Hand Hygiene Promotion in a Health Care Setting

This report discusses the importance of hand hygiene promotion in a health care setting and its benefits. It explores the concept of hand hygiene promotion, various benefits, and issues associated with it. The report also includes a literature review on the topic.

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relating to plagiarism. All the material in this assignment is my own
work, except where I have indicated with appropriate references
Contents
Topic - HAND hygiene promotion in a health care setting................................................1
INTRODUCTION...............................................................................................................1
Background of research.................................................................................................1
Background of an organisation......................................................................................1
Research aim.................................................................................................................1
SIGNMENT COER
PAGE

Objectives.......................................................................................................................2
Questions.......................................................................................................................2
Rationale of research.....................................................................................................3
CHAPTER 2: LITERATURE REVIEW...............................................................................4
Concept of hand hygiene promotion..............................................................................4
Various benefits of hand hygiene promotion with in health care setting.......................5
Different issues or problems that are associated with the promotion of hand hygiene
in health care setting......................................................................................................6
CHAPTER 3: RESEARCH METHODOLOGY...................................................................9
CHAPTER 4: DATA ANALYSIS......................................................................................13
Chapter 5: Conclusion and Recommendations...............................................................29
Chapter 6: Reflection & Alternative research Methodology............................................31
REFERENCES................................................................................................................31

