help in
the transmission of infection and at the same time slow down or cease the process of
transmitting resistant bacteria. In addition to this, research studies have further revealed that

40DISSERTATION
hand washing with soap and water could reduce deaths due to pneumonia and bacteria by
65%. Further, it has also been mentioned that washing hands in the correct manner and at the
correct times could help in preventing infections better than taking medications or vaccines to
nullify the effect of the infections (Davey et al., 2015). Further, it has also been mentioned
that washing hands for about 20 seconds could help in getting rid of microbes and germs that
serve as the causative agent of a number of infectious diseases such as Diphtheria, Diarrhoea
or even pneumonia. It should further be noted in this regard that research studies state that
hand transmitted illness includes Diarrhoea and Pneumonia which can effectively be treated
with access to clear water, soap as well as medical care (Lee et al., 2014). Bacterial infections
strikingly threaten lives at hospitals as well as other healthcare clinics that host a majority of
patients who present on account of chronic illnesses (Larson, 2013). The primary
interventions that can help in the prevention of microbial infections include the use of alcohol
based hand sanitizers as well as soap and water.
It should be noted in this context that hand hygiene forms the most effective method
used by individuals in order to prevent the transmission of infections within a healthcare
setting. Also, the percentage of reduction has been estimated to be equivalent to 50% upon
complying with hand hygiene within a clinical environment. It is important to note here that
the heightened transmission of infection over the years has been highlighted over the past
decade on account of non-compliance with infection control policies as well as adherence
with the hand hygiene protocol. A number of research studies have further stressed upon
researching and evaluating methods in order to improve compliance within a hospital setting
(Larson, 2013). Typically it was found that non-compliance was usually on account of lack of
education and awareness in relation to the negative implication of observing hand hygiene
within a care environment and the associated relationship with the infection burden. It should
further be noted in this context that the evidence base suggests that the primary method that

41DISSERTATION
was used by the researchers to improve compliance to hand hygiene routine among the care
professionals working within a hospital comprised of conducting education and awareness
workshops (Kingston et al., 2016; Kwok et al., 2015). It should be noted that through the
researchers effectively suggested that awareness workshops or the use of educational tools
such as informative poster or power point presentation could effectively help in disseminating
awareness among the care professionals about the need to adhere to the hand hygiene
protocol. It would help in improving the knowledge as well as perception among the care
professionals about hospital acquired infections and nosocomial infections and what could be
done on their part to reduce the incidence of the infection (Nabavi et al., 2015). As has
already been discussed in the previous sections, the researcher in this case conducted a
primary research and commenced a training program in order to educate the professionals
about the importance of complying with the hand hygiene routine. In order to obtain
knowledge about the existing perception in relation to the awareness and importance of
maintaining hand hygiene, the researcher typically made use of a pre-training questionnaire
form. The obtained responses clearly revealed that the nursing professionals were not aware
about the importance of observing hand hygiene and at the same time, had also not been
advised by a supervisor or a preceptor to be enrolled in a hand hygiene program. Further, the
survey response also revealed that the nursing professionals considered it unimportant to
comply and observe the five moments of hygiene and justified their non-compliance with
busy schedule and excessive patient load. On the basis of the evaluation of the pre-training
questionnaire form, a heightened need could be felt to initiate a training program in order to
impart education about the hand hygiene routine and at the same time also demonstrate the
correct procedure of donning PEP and effectively washing hands so as to complete the hand
hygiene routine. After the workshop, it was observed that the compliance with hand hygiene
had greatly improved and at the same time the post-training questionnaire responses of the

42DISSERTATION
care professionals revealed that they were informed about the relationship existing between
poor hand hygiene compliance and the increased progression of hospital acquired infections
as well as associated noso-comial infections.
5.4: Key Findings:
Therefore, on the basis of the findings and discussion, it can be mentioned that the
training workshop in hand hygiene helped in improving compliance with the hand hygiene
routine and at the same time also changed the perception of the care professionals who
participated in the program. Further, a stark difference was noticed between the responses of
the care professionals acquired before and after the training which suggested that the training
was effective. Further, it was observed that the care professionals washed their hands
frequently and effectively complied with the hand hygiene routine which helped in securing a
hygienic care environment and preventing the scope of transmission of the hospital acquired
infection among the patients. Further, it was also observed that prior to conducting the
training workshop; the care professionals were not aware about the implication of following
hand hygiene and were also not advised by their supervisors to maintain effective hand
hygiene. However, it was observed that after the completion of the workshop, the care
professionals were more aware and were confident while caring for the patients and were
self-informed that effective compliance with hand hygiene would lead to positive patient
outcome and reduce the possibility of transmitting hospital acquired infection among the
patients. In addition to this, it should also be noted that the cumulative outcome acquired after
conducting the training programs was supported by a number of evidence based research
studies which indicated that the conducting educational and awareness training workshop on
hand hygiene helped in improving the clinical outcome among the care professionals and at
the same time also helped in increasing compliance with the WHO recommended hand
hygiene protocol (Ariyaratne et al., 2015; Tschudin-Sutter et al., 2015; Rosenthal et al.,

