Hand Hygiene: Importance, Strategies, and Recommendations

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Hand Hygiene
Name of the student
Name of the university
Author’s name
Balwinder Singh, U1112475, NUR2300

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Introduction
There are various kinds of diseases which are obtained during the period when a person is
getting a treatment in the hospital. Such kind of disease is called as Health care-associated
infections (HAI). Around hundreds of millions of patients get affected to the HAI each year.
Acquiring HAI, lead to rise of several critical diseases, rise in the duration of stay, rise in various
health disabilities which ultimately increases the costs of family and lead to a tremendous
financial burden on the healthcare system and sometimes it may result in death of the individual
(Ellingson et al., 2014). As a result of the nature of the diseases, HAI are caused by many factors
linked to systems and processes of delivery of care and also the human behavior which is tagged
by the literacy, political and economic restraints on systems and nations, and often on societal
culture and ideas. Though, there are several infections which can be prevented. The spread of the
HAI occurs as a result of the spread of health care-associated microorganisms which takes place
through a direct or indirect touch with the infected fluids, air and through a common vehicle
(Chen et al., 2013). There are several research papers which show that the healthcare workers
often spoil their hands or gloves by coming in contact with the Gram-negative bacilli, S. aureus,
enterococci or C. difficile (Marchaim & Kaye, 2017).
Hand hygiene is a very essential strategy to reduce the incidence of the Health care-
associated infections. It is a simple and very effective approach, though its lack of compliance
among the healthcare professionals is the main reason behind the incidence of HAI worldwide. It
has already been proved that hand hygiene is a significant asset in preventing the spread of the
HAI among patients. Therefore, this study will describe what a HAI is and how hygiene hands
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can prevent the spread of the HAI. It will develop a research question which will be answered
through critical analysis using the CASP tool.
Search Strategy
To initiate gathering of information on hand hygiene, it is necessary to develop a research
question. The PICO strategy will be used to develop the question.
PICO
 P - Health care-associated infections (HAI)
 I – Hand Washing
 C - No hand washing, or other solutions, alcohol based hand rub
 O – Decrease in the rate of HAI
Can hand hygiene approach reduce the incidence of the HAI by increasing the compliance rate
among the healthcare?
A systematic review has been conducted on understanding the effectiveness of hand hygiene in
the reduction of HAI and to answer the research question. Different online databases and
websites have been used to search for the literature studies such as NCBI, Google Scholar,
Cinahl, PubMed, and Medline. Few keywords were used in order to search for the articles in an
easy way, which are Hand Washing, Hand hygiene, Healthcare-associated infections (HAI) and
compliance of Hand hygiene guidelines by the healthcare staffs. The chosen articles are –
1. Allegranzi, B., Conway, L., Larson, E., & Pittet, D. (2014). Status of the implementation of
the World Health Organization multimodal hand hygiene strategy in United States of
America health care facilities. American journal of infection control, 42(3), 224-230.
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2. Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change
within multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.
3. Chen, L. F., Carriker, C., Staheli, R., Isaacs, P., Elliott, B., Miller, B. A., ... & Rhodes, L.
(2013). Observing and improving hand hygiene compliance implementation and refinement
of an electronic-assisted direct-observer hand hygiene audit program. Infection Control &
Hospital Epidemiology, 34(2), 207-210.
4. Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., ... &
VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through hand
hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960.
5. Pfoh, E., Dy, S., & Engineer, C. (2013). Interventions to improve hand hygiene compliance:
brief update review. Making health care safer II: An updated critical analysis of the evidence
for patient safety practices.
Reviewing and synthesizing the evidence
Rationale for selecting this articles
Healthcare-associated infection (HCAI) has become a very terrible and dangerous disease
that is threatening the lives of millions of individuals worldwide. Every year, hundred million
individuals die just due to the infections acquired from the healthcare settings. Acquiring HAI,
lead to rise of several critical diseases, rise in the duration of stay, rise in various health
disabilities which ultimately increases the costs of family and lead to a tremendous financial
burden on the healthcare system and sometimes it may result in death of the individual. Even
after different researchers conducted research to understand the importance of the hand hygiene,
researchers and healthcare systems have consistently failed in implementing this policy widely
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and it has caused a hug gap causing lack of hand hygiene compliance. Hand hygiene compliance
is still lacking in several developing and developed countries.
Thus, these articles were chosen because these articles give different interventions to
improve hand hygiene compliance (Pfoh, Dy & Engineer, 2013), recommend different strategies
to prevent healthcare-associated infections through hand hygiene (Ellingson et al., 2014), uses an
electronic-assisted direct-observer hand hygiene audit program to observe the improvement of
hand hygiene compliance (Chen et al., 2013) and provides various other information regarding
hand hygiene and HAI. The selected research papers will help in answering the research question
and will prove that hand hygiene is a successful way for reducing the frequency of hospital-
related infections by healthcare professionals. A critical appraisal will be done of a research
paper through the CASP tool in order to answer the research question.
CASP
For the critical appraisal the following article has been chosen –
Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change within
multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.
 Did the review address a clearly focused question?
This research article has clearly addressed the PICO research question as this review précises
different available research papers signifying a system change are highly required which can
be initiated through the help of a multi-modal hand hygiene improvement strategy.
 Did the authors look for the right type of papers?
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Yes, the authors have used those papers which provide information regarding the hand
hygiene practices of the healthcare professionals and describe the factors that suggest a need
in system change.
 Do you think all the important, relevant studies were included?
Yes, the authors have included those papers which provide information regarding the hand
hygiene practices of the healthcare professionals and describe the factors that suggest a need
in system change. The paper has included those papers also which demonstrate the factors
responsible for lack of hand hygiene compliance.
 Did the review’s authors do enough to assess quality of the included studies?
Yes, authors conducted the study very thoroughly and did enough to assess the quality of the
included studies.
 If the results of the review have been combined, was it reasonable to do so?
Yes, combination of the different results of diverse review was reasonable to do as by
combining the results, it efficiently answered the PICO research question and was able to
decide that a system change is required to improve hand hygiene in healthcare.
 What are the overall results of the review?
The following article chose 121articels to conduct a literature review. The review concluded
that a system change is required starting from the alcohol hand rub. The paper suggested that
to attain continued development, critical aspects have to be considered.
 How precise are the results?
Since this paper was a literature review and the data which have been provided or the
research articles selected for this review are outdated. So the precision of the results cannot
Balwinder Singh, U1112475, NUR2300