Topic - Hand hygiene promotion in a health care setting
INTRODUCTION
Background of research
Hand hygiene is way to cleaning hand that minimized the potential pathogens on
hands. It is regarded as primary measure for minimizing transmitting risk infection
between the patients and the heath care personnel’s. It is very important for individual to
maintain proper hand hygiene in order to enhance health care. Promotion of health
hygiene is very important as it is significant for providing importance or significance of
health hygiene for individual. It is very important that individual is focusing on their
health hygiene as well as regularly washing hands. Hand hygiene is considering as one
of the effective way to prevent infection and it play crucial role in overall health of a
person (Alzyood and et. al., 2018.). This support person in not getting infected as well
as prevention of spreading infection for one person to others. This report includes
information regarding various aspects of hand hygiene promotion in a health care
setting. This report includes data collection form different methods and approaches in
order to gather accurate data. Hand hygiene is mainly consisting use of the alcohol
based hand rub is simple and efficient way to be prevent spread of the infections and
pathogens in the healthcare settings. Promoting the better hand hygiene is one of the
powerful tools that the people continue to be leverage to minimize spread of the COVID-
19. With the COVID-19, the transmission spreading among the people by indirect, direct
or the close contact with the infected people through nose secretions and mouth,
washing hands and the running water is necessary.
Background of an organisation
National Health Service (NHS) is publicly funded healthcare system in the England
and this is second largest single payer healthcare system in world after Sistema Único
de Saúde. NHS mainly provides the healthcare to all the legal English residents and
also from the other regions within UK with many of services are free at use point. It
provides majority of the healthcare in the England consisting the in- patient care,
primary care, dentistry and long term healthcare (Arntz and et. al., 2016).
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Research aim
The aim of research mainly expresses aspiration or intention regarding research
study. This mainly summarise in single sentence to attain end of research project. It is
necessary that research aim should be phrased and particular in such a manner that is
possible to be determined when this has to be attained. The aim of research is mainly
developed on the basis of specific research area. The focus of research aim is on long
term outcomes of projects effectively. This can be written in short paragraph or single
sentence.
The aim of this research is “To determine the importance of hand hygiene
promotion in order to enhance health care setting practices.” Cast study of NHS.
Objectives
It explains concisely what an investigation is trying to be attained. They mainly
summarise attaining an investigation to doing project and also give proper direction to
study. The research objectives are developed on the basis of research aim. It is
essential that the research objectives may linked with statement of the purpose in study
that does not have hypothesis. Developing the clear and relevant information helps in
providing the positive outcomes (Belela-Anacleto, Peterlini and Pedreira, 2017).
 To understand the concept of hand hygiene promotion.
 To analyse the various benefits of hand hygiene promotion with in health care
setting
 To evaluate different issues or problems that is associated with the promotion of
hand hygiene in health care setting.
Questions
The better research questions are necessary to guide research paper and project.
This generally pinpoints what need to attain and provide work clear focus. It is
necessary that all the research questions should be focused on specific issue or
problem. Other than this, research questions are mainly lie at core of the systematic
research and it is recording the relevant research outcomes to asking correct questions.
Asking correct questions when conducting an investigation can assist to gather
insightful and relevant information that influence work ultimately.
 What is the concept of hand hygiene promotion?
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 What are the various benefits of hand hygiene promotion with in health care
setting?
 What are different issues or problems that are associated with the promotion of
hand hygiene in health care setting?
Rationale of research
This report will include different elements that are associated with hand hygiene
along with different aspects that are crucial for promotion of hand hygiene. This is very
important and essential for individual to consider hand hygiene as well as enhance
overall health of a person. Good hand hygiene is very important for a person and it will
lead to have direct impact on health or a person. Good hand hygiene is significant for
spreading infection, controlling risk of bacterial mutational and antimicrobial resistance.
This is very effective in order to make or conduct health care practices more
significantly. Promotion of hand hygiene is considering being significant for providing
information about the benefits of regular washing hands as well as its health care
advantages (Boyce, 2017). This is very effective in order to provide information to
individual regarding enhancing health care for individual. Through this researcher is
able to gain information about the advantages of hand hygiene promotion along with
different issues that are associated with this.
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CHAPTER 2: LITERATURE REVIEW
Literature review refers to the survey regarding scholarly sources on particular
subject area. this mainly gives the overview regarding current knowledge that helps in
determining the relevant models and theories in existing investigation. The aim of
literature review is to attaining research objectives in a detailed manner by consisting
secondary sources. In an investigation, researcher use literature as foundation as well
as support for new insight which contribute. Its main focus is to synthesize as well as
summarise arguments along with the ideas without adding any contribution. In
conducting the literature review, there has been a secondary source used for an
instance articles, scholars, journals, internet sources and others. Narrow scope
literature may be considered as part of peer reviewed journal article that presenting the
new investigation, serving to present study (Boyce, 2019). Process of reviewing
literature needs various kinds of the activities as well as thinking ways. Procedure of
reviewing literature is ongoing and also informs several aspects of empirical
investigation project. The literature review is mainly conducted on HAND hygiene
promotion in a health care setting.
Concept of hand hygiene promotion
According to opinion of Patrick Boshell (2020) Hand hygiene is way to cleaning the
one hand that generally reduced the pathogens on hands. Hand hygiene process
consists use of the alcohol based rubs and the hands wash with water and soap.
Alcohol containing preparation that designed to hands to be inactive microorganism and
suppress growth. It is general term that mainly applied to handwashing, surgical hand
antisepsis and the antiseptic hand rub. The better hand hygiene is necessary aspect to
protect an individual from the transmission of infections. This is most effective and
better way to prevent the hospital care related infection rates. In regards to this, failure
to perform better hand hygiene is regarded as leading cause of the healthcare related to
the information s and also spread of the multi resistant organisms. Washing hands with
the water and soap is recommended for the siled hand and it is better way to overcome
of germs in many situations (Pires and et. al., 2017). If water and soap are not available,
then they can use alcohol based hand sanitiser that mainly contains the 60% alcohol.
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Theses sanitizers are better approach to minimize infections spread from one individual
to the other. The infectious disease is mainly continuing to health challenge along with
the economic burden with communities. The hand hygiene education is necessary as
there has been the steady reduction in the hygiene promotion mainly in home. Impact of
the poor hand hygiene habits are related to enhance occurrence of the absences and
the illness related to the costs. Continuous handwashing is better way to remove the
germs, avoid to getting sick and also prevent spread of the germs to other people.
Washing hand in proper manner is better thing to control as well as prevent of several
illnesses. Better hand hygiene will minimize risk about food poisoning, flu and some of
the healthcare related infections which being passed from individual to individual. In the
COVID-19 situation, people are advised to observe the physical distancing and also
better hygiene habits that amidst pandemic. Simple practice regarding handwashing
with water and soap is better way to prevent from the virus and germs (Carter and et.
al., 2016). COVID-19 has emphasised significance of the handwashing with soap to
minimize virus spread. This pandemic situation mainly reinforces significance regarding
handwashing with soap to assure way of preventing the infection from the infectious
disease for an instance common cold, Lassa fever, foodborne disease and some of the
other gastrointestinal disorders. To promote the awareness regarding hand hygiene, it is
necessary to conduct the campaigns to yield the positive outcomes from response of
government to humanitarian space and from the professionals whose duties are to be
overlap in health sector.
Various benefits of hand hygiene promotion with in health care setting
On the basis of Corey Whelan (2020) hygiene promotion may be used to assists
affected people to neglect and also limit extraordinary hygiene risk that developed
through emergency situation as poor sanitation. The main objective of the hygiene
promotion is to assist people to understand as well as develop better hygiene practices
to prevent disease and also promote the positive attitude towards cleanliness. This is
dialogued with the communities regarding hygiene and some other health related issues
to encourage the improve hygiene practices. In regards to this, hygiene promotion
messaged along with the activities mainly addresses the misconceptions and
behaviours that target the all group people. Hand washing before the administering
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medicine can be prevent or reduce disease spread. Main purpose of washing hands is
to be cleansing pathogens hand as well as chemicals which can cause the harm. It is
necessary to rinse hands under the running water at comfortable temperature. The
warm water is not more effective than the cold water at killing germs (Ophardt OP-
Hygiene IP GmbH, 2018). Germs from the unwashed hands can transferred to some
other objects transferred to the hand of other individual. Removing the germs by
handwashing aids in prevent from the respiratory infections and diarrhoea and this
many prevent the eye and skin infections. Campaigning can be helpful in develop
collective and energy and this is helpful in creation of movement of people and the
groups in common cause. Clean hands are helpful in preventing spread of the germs
directly or indirectly by hand to the surface contact. Numbers in the healthcare
environments are more troubling with similar percentage of the employees self-reporting
regarding the hand washing related practices. It is necessary to was the hands after or
before interact with the patients (Conway, 2016). Washing hands is beneficial for person
to stop germs from entering bodies by mouth, eyes and nose. It prevents from the
disease for an instance influenza and diarrhoea. Prevent any disease considerably
communicable disease as well as bacterial infections.
As contrary to this Deborah Weatherspoon (2021) this is easy for the people who
