Hand Hygiene Practices in Healthcare

This assignment delves into the crucial topic of hand hygiene practices within healthcare settings. It examines various interventions aimed at improving hand hygiene compliance, including bundled approaches and educational campaigns. The impact of these interventions on healthcare-associated infections is analyzed, drawing upon studies conducted in diverse healthcare environments like ICUs and hospitals. Additionally, the role of multidisciplinary programs and research in shaping effective hand hygiene practices is explored.

Running head: IMPLEMENTING EVIDENCE FOR PRACTICE
Implementing Evidence for Practice
Name of the Student:
Name of the University:
Author’s Note:

1IMPLEMENTING EVIDENCE FOR PRACTICE
Table of Contents
Introduction......................................................................................................................................2
Summarizing a clinical issue...........................................................................................................2
Formulating a structured clinical question......................................................................................3
1. Framing the question............................................................................................................3
2. Outlining a systematic search strategy.................................................................................4
3. After reviewing the initial search results..............................................................................4
4. Filtering the evidence...........................................................................................................5
Presenting relevant studies in tabular form.....................................................................................6
Critically reviewing the study and findings...................................................................................12
Relating key implications of reviewed evidence to the identified clinical problems....................15
Identifying the key barriers and facilitators to implementation.....................................................18
Describing two evidence-based strategies suitable for facilitating the practice change in own
clinical setting................................................................................................................................19
Conclusion.....................................................................................................................................20
References......................................................................................................................................22

2IMPLEMENTING EVIDENCE FOR PRACTICE
Introduction
Maintaining sanitation and sterility in the clinical settings is of utmost significance, as
this helps in controlling infections. While working in the clinical settings, it is essential for the
nurses and the healthcare professionals to wash hands according to the clinical standards. This
helps in ensuring removal of infection in the hands while treating the patients. As commented by
Pincock et al., (2012), hand hygiene compliance among the healthcare workers is essential to
reduce the rate of infections in the clinical settings. Bare hands contain several microorganisms
that are harmful if used in the clinical settings (Rosenthal et al., 2012). Therefore, washing hands
reduces infections in the clinical settings thereby, reducing the rate of infections.
This report highlights the significance of washing hands in the clinical setting. This report
summarizes the clinical issue along with formulating a structured clinical question by using
PICOT structure. Additionally, the databases and the keywords used for finding the relevant
articles are also discussed in this article. At least six relevant articles selected using the keywords
and critically evaluated along with relating the key implications to the identified problems in the
articles used. The key barriers are addressed along with implementing strategies for facilitating
changes in the clinical settings.
Summarizing a clinical issue
As commented by Pincock et al., (2012), 1 in every 5 people in the clinical settings
experience nosocomial infection. It has been seen that at a single time, over 1.4 million people
suffer from infections related to healthcare. Bare hands contain numerous microorganisms that
results in hospital-acquired infections thereby, leading to more than 90,000 deaths per year
(Rosenthal et al., 2012). The immunity power of the patients is less compared to the normal

3IMPLEMENTING EVIDENCE FOR PRACTICE
individuals thereby, making them vulnerable to basic and common diseases. Therefore, the
nurses and the healthcare professionals need to ensure that they maintain proper sanitation to
prevent diseases.
In the clinical setting, the major issues encountered are nosocomial infections that are
caused due to improper sanitation. It has been seen that postoperative infections and infections
during the operations are caused when the nurses and the healthcare professionals fail to
maintain hand sanitation. While attending the patients and handling the equipment at the clinical
settings, appropriate selecting of hand washing technique needs to be followed. Hand washing
ensures hygiene that helps in getting rid of the microorganisms that cause the infections. As
commented by Bereket et al., (2012), hand washing does help in mitigating the chances of risks
in the clinical settings. Appropriate hand washing helps in getting rid of the microscopic
microorganisms in the hands that helps in reducing the rate of infections.
Formulating a structured clinical question
The PICOT structure was used for formulating the question based on the clinical setting
(Hockenberry, Wilson & Rodgers, 2016). The formulated clinical question is stated below:
1. Framing the question
Does hand washing among health care workers reduce hospital-acquired infections?
The question above includes the PICOT element:
P- Problem: Infection acquired from the hospital
I-Intervention: Washing of hands

4IMPLEMENTING EVIDENCE FOR PRACTICE
C- Compare: Improper washing of hands, masks, and other solution
O- Outcome: Decrease in the rate of infection
T- Type of Study: Journals and articles
2. Outlining a systematic search strategy
The search strategy is conducted by identifying the major elements of the questions along
with translating the natural language terms to subject descriptors, MeSH terms or descriptors
(Richter & Austin, 2012). P and I were used only to begin the search thereby, keeping the
initial search results broad.
Natural language Term mapped to database vocabulary
P (Problem/Population/Patient) = Infection
acquired from hospital
Cross infection [MeSH]
Cross infection [CINAHL]
I (Intervention or indicator) = washing of
hands
Hand disinfection [MeSH]
Washing of hands [CINAHL]
A simple database search strategy should begin with the P and I: For example cross infection
AND (Hand washing OR Hand Disinfection)
The search was initiated with both CINAHL and PubMed for a scoping research for the majority
of the health science questions. Therefore, the search was linked to a detailed research:
Does hand washing among health care workers reduce hospital-acquired infections?
3. After reviewing the initial search results
After reviewing the initial search results, it can be decided to narrow the search results with
terms for the comparison, outcome, time factor or the type of study (Choo, Simons & Sheikh,