43DISSERTATION
2013). In addition to this, the changes noted in the attitude and perception of the care
professionals post the training session could be correlated with the findings of the research
study conducted by Gould et al. (2017). Further, the research studies also suggested that
practicing effective hand hygiene within the care environment could help in reducing the
death rate due to hospital acquired infection by up to 65%. Also, post the training workshop,
the care professionals were more confident in taking care of the patient and believed that
complying with hand hygiene routine could help in preventing the transmission of infections
and at the same time could also help in saving lives. It was further evaluated on the basis of
the basis of the research study findings that washing hands for a total of 20 seconds could
help in eliminating infectious microbes that cause Diphtheria, Diarrhoea as well as
Pneumonia (Kwok et al., 2015). Additionally, it was also found that hand hygiene could help
in the progression of antibiotic resistant microbes from transmitting from one individual to
another (Larson, 2013). The awareness workshop therefore helped in fostering education
about effective hand hygiene and helped in disseminating awareness about a hygienic clinical
environment.
5.5: Summary:
Therefore, to summarize the findings of the research study, it can be said that an
education and awareness training session was conducted by the researcher to ensure better
compliance with hand hygiene routine. A total of 80 participants had attended the training
session. Typically two distinct questionnaire responses were retrieved from the participants,
one prior to the training and the second one after conducting the training. Typically, the
responses collected prior to the workshop suggested that the participants were not much
aware about the effectiveness of following the hand hygiene routine and were not
recommended to attend the hand hygiene routine by their preceptors and supervisors.
However, the responses collected after conducting the training workshop suggested that the

44DISSERTATION
participants were aware and were well informed about effective hand hygiene compliance.
Also, it was observed that after conducting the workshop, the care professionals washed their
hands frequently and were confident while caring for the patients. Further, the care
professionals were also informed about the transmission of infectious agents that could
spread if effective hand hygiene routine was not followed and it could even lead to fatal
outcome. Therefore, it can be said that the training helped in bringing a positive change in the
level of perception as well as performance output of the care professionals that subsequently
helped in improving clinical outcome. In addition to this, a number of evidence based
research studies also predicted that conducting effective education and training workshops
helped in improving clinical outcome and helped in promoting improved patient outcome.
Overall the finding of the primary research study was supported by similar findings evaluated
by the researchers in a number of research studies. The research study conducted by Lee et al.
(2014), suggested that hand hygiene compliance could potentially be improved by making
use of promotional programs that specifically made use of educational tools such as
informative posters or presentations and at the same time including a scheme to monitor the
performance with the help of a proper feedback. Further, as per Ethan et al. (2013), it was
evaluated that hand hygiene compliance could be essentially improved by facilitating a
specific behavioural change. In this context, it should be noted that complying with
psychological or social principles in combination with operant conditioning and inclusion of
peer feedback could help in bringing about a change in the care professionals with regard to
hand hygiene and compliance. The researchers further suggested that application of the
psychological principles helps in progressively improving hand hygiene compliance across
different healthcare setting. On the other hand, Davey et al. (2015) had opined that improving
the perception in relation to hand hygiene routine would require disseminating a change in
the personal perception and induce a self-reporting and self-feedback tendency to improve

45DISSERTATION
adherence with hand hygiene technique. Also, Gould et al. (2017), stressed upon the use of
educational tools as well as awareness workshops to improve compliance with hand hygiene
in care professionals working within a hospital.