are monitored closely to keep hands clean with the constant reminders. Adults who
mainly caught up with daily basis activities have high tendency to be overlooked hand
washing. Knowing positive impact of the handwashing on life of an individual is better
motivating factor in order to maintain the better hygienic habits. In this, nature of the
several types of the medical process is delicate. This mainly deals with the exposed
passing drugs or internal organs into body. In specific cases, hand washing needs to be
taken on serious basis because harmful bacteria can get into the bodies to cause the
more harm. Better medical facilities have basic facilities for the hand washing
accessible. These are the facilities should mainly use on regular basis through patients,
visitors and doctors. Those facilities are requiring being sanitary and soap dispensers
and some of the other items which require replenishing on regular basis. Efforts
regarding safe working environment consists more thorough and hand rubbing than this
this is expected from some of the staff members.
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Different issues or problems that are associated with the promotion of hand hygiene in
health care setting
John M Boyce (2021) stated that Health are related infection arise globally and
affect both developed and resource poor nations. Infections obtained in health care
setting are between the main reasons of death ad maximised morbidity in hospitalised
patients (Boyce, 2019). They represent an importance burden for both the patient and
their family and for public health. In resource-poor nations, where the health system
requires to deliver care to a population with lower health status and to cope with the lack
of human and technical assets, the burden of health care linked infections are the cause
of death for the whole population. According to CRNA R. N. (2020), HCAI is a problem
which in present time faced by all health care services across the world regardless of
economic state. Not only does it concession patient safety but also that of HCWs. It is
the interest of all health care providers to address the situation and make sure
developed patient safety as well as make suitable work atmosphere for workers. Most
especially since the unfavourable influence and problem with the promotion of hand
hygiene in health care consider as excessive costs for patients, maximised resistance to
antimicrobials and a higher economic burden for the community as a whole (Loftus and
et. al., 2019). Number of the health care providers in LIC is suffered through a
combination of diverse determinants due to a higher transmission threat of HCAIs.
These might consider understaffing, poor infrastructure with lacking hygiene and
sanitation situations, lack or shortage of basic equipment, patient overcrowding all of
which can be connected to limited economic resources. There are some other issues
which are associated to hand hygiene in the healthcare setting. Gloves, the use of
gloves in health care setting has increased in current era due to COVID 19 pandemic.
The utilisation of gloves is suggested to minimise contamination of the hands with flora
that may be transferred to patients Information that globes can prevent hands from
becoming polluted with microorganisms both from the patients and the inanimate
atmosphere is offered by different studies. It is crucial that hands are secured from
becoming contaminated as hand hygiene activities are not always successful in
removing all pathogenic organisms when hands are heavily contamination it is not
basically potential to acknowledge how many organisms have been obtained and the
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subsequent risk of transmission. The use of gloves is one of the main issues which
affect the promotion of hand hygiene in health care in term of hand wash. Because
when people make high focus on use of gloves then they do not centre on washing their
hand with hand wash in more effective manner (Hand hygiene: simple and complex.
2020). There are several developments in glove technology have considered the
incorporations of microspheres in to gloves that discharge chlorine dioxide when
activated through light or moisture and double layered gloves that offer extra protection
when staining sensitivity. It is not acknowledged that what influence these innovations
will have on future hand hygiene suggestions.
As contrary to this, P.A.Jumaa (2021) Hand creams and emollients are some other
issues which create barriers in term of promotion of hand hygiene in health care setting.
Dry hands are a frequently reported problem between HCWs who are needed to wash
or fumigate their hands frequently. Lipids contribute to the barrier function of the skin
creams, lotions and emollients may maximise the skin hydration and further add to the
protection of skin. There is also apprehension that oil based commodities may inhibit
the barrier function and the efficiency of antimicrobial agents utilised in hand hygiene
practices. Hand hygiene policies suggested that sleeves should be rolled up before
hand hygiene procedures as they also create barriers in promotion of hand hygiene in
health care setting. Most uniform policies also suggest short sleeves, though short
sleeves are not basically implemented for HCWs who do not wear uniforms. It would be
expected that wet sleeves, in ordinary with any moist surface, could act like a pool for
microorganisms that could then be transferred to hands by instant contact (Lee and et.
al., 2019). The subungual area contains wide amount if bacteria that are widely
inaccessible during hand hygiene activities and are thus complex to clean compared
with the rest of the hands, most infection control directions suggest that fingernails are
kept short, this makes easy cleaning but is has also been demonstrated that longer
nails have maximised number of microorganisms. On the other hand, Artificial nails are
highly reported as having the possible to transmit infections in the healthcare setting.
Artificial nails are more probable to be colonised with Gram negative bacilli and yeasts
than natural nails. Other forms of nail art and technology have become famous in
several nations and have currently analysed in reference to hand hygiene in HCWs. In
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current time, people highly make focus on artificial nail, nail art and many more kind of
things which is one of the barrier and issues which affect the promotions of hand
hygiene. Cause of which there is several possible health issues, considering local
infection for people who have undergone some form of nail technology. There is also
potential risk that these activities may pose a problem to patients and in other critical
area like food sector. Temporary tattoos on the hands are a problem which also affects
the promotion of hand hygiene. These kinds of tattoos are designed with henna and it is
not unusual for female HCWs in different nations (Alzyood and et. al., 2018). Apart from
all these, fund and finance is the key factor which affect the promotion of hand hygiene
because in this current corona virus pandemic the use of hand wash and hand wash
related material’s demand is high so different companies which offer these kind of
products maximise the cost of hand hygiene products which highly affect the use of
hand wash related commodities.
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CHAPTER 3: RESEARCH METHODOLOGY
This is referring as the procedure or process which is considered by researcher in
order to successfully or effectively conducting research practices. It is very important
that research methodology practices are successfully performed as it assists in better
decision making along with this completing all task in accurate manner. It can be
describing as the particular systems or methods used to distinguish, select, measure,
and dissect data about a subject. In an exploration paper, the philosophy area permits
the researcher to fundamentally assess an examination's general legitimacy and
dependability. Research methodology includes various elements that is helpful for
providing guidance and direction to correctly perform research practices along with this
taking correct or accurate decisions (Gould and et. al., 2017).
Research philosophy – This is considering as very important part of research
practices as it is the belief on which different practices of research will be performed. It
is resolved as a way of thinking which is utilized by a scientist while gathering data
identified with the subject of exploration as through that they ready to gather more verify
just as dependable data in a successful way. There are two sorts of examination
methods of reasoning, for example positivism as well as interpretivism research
philosophy (McCalla and et. al., 2017).
Justification: In regard of this task, the investigator is considering positivism
research theory since that helps in agreement is gathering data in a legitimate way,
which prompts getting want result effectively (Mahida, 2016). This research philosophy
will be more significant for researcher as it will help in taking better decision to
successfully conduct research practices.
Research approach – This is referring as the process or plan that includes step of
assumption in order to detailed methods of data collation, analysis as well as
interpretation. It is considered as cycle or plan which considered stage identified with
the expansive suspicions of the itemized approaches for social affair data and
assessing it appropriately so analyst will get the fitting result (Handorf, 2016.). There are
chiefly two sorts of exploration draws near, for example inductive, and deductive
exploration draws near. In regard of this exploration venture, the specialist is executing
inductive examination approaches as through that they ready to gather more validate
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just as dependable data identified with the theme. In inductive research approach
known premises are used with the motive of generating untested conclusion. Through
this approach data collection can be used to explore a phenomenon, identify theme as
well as patterns in order to create a conceptual framework.
Justification: In conducting the present investigation, deductive research
approach has been used. The main reason to use deductive approach is that it provides
the general to specific information. This research approach examined possibilities to
reach at the particular as well as logical conclusion. The deductive research approach
has been used as it is suited to work with the quantitative data. Process consists
reproducing previous study and also seeing if similar outcomes are to be produced.
Research strategy- It is step by step action plan that produce the direction to
efforts and thoughts enabling to conduct the investigation in systematic manner. It
schedules to produce the quality outcomes and reporting. This introduces major
components of research project for an instance topic area and research perspectives.
Research strategy is systemic process of how an investigation is conducted to solve
inquiry issue (Kanwal and Hameed, 2017).
Justification: In this present investigation, survey has been considered the
better research strategy as it is cost saving and the time saving. The surveys consist
small cost as per the respondents as this can be developed in minimum time period.
Benefit of the survey consist having large population and effective statistical power,
ability collect more information and having validated models availability. From the
survey, data collection is easier with the surveys that tend to use easier to read the data
sources which can examined as required for an investigation.
Research method– This is viewed as a technique or instrument which is embraced
by a specialist to accumulate more validate just as dependable data. There are
commonly three examination techniques which are received by the researcher for
example qualitative, quantitative just as mixed research methods. Quantitative research
can be describing as the method of gathering data in more systematic and accurate
manner. Through this research method, investigator will be able to collect or gather data
from different sources. In this data or information can be represented in for numerical or
statically form. This is easy to understand and analyse data. Qualitative research is
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effective way of gathering or collecting in depth information about the any topic. In
qualitative research method investigator is focus on gathering information from the
opinions, reviews, experiences and so on (Kilpatrick and et. al., 2018).
Justification: In regard of this research project, the investigator is receiving
quantitative research strategies as through that they can accomplish or accumulate
information or data which are mathematical and measurable based. Moreover, for
quantitative technique researcher may receive various strategies for example, interview,
online poll, survey, questionnaire etc. Main objective of the quantitative research is to
understand relationship among independent as well as the dependent variable in
population (Lumapow and Tumiwa, 2017).
Data collection method– It is very important to collect data and information for
different sources that will assist in finding accurate or correct information about the topic
as well as help in enhancing overall performance of the research. Investigator can
collect information for primary and secondary sources. Both of these data collection
methods are effective and useful for researcher. Primary data collection method can be
describing as the way in which researcher is focusing on collecting first hand
information. Researcher who is collecting primary data or original data is known as the
owner of the information (King and et. al., 2016). It is clarified as direct information that
assembled by analyst for first time and this is unique in nature. A specialist accumulates
new information when exploration issue is one of a kind and no concerned examination
work is to be vault through other person. Examination results are to be solid when the
data is gathered straightforwardly by an agent however it is tedious and exorbitant.
There are different ways of collecting primary data such as questionnaire, survey,
interview, observation, and experimental data and so on (Loftus and et. al., 2019). All of
these are effective way to gather significant amount of information and take decision
accordingly. The major issue which primary data collection is the it includes more time
and cost. On the other hand, secondary method of data collection is referring as the
data is gathered by a portion of the other individual for examination related work that
went effectively through measurable investigation. This type of data collection can be
describing as the way in which researcher is gathering data from the already collected
information of primary data. In this investigator can use different sources such as online
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data, books and journals, articles, business papers, government documents and many
others. Advantage of utilizing this technique is that this is less exorbitant. Diverse
optional sources to gather the data are books, articles, diaries and web sources as all of
these are able to provide better and correct information to researcher as well as assist
in better decision making. In this research practices, researcher is considering both
primary and secondary way of data collection. This will lead to enhance overall
performance of the research. The disadvantage of secondary data collection is that it is
not able to provide authenticate and accurate sources of data.
Justification: In conducting the present investigation, there has been the primary
method of data collection has been used. There has been questionnaire developed by
including the different questions regarding the particular subject area. The main reason
to use primary research method is that it is economical in nature and also time saving.
In this method, an investigator is gathering information and data for particular purposes
of study (Kumar, 2015).
Sampling- The sampling is defined as the process that mainly used in statistical
analysis under which the pre-identified observations number are mainly taken from
large size population. Methodology is mainly used to sample from large size population
based on kind of the analysis that is being performed but this many consists the random
sampling method.
Justification: In conducting the present investigation, there has been 50 sample
size chosen by using the random sampling method. The random samples are better and
effective method of choosing sample from population of interest. This method has been
used because it is unbiased and gives the equal chance to chosen respondents. Benefit
of using this method is that sample should be representing target population and also
eliminates the sample bias (Kwok, Juergens and McLaws, 2016).
Time horizon- The cross sectional and longitudinal are two different kinds of the time
horizon. The cross sectional time horizon is limited to particular time period. An
investigation is limited to particular time period. The longitudinal studied are mainly
repeated over extended period of time. It is mainly done through investigating similar
situation over period of time under which issues run its course.
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Justification: In conducting the present investigation, there has been cross-
sectional time horizon used because it provides the specific time to given time period.
An investigator records the information regarding participants without changing the
manipulating environment in which they mainly exist. Cross- sectional investigation
does not consist conducting the experiments; investigators use this to understand the
outcomes (Lambe and et. al., 2019).
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CHAPTER 4: DATA ANALYSIS
Data analysis refers to inspecting, transforming, cleansing and also modelling the
data with an objective of search the useful information and supporting effective decision
making. This is process to obtain the raw data and converting in to the information that
is useful for take decisions through users (Lee and et. al., 2019). There has been
primary method of data collection used in which questionnaire has been developed. For
analyse collected data, there has been thematic analysis conducted in which themes
are developed and also make the interpretations about gathered information effectively.
There has been random sampling method used by consisting the 50 respondents. The
chosen respondents are healthcare professional and the main reason behind selecting
these respondents that they have proper understanding about the healthcare and the
hand hygiene. The chosen respondents i.e. healthcare professionals completed
questionnaire.
The questionnaire is research instrument that consisting series of the questions
for purpose of collecting information from chosen respondents. The questionnaire is all
about the hand hygiene promotion.
QUESTIONNAIRE
Name:
Age:
Gender:
Q1) Do you have understanding about the concept of hand hygiene in context
to healthcare settings?
a) Yes
b) No
Q2) According to you, what are the various benefits of hand hygiene promotion
with in health care setting?
a) Creating safe working environment
b) Prevention of diarrhoea
c) Avoidance of common eye infections
d) Keeping workplace free from bacteria
Q3) As per your perspective, does hand hygiene promotion is important for the
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people to protect from illness?
a) Yes
b) No
Q4) What are the various factors mainly impacting the hand hygiene
compliance?
a) Overcrowding
b) Lack of adequate facilities and equipment
c) Wearing gloves
Q5) According to your viewpoint, what are the different ways healthcare setting
should be used for the purpose of promoting hand hygiene?
a) Show videos regarding hand washing
b) Launching an initiative
c) Give hand sanitizer to patients
d) Give guidance regarding hand hygiene
Q6) What are various level of the hand hygiene included in the healthcare
setting?
a) Routine hand wash
b) Antiseptic Hand Hygiene
b) Social Hand Hygiene
c) Surgical Hand Hygiene
Q7) What are the various issues faced by the healthcare setting related with the
promotion of hand hygiene?
a) Spread illness
b) Respiratory illnesses
c) Influenza
Q8) What are the different issue faced through staff members with the Hand
Hygiene Compliance?
a) Believes that hand hygiene is not problem
b) Do not have time to wash hands
c) Never any soap
d) Not knowing correct way to wash hands
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Q9) What are various movements associated with the hand hygiene in regards
to the health care setting?
a) After body fluid exposure/risk
b) Before touching a patient
c) Before clean/aseptic procedures
d) After touching patient surrounding
Q10) According to your opinion, what are main factors needed to be included
while choosing the effective hand hygiene products?
a) Cost issues
b) Aesthetic preferences of HCWs
c) Dermal tolerance and skin reactions
d) Efficacy of antiseptic agents
Q11) What are various guidelines people need to be followed during COVID-19
pandemic?
a) Use mask
b) Wash your hands with soap and water
c) Use alcohol-based hand sanitizer
d) Maintain social distancing
Q12) As per your perspective, what are various strategies used by NHS for
promotion of the hand hygiene successfully?
a) System change
b) Improve institutional safety climate
c) Reminders in the workplace
d) Hand hygiene education
Q13) Recommend ways to overcome from the issues in the hand hygiene
compliance.
FREQUENCY TABLE
Q1) Do you have understanding about the concept of hand
hygiene in context to healthcare settings?
Frequency
a) Yes 45
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b) No 5
Q2) According to you, what are the various benefits of hand
hygiene promotion with in health care setting?
Frequency
a) Creating safe working environment 20
b) Prevention of diarrhoea 12
c) Avoidance of common eye infections 10
d) Keeping workplace free from bacteria 8
Q3) As per your perspective, does hand hygiene promotion
is important for the people to protect from illness?
Frequency
a) Yes 40
b) No 10
Q4) What are the various factors mainly impacting the hand
hygiene compliance?
Frequency
a) Overcrowding 12
b) Lack of adequate facilities and equipment 18
c) Wearing gloves 20
Q5) According to your viewpoint, what are the different ways
healthcare setting should be used for the purpose of
promoting hand hygiene?
Frequency
a) Show videos regarding hand washing 10
b) Launching an initiative 10
c) Give hand sanitizer to patients 20
d) Give guidance regarding hand hygiene 10
Q6) What are various level of the hand hygiene included in
the healthcare setting?
Frequency
a) Routine hand wash 10
b) Antiseptic Hand Hygiene 15
b) Social Hand Hygiene 15
c) Surgical Hand Hygiene 10
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Q7) What are the various issues faced by the healthcare
setting related with the promotion of hand hygiene?
Frequency
a) Spread illness 20
b) Respiratory illnesses 20
c) Influenza 10
Q8) What are the different issue faced through staff
members with the Hand Hygiene Compliance?
Frequency
a) Believes that hand hygiene is not problem 15
b) Do not have time to wash hands 15
c) Never any soap 10
d) Not knowing correct way to wash hands 10
Q9) What are various movements associated with the hand
hygiene in regards to the health care setting?
Frequency
a) After body fluid exposure/risk 15
b) Before touching a patient 11
c) Before clean/aseptic procedures 10
d) After touching patient surrounding 14
Q10) According to your opinion, what are main factors
needed to be included while choosing the effective hand
hygiene products?
Frequency
a) Cost issues 20
b) Aesthetic preferences of HCWs 15
c) Dermal tolerance and skin reactions 10
d) Efficacy of antiseptic agents 5
Q11) What are various guidelines people need to be followed
during COVID-19 pandemic?
Frequency
a) Use mask 15
b) Wash your hands with soap and water 12
c) Use alcohol-based hand sanitizer 10
d) Maintain social distancing 13
Q12) As per your perspective, what are various strategies Frequency
19