46DISSERTATION
Chapter 6:
Conclusion:
Therefore to conclude, it can be mentioned that effective compliance with hand
hygiene protocol is integral for the prevention of the transmission of hospital acquired
infections. Further, it should be mentioned that hand hygiene compliance is majorly observed
and evaluated by observing the level of adherence to the five WHO moments. It should
typically be noted in this context, that despite being an important issue within the health care
domain, care professionals are typically unaware about the importance of complying with the
effective hand hygiene routine within a care environment. In order to disseminate awareness
as well as increase compliance, the researcher conducted a training workshop where 80 care
professionals participated. Typically the workshop comprised of educating the professional
about the maintenance of hand hygiene routine and at the same time also demonstrated the
correct hand washing technique and the procedure of donning PEP equipment. A total of 80
participants had attended the training session. Typically two distinct questionnaire responses
were retrieved from the participants, one prior to the training and the second one after
conducting the training. Typically, the responses collected prior to the workshop suggested
that the participants were not much aware about the effectiveness of following the hand
hygiene routine and were not recommended to attend the hand hygiene routine by their
preceptors and supervisors. However, the responses collected after conducting the training
workshop suggested that the participants were aware and were well informed about effective
hand hygiene compliance. Also, it was observed that after conducting the workshop, the care
professionals washed their hands frequently and were confident while caring for the patients.
Further, the care professionals were also informed about the transmission of infectious agents
that could spread if effective hand hygiene routine was not followed and it could even lead to
fatal outcome. Therefore, it can be said that the training helped in bringing a positive change

47DISSERTATION
in the level of perception as well as performance output of the care professionals that
subsequently helped in improving clinical outcome. It should be noted in this context that a
number of research studies have shed light on the importance of conducting awareness
programs so as to secure a hygienic environment within the healthcare setting and improve
the quality of patient care. Upon completion of the training program it was observed that the
care professionals were more aware and washed their hands frequently while caring for the
patients. It helped in estimating that the care professionals observed the moments of hygiene
and were able to render effective care to the patients. Also, the training program helped in
improving patient outcome.
However, in order to foster continuous quality improvement and ensure that the
compliance with the hand hygiene routine is not compromised, there is a need to implement
follow up training courses or refreshment training courses. Refreshment courses and frequent
follow up courses would help in improving the quality of compliance and at the same time
would also ensure that the care professionals are adhering to the hand hygiene protocol within
the care environment. In addition to this, it should also be noted that stringent implementation
of key performance indicators would help in ensuring that compliance is routinely followed
within the care environment and would also help the researcher in modifying the training
workshop so as to ensure maximum compliance among the health professionals. It can hence
be summed up in total that effective hand hygiene training helps in improving clinical
performance which ultimately helps in reducing the transmission of hospital acquired
infection.

48DISSERTATION
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56DISSERTATION
Appendices:
Appendix1: Pre-training questionnaire
Employee id
1 What is your profession Nurse Midwif
e
2 Your work experience Nursing
Internship
less
than 1
year
1 to 5
years
5 to 10
years
more than
10 years
3 Your Department Emergenc
y
Materna
l care
Surgical Medica
l care
Intensive
Care
4 Have you received any formal hand
hygiene raining in last three years?
Never Once More
than once
5 Have you ever revive from
supervisors regarding hand hygiene?
None Rarely Sometime
s
Often Always
6 How much essential is the hand
hygiene in nursing practice?
Very low Low Moderate High Very high
7 How could hand hygiene be the
cause of deteriorating infectious
disease?
Very low Low Moderate High Very high
8 How frequently do you wash your
hand in your regular work schedule?
Once a
day
1 to 5
times
6 to 10
times
10 to
20
times
Uncountabl
e
9 How essential is hand hygiene
training for
caregivers/nurses/midwife?
Very low Low Moderate High Very high
1
0
How do you usually prioritise hand
hygiene when assessing a patient
Very low Low Moderate High Very high

57DISSERTATION
with an infectious disease?
1
1
How treatable is infectious disease
through proper nursing?
Impossibl
e
Very
difficult
Default Easy Very Easy
1
2
What is your success rate in treating
a patients with infectious disease
compared to other diseases
Very low Low Moderate High Very high
Appendix2: Post-training questionnaire
Employee id
1 How beneficial was the training for
your professional improvement?
Very low Low Moderate High Very high
2 Rate your desire to get further hand
hygiene training
Very low Low Moderate High Very high
3 How much essential is the hand
hygiene in nursing practice?
Very low Low Moderate High Very high
4 How could hand hygiene be the
cause of deteriorating infectious
disease?
Very low Low Moderate High Very high
5 How frequently do you wash your
hand in your regular work schedule?
Once a
day
1 to 5
times
6 to 10
times
10 to
20
times
Uncountabl
e
6 How essential is hand hygiene
training for
caregivers/nurses/midwife?
Very low Low Moderate High Very high
7 How do you usually prioritise hand
hygiene when assessing a patient
with an infectious disease?
Very low Low Moderate High Very high

58DISSERTATION