used by NHS for promotion of the hand hygiene
successfully?
a) System change 10
b) Improve institutional safety climate 20
c) Reminders in the workplace 10
d) Hand hygiene education 10
THEME 1: Understanding about the concept of hand hygiene in context to
healthcare settings
Q1) Do you have understanding about the concept of hand
hygiene in context to healthcare settings?
Frequency
a) Yes 45
b) No 5
a) Yes b) No
0
5
10
15
20
25
30
35
40
45
50
45
5
Interpretation: From the above mention graph, it has been stated that there are 45
respondents which said that they have understanding related to the hand hygiene in
detailed manner. Hands are main pathways of the germ that transmission at the time of
healthcare. The hand hygiene is necessary components measure to neglect
transmission of the harmful germs and it mainly prevents the healthcare associated
infections. According to them, in COVID-19 situation, it is necessary to wash hands with
the soap and also sanitize them. The healthcare associated infections are mainly
20

prevented by the better hand hygiene. There are 5 remaining respondents which said
that they do not have the information regarding the hand hygiene concept in detailed
manner.
THEME 2: Benefits of hand hygiene promotion with in health care setting
Q2) According to you, what are the various benefits of hand
hygiene promotion with in health care setting?
Frequency
a) Creating safe working environment 20
b) Prevention of diarrhoea 12
c) Avoidance of common eye infections 10
d) Keeping workplace free from bacteria 8
a) Creating safe
working environment b) Prevention of
diarrhoea c) Avoidance of
common eye
infections
d) Keeping workplace
free from bacteria
0
5
10
15
20
25
20
12
10
8
Interpretation: There are different benefit regarding the hand hygiene promotion in the
health care settings. There are 20 respondents and as per their opinion that developing
safe working environment is one of the effective benefits related to the hand hygiene.
Nature of several types regarding the medical procedure is to be delicate. This mainly
deals with the exposed passing drugs or internal organs inti body. In specific cases,
hand washing has mainly taken because the harmful bacteria can get into bodies easily
that cause harm. The better medical facilities have basic facilities for the hand washing
accessible in an easy manner. On the basis of 12 respondents that benefit of the hand
hygiene to people is regarding prevention of diarrhoea. Contact with the faecal matter
that laden with causative bacteria which lead to the intestinal and diarrhoea illness.
21

Washing hands on regular basis will remove bacteria from hands. According to opinion
of 10 respondents that proper hand hygiene is helpful in avoidance of common eye
infections. These issues are mainly caused through the bacteria that get in eyes from
hands. This would be better if an individual could be refraining from touching eyes with
bare hands. There are 8 remaining respondents and according to them proper hand
hygiene is helpful in keeping workplace free from the bacteria.
THEME 3: Hand hygiene promotion is important for the people to protect from
illness
Q3) As per your perspective, does hand hygiene promotion
is important for the people to protect from illness?
Frequency
a) Yes 40
b) No 10
a) Yes b) No
0
5
10
15
20
25
30
35
40
45
40
10
Interpretation: The hygiene promotion is one of the better terms that used for covering
the strategies aimed to make improvement hygiene behaviour of people and prevent
disease spread. On the basis of 40 respondents that hand hygiene promotion is
effective in the hand hygiene promotion for the people to protect from illness. According
to them, washing hands in proper manner is essential things that can do help to prevent
as well as control spread of several illnesses. Washing hands in the proper manner is
necessary things through which the health issues such as food poisoning, flu and some
22

other healthcare related infections can be reduced to being passes from one individual
to other. Other than this, there are 10 remaining respondents which are not agreeing
with the given statement.
THEME 4: Factors mainly impacting the hand hygiene compliance
Q4) What are the various factors mainly impacting the hand
hygiene compliance?
Frequency
a) Overcrowding 12
b) Lack of adequate facilities and equipment 18
c) Wearing gloves 20
a) Overcrowding b) Lack of adequate
facilities and equipment c) Wearing gloves
0
5
10
15
20
25
12
18
20
Interpretation: From the above mention graph, it has been stated that there are
different factors which impacting hand hygiene compliance. On the basis of 12
respondents that overcrowding is one of the main factors that affect the hand hygiene.
The large number of people are gather at one place and it can cause the many health
related issues. According to opinion of 18 respondents that lack of the facilities as well
as the equipment’s arise the more issues. There are 20 remaining respondents which
agree with wearing the gloves. Not wearing the gloves arise the main issue at
workplace and this can cause the health infections.
THEME 5: Ways healthcare setting should be used for the purpose of promoting
hand hygiene
Q5) According to your viewpoint, what are the different ways Frequency
23

healthcare setting should be used for the purpose of
promoting hand hygiene?
a) Show videos regarding hand washing 10
b) Launching an initiative 10
c) Give hand sanitizer to patients 20
d) Give guidance regarding hand hygiene 10
a) Show videos
regarding hand
washing
b) Launching an
initiative c) Give hand
sanitizer to patients d) Give guidance
regarding hand
hygiene
0
5
10
15
20
25
10 10
20
10
Interpretation: It has been stated from above mention graph that there are 10
respondents which said that there are various ways in the healthcare setting which are
mainly used to promote the hand hygiene. On the basis of 10 respondents that it is
necessary to show that videos related to hand washing. This gives the message to the
people about benefits of hand washing to them. According to viewpoint of 10
respondents that it is necessary for the healthcare setting to launching initiative
regarding promotion of the hand hygiene with proper benefits. As per opinion of 20
respondents that it is necessary to healthcare company to give the hand sanitizer to the
patients so that they can be protected and do not face any of the health issues. There
are 10 remaining respondents which said that it is necessary to give the proper
guidance related to hand hygiene to patients.
THEME 6: Level of the hand hygiene included in the healthcare setting
Q6) What are various level of the hand hygiene included in
the healthcare setting?
Frequency
24

a) Routine hand wash 10
b) Antiseptic Hand Hygiene 15
b) Social Hand Hygiene 15
c) Surgical Hand Hygiene 10
a) Routine hand
wash b) Antiseptic Hand
Hygiene b) Social Hand
Hygiene c) Surgical Hand
Hygiene
0
2
4
6
8
10
12
14
16
10
15 15
10
Interpretation: According to given graph, it has been stated that there are different
level regarding hand hygiene considered in healthcare settings. On the basis of 10
respondents that it is necessary to do the hand wash on routine basis. As per opinion of
15 respondents that antiseptic hand hygiene is one of the main levels of hand hygiene.
The Antiseptic hand disinfection with antiseptic hand wash agent like hyrax is mainly
carried out for the aseptic process ward and also isolation. The hygienic hand
disinfection will be removing as well as kill transient microorganisms. There are 15
respondents and according to them maintain the social hand hygiene is necessary. Its
aim is to wash hands with the warm water and soap to remove the organic material and
dirt. On clean hands visible this can be undertaken using the alcohol hand rub and it will
remove the transient organisms. As per opinion of the 10 respondents that the surgical
hand washing needs remove as well as killing the transient substantial and micro-
organism reduction. It is necessary to assure that the fingernails are clean and kept
short. Jewellery and watches should be removed before the surgical hand disinfection.
THEME 7: Issues faced by the healthcare setting related with the promotion of
hand hygiene
25

Q7) What are the various issues faced by the healthcare
setting related with the promotion of hand hygiene?
Frequency
a) Spread illness 20
b) Respiratory illnesses 20
c) Influenza 10
a) Spread illness b) Respiratory illnesses c) Influenza
0
5
10
15
20
25
20 20
10
Interpretation: As per the mention graph, it has been stated that there are different
issues faced through the healthcare setting regarding promotion of the hand hygiene. It
is essential to identify which of the additional promotional activities can be make
improvements in the hand hygiene that attained through executing multimodal
improvement strategy. As per the opinion of 20 respondents that spread illness is main
issues about the promotion of hand hygiene. The illness arises the many of the health
related issues. According to viewpoint of the 20 respondents that Respiratory illness is
one the of the main issues faced by the healthcare setting related with the promotion of
hand hygiene. On the basis of 10 remaining respondents that influenza is main issue as
it arises the many issues and develops negative impact on health. This is infectious
disease that mainly caused through influenza virus. The symptoms can mild to be serve
and this arise the many symptoms such as runny nose, headache, feeling tired and the
high fever.
THEME 8: Issue faced through staff members with the Hand Hygiene Compliance
Q8) What are the different issue faced through staff Frequency
26

members with the Hand Hygiene Compliance?
a) Believes that hand hygiene is not problem 15
b) Do not have time to wash hands 15
c) Never any soap 10
d) Not knowing correct way to wash hands 10
a) Believes that hand
hygiene is not
problem
b) Do not have time
to wash hands c) Never any soap d) Not knowing
correct way to wash
hands
0
2
4
6
8
10
12
14
16 15 15
10 10
Interpretation: As per mention graph, there are some issues faced by the employees at
workplace regarding hand hygiene compliance. Washing hands is simple tasks that
complete on daily basis. On the basis of 15 respondents that staff members believe that
the hand hygiene is not issues here. There were more issues when employees do not
think that there is problem with the hand hygiene with facility. In regards to this, there
was completed that provided direct observation is intensive care unit. According to
opinion of the 15 respondents that do not have time to wash hands. Some of the times,
there may be less to no time among jumping from the patient to the patient. Difference
among the passing germs from one patient to other could mean death or life, hand
washing required to taken as priority. 10 respondents that there is not any soap. There
is common problem is the facilities that may think. Wrong dispenser is mainly installed
in location; dispenser is mainly filled with wrong solution. Have open dialogue with the
custodial employees regarding this issue. There are 10 remaining respondents which
are agree with not knowing correct way to wash hands. There are number of better way
27

to wash hand in proper manner with water and soap. It is necessary to provide correct
education is assuring that employee is compliant.
THEME 9: Movements associated with the hand hygiene in regards to the
health care setting
Q9) What are various movements associated with the hand
hygiene in regards to the health care setting?
Frequency
a) After body fluid exposure/risk 15
b) Before touching a patient 11
c) Before clean/aseptic procedures 10
d) After touching patient surrounding 14
a) After body fluid
exposure/risk b) Before touching a
patient c) Before clean/
aseptic procedures d) After touching
patient surrounding
0
2
4
6
8
10
12
14
16 15
11
10
14
Interpretation: According to mention graph, it has been stated that there are different
movements regarding with hand hygiene in context to healthcare settings. As per
viewpoint of 15 respondents that the main movement is regarding after the body fluid
exposure. Hand hygiene immediately after process or the exposure risk of body fluid as
hands could be mainly contaminated with the body fluid. If an individual had the gloves
that it is necessary to perform still hand hygiene after removing them as the gloves.
There are 11 respondents and they said that it is necessary to wash hands before
touching patient. There is a need to perform the hand hygiene on entering zone of
patient before touching patient. It helps in protect patient against acquiring the harmful
germs from hand of health care workers. On the basis of 10 respondents that hand
28

should be wash before the aseptic procedures. There are 14 remaining respondents
and they said that after touching the patient surroundings, an individual should wash the
hands. The hand hygiene after touching surroundings of the patient even when patient
has not touched. An individual protect itself and healthcare surroundings from
contaminated with the microorganisms.
THEME 10: Factors needed to be included while choosing the effective hand
hygiene products
Q10) According to your opinion, what are main factors
needed to be included while choosing the effective hand
hygiene products?
Frequency
a) Cost issues 20
b) Aesthetic preferences of HCWs 15
c) Dermal tolerance and skin reactions 10
d) Efficacy of antiseptic agents 5
a) Cost issues b) Aesthetic
preferences of HCWs c) Dermal tolerance
and skin reactions d) Efficacy of
antiseptic agents
0
5
10
15
20
25
20
15
10
5
Interpretation: On the basis of mention graph, this has been stated that there are many
factors which required being included while choosing the effective hand hygiene
products. According to the 20 respondents which said that cost issues are the main cost
issues. On the basis of 15 respondents that aesthetic preferences of HCWs is one of
the major factors needed to be included while choosing the effective hand hygiene
products. There are 10 participants who said that hand hygiene products are arise the
29

issues regarding dermal tolerance and skin reactions. As per opinion of 5 respondents
which said that efficacy of antiseptic agents. The germs arise the many issues on health
of people.
THEME 11: Guidelines people need to be followed during COVID-19 pandemic
Q11) What are various guidelines people need to be followed
during COVID-19 pandemic?
Frequency
a) Use mask 15
b) Wash your hands with soap and water 12
c) Use alcohol-based hand sanitizer 10
d) Maintain social distancing 13
a) Use mask b) Wash your hands
with soap and water c) Use alcohol-based
hand sanitizer d) Maintain social
distancing
0
2
4
6
8
10
12
14
16 15
12
10
13
Interpretation: As per the mention graph, there are different guidelines which people
required to followed at the time of COVID-19 pandemic. On the basis of 15 respondents
that people should use the mask. Make wearing mask as normal part to be around of
the other people. Proper use, cleaning and storage are necessary to make the masks
possible. There are 12 respondents and as per their opinion that it is necessary to wash
hands with the water and soap on regular basis. It is necessary to assure to wash the
hands after blow the nose, use restroom and sneeze into issue, before preparing food
etc. Other than this, there are 10 participants which said that people should use the
alcohol based hand sanitizers. There are 13 remaining respondents which are agree
30

with maintain the social distancing. Maintain social distancing helps in make the reduce
the chances of illness and any other health issues.
THEME 12: Strategies used by NHS for promotion of the hand hygiene
Q12) As per your perspective, what are various strategies
used by NHS for promotion of the hand hygiene
successfully?
Frequency
a) System change 10
b) Improve institutional safety climate 20
c) Reminders in the workplace 10
d) Hand hygiene education 10
a) System change b) Improve
institutional safety
climate
c) Reminders in the
workplace d) Hand hygiene
education
0
5
10
15
20
25
10
20
10 10
Interpretation: It is necessary for the NHS to use the different strategies for promotion
of hand hygiene in successful manner. According to the 10 respondents that system
change is necessary for promoting hand hygiene. On the basis of 20 respondents that
NHS should focus on make improvement in institutional safety climate effectively. There
are 10 respondents and according to them healthcare settings to make improvement in
the institutional safety climate. This is one of the effective ways to promote hand
hygiene in an effective manner. 10 respondents are agreeing with make the reminder
within an organisation. There are 10 remaining respondents and according to them,
providing the knowledge regarding hand hygiene is necessary for the people.
31

Chapter 5: Conclusion and Recommendations
On the basis of a given report, it has been analysed that hand hygiene is
determined as a way of cleaning hand that help in minimising potential pathogens within
hand. It is determined as a primary or basic measure that helps in minimising risk that is
infected among patients as well as healthcare personnel. In addition to this, it is a
significant for individual person to manage appropriate hand hygiene for accomplishing
or enhancing healthcare. Promotion or improvement in health is significant for offering
importance related to health for particular person. In assistance of this, it is significant
for individual person to emphasis on health hygiene and continuously washing hand.
Therefore, in this report it also has been analysed that due to covid-19, the transmission
which is spread between organisations is direct as well as indirect contact that is
infected individual person by nose secretion and mouth washing hands as well as using
water is important. Apart from this, in this report the NHS is taken for providing safety
measure to its customers during particular phase of time period. In addition to this, in
this report there is a discussion regarding literature review which is important for
implementing survey regarding scholarly sources on a specific subject area. They also
define the concept related to hand hygiene promotion during particular phase of time
period. In assistance of this, in this report there is a different kind of research method is
used for collecting data or information for conducting appropriate research during
particular phase of time period. They also focus on data analysis that help in inspect
and transformation as well as modelling data information in order to accomplishing
goals as well as objective of business organisation and taking decisions during
particular phase of time period. Apart from this, they also provide a discussion regarding
conclusion, recommendation in this report and they also provide a discussion regarding
reflection as well as alternative research methodology in order to conduct appropriate
research during particular phase of time period. This support person is not getting
infected as well as prevention of spreading infection for one person to others. This
report includes information regarding various aspects of hand hygiene promotion in a
health care setting. This report includes data collection form different methods and
approaches in order to gather accurate data. The aim of research is mainly developed
on the basis of specific research area. The focus of this report is to implement research
32

on long term outcomes of projects effectively. This can be written in short paragraph or
single sentence. They emphasised on providing appropriate information in order to
conduct survey for implementing particular research in an proper manner. Therefore, in
this assignment, the business organisation focuses on collecting important information
for achieving favourable outcomes in future period of time. In addition to this, it is a
significant for individual person to manage appropriate hand hygiene for accomplishing
or enhancing healthcare. This report includes information regarding various aspects of
hand hygiene promotion in a health care setting.
Apart from this, this is recommended that during this COVID-19 as it is important for
individual to maintain proper hand hygiene in order to enhance health care. Promotion
of health hygiene is very important as it is significant for providing importance or
significance of health hygiene for individual. It is very important that individual is
focusing on their health hygiene as well as regularly washing hands (Handorf, 2016).
Along with this, This is very important and essential for individual to consider hand
hygiene as well as enhance overall health of a person. Good hand hygiene is very
important for a person and it will lead to have direct impact on health or a person. Good
hand hygiene is significant for spreading infection, controlling risk of bacterial mutational
and antimicrobial resistance. This is very effective in order to make or conduct health
care practices more significantly. Promotion of hand hygiene is considering to be
significant for providing information about the benefits of regular washing hands as well
as its health care advantages. This is very effective in order to provide information to
individual regarding enhancing health care for individual. Additionally, there are different
benefit regarding the hand hygiene promotion in the health care settings so safe
working environment is one of the effective benefits related to the hand hygiene. Nature
of several types regarding the medical procedure is to be delicate. This mainly deals
with the exposed passing drugs or internal organs into body. In specific cases, hand
washing has mainly taken because the harmful bacteria can get into bodies easily that
cause harm. The better medical facilities have basic facilities for the hand washing
accessible in an easy manner. Instead of this, it has been recommended that there are
different movements regarding with hand hygiene in context to healthcare settings. The
main movement is regarding after the body fluid exposure. Hand hygiene immediately
33

after process or the exposure risk of body fluid as hands could be mainly contaminated
with the body fluid. If an individual had the gloves that it is necessary to perform still
hand hygiene after removing them as the gloves (Kanwal and Hameed, 2017). In
addition to this, this is also suggested that there are different guidelines which people
required to follow at the time of COVID-19 pandemic and also by firm. So, as per the
analysis there are various guidelines such as use mask, wash your hands with soap
and water, use alcohol-based hand sanitizer, maintain social distancing.
Chapter 6: Reflection & Alternative research Methodology what does
this mean please explain
All through the time of performing research, there is numerous kinds of studies that
are gained with the aid of and they are benefited to me for the entirety of modern-day
research challenge and also will assist in accomplishing my future research projection.
At the time of executing in this studies challenge I face numerous problems due to loss
of powerful sources like time and finance which create barrier in collecting facts in
efficient manner. I also make improvement in some skills and know-how areas. To
accumulate facts by way of the use of number one aid, I exploit questionnaire which
assist me in making development in me communicates talents due to the fact via the
use of this research tool, journey unique locations and speak to numerous man or
woman who belong from one-of-a-kind religions and way of life or use numerous
languages. So on the time of making conversation with them I additionally tried to
examine their languages. I also make development in my time management abilities
because the research undertaking is large but the time which is given to me is much
less so I gathered powerful facts with fewer time frames.
Beside this, it also provides me opportunity for exploring my understandings as well
as competencies at boarder level. In addition to this, through appropriate analysis of
literature review, data analysis, and research methodology assisted me to perform my
research in effective and efficient way as well as also develop my research and
analytical competencies. Additionally, this was a effectual opportunities for me for
putting my critical thinking skills within respective investigation that also aids me to
acknowledged this particular concepts that is HAND hygiene promotion in a health care
34

setting. Apart from this, during this investigation I also tackle various issues as this is
tough for me to obtain relevant information respected to particular subjects’ matters as
several thinking as well as conceptions of person at work areas. Additionally, I analysed
that there are many factors which required being included while choosing the effective
hand hygiene products such as Aesthetic preferences of HCWs, Dermal tolerance and
skin reactions and many others (Lumapow and Tumiwa, 2017). Rather than this, I
develop my huge understanding that is advantageous for me in attaining my future
objectives as well as growth. Also, by performing out investigation that is not simple
work as well as that needs deep level of concentration and specialised without that is
not possible for person for implementing or initiating a research upon specific topic.
Therefore, credentials are required to be adapted so that effectual as well as relevant
potential is attained in well-defined manner.
Alternative research Methodology
The alternative research methodology differs from the qualitative and quantitative
data through focusing on the data on the basis of fact based investigation. In this,
researcher can use the interview method for data collection instead of survey. Within
present research, questionnaires have been utilised as technique of research in order to
collect the facts from application of various sources. In addition, this, questionnaires are
composed the particular questions undertaking such as different guidelines which
people required to followed at the time of COVID-19 pandemic. Also, Hand hygiene
immediately after process or the exposure risk of body fluid as hands could be mainly
contaminated with the body fluid. If an individual had the gloves that it is necessary to
perform still hand hygiene after removing them as the gloves and many others related
questions (Kumar, 2015). Along with this, the fundamental reason behind the usages of
questionnaire is that, it is lower cost budget as well as researcher may become
competent for accumulating data from the huge sample size is smoother way. Another
than this, interview can be utilised as an alternative method that there is communication
among interviewee as well as interviewer. Furthermore, respective techniques changed
within no longer usages into this investigation as this undertakes this undertakes
additional period as well as also costly as analysis to questionnaires method. Therefore,
35

this would aid in enhancing chances associated for attaining favourable results
upcoming time durations.
36

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