5IMPLEMENTING EVIDENCE FOR PRACTICE
2013). On the contrary, the results might be viewed in terms of the abstracts, full text of the
articles in order to view the comparison and outcome of the elements. For example, database
filters are used in filtering the evidence.
4. Filtering the evidence
 Tips for expanding the search
 Tips for narrowing the search
 Number of sample searches
 Downloading the Boolean Worksheet in order to help planning the database search
For example Stone, S. P., Fuller, C., Savage, J., Cookson, B., Hayward, A., Cooper, B., ... &
Roberts, J. (2012). Evaluation of the national Cleanyourhands campaign to reduce
Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England
and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series
study. Bmj, 344, e3005.
Often at the beginning of the project, considering the background and the overview information
is essential. This will help in answering a background question with relevant articles in terms of
the topic.
The background information is found in sources that are furnished below:
 References and book entries
 Appendices, textbooks, and chapters
 Newspaper articles and monographs
 Online library
 Specific electronic reference tools in clinical settings

6IMPLEMENTING EVIDENCE FOR PRACTICE
Presenting relevant studies in tabular form
Author/ Year Design of the
Study
Sample and
setting
Main findings Strengths and
limitations
Stone et al., (2013) Non-randomized
after and before
study
187 acute trusts in
Wales and
England
The nurses and the
healthcare
professionals need
to ensure they
maintain the
sterilizing
techniques in order
to prevent the
onset and spread
of infections. Hand
hygiene can be
ensured by the
washing of hands
by soaps and
alcohols. It can be
seen in the study
that both soaps and
alcohols have been
used in the clinical
settings of Wales
and England for
washing of hands.
Strength: The
data has been
collected from
various
secondary
resources that
included data and
information from
the past. As a
result, it was able
to compare the
rate of successful
implementation
of hand hygiene
in the past and
the present.
Limitation:
Primary data
collection was
not used due to

7IMPLEMENTING EVIDENCE FOR PRACTICE
which the
reasons for
inappropriate
implementation
of hand hygiene
is still unknown.
Ellingson et al.,
(2014)
Descriptive study
has been used
that included
interviewing the
management of
the hospital
150 hospitals in
the United States
Washing hands
with 90% alcohol
and wearing
gloves
immediately helps
in preventing
infections in the
clinical settings.
On the other hand,
the nurses and the
healthcare
professionals also
need to wash
hands by alcohol
after treating the
patient. This is
because there are
chances that
microorganisms
Strength: The
data has been
collected from
various
secondary
resources that
included data and
information from
the past. As a
result, it was able
to compare the
rate of successful
implementation
of hand hygiene
in the past and
the present.
Limitation:

8IMPLEMENTING EVIDENCE FOR PRACTICE
from the patients
are spread in the
clinical settings.
Therefore, the
nurses and the
healthcare
professionals’
needs to wash
hands both before
and after treating
patients by alcohol
for prevents
infections in the
clinical settings.
Primary data
collection was
not used due to
which the
reasons for
inappropriate
implementation
of hand hygiene
is still unknown.
Anderson et al.,
(2014)
Descriptive
research study
The past and
present records of
the 70 hospitals in
the United
Kingdom
The patients in the
clinical settings
already lack
immunity and are
more vulnerable to
infections.
Therefore, the
nurses and the
healthcare
professionals need
to wash hands
Strength: The
data has been
collected from
various
secondary
resources that
included data and
information from
the past. As a
result, it was able

9IMPLEMENTING EVIDENCE FOR PRACTICE
according to the
protocols in order
to prevent the
spread of
infections through
the blood stream.
While conducting
the study, the
authors gathered
data by
interviewing the
nurses and the
healthcare
professionals.
to compare the
rate of successful
implementation
of hand hygiene
in the past and
the present.
Limitation:
Primary data
collection was
not used due to
which the
reasons for
inappropriate
implementation
of hand hygiene
is still unknown.
Kirkland et al.,
(2012)
Interviewing the
student nurses
thereby,
suggesting
descriptive study.
The nurses and the
management of 75
clinical settings in
the United
Kingdom
Alcohol with more
than 70%
concentration is an
ideally stronger
solution that
coagulates the
protein in the
microorganisms.
Strength:
Interviewing the
management and
the nurses helped
in understanding
the potential
reasons of

10IMPLEMENTING EVIDENCE FOR PRACTICE
Because of protein
coagulation, the
cells become
inactive thereby,
leading to their
death. The rate of
cell death due to
the use of alcohol
is extremely faster
thereby, ensuring
effective
sanitation.
increment of
maternal death in
the hospital.
Limitation:
Interviewing the
nurses and the
management
individually was
time-consuming
thereby,
hampering the
progress of the
research.
Anderson &
Weese (2012)
The descriptive
study has been
used. Moreover,
the female was
interviewed.
The nurses of 75
veterinary
hospitals
Few numbers of
people working in
the clinical settings
apply the lessons
taught in the
educational
campaign. Apart
from the humans,
the effectiveness
of hand hygiene is
also applicable for
Strength:
Interviewing the
management and
the nurses helped
in understanding
the potential
reasons of
increment of
maternal death in
the hospital.

11IMPLEMENTING EVIDENCE FOR PRACTICE
the animal
veterinary
However, it has
been seen that
hand hygiene helps
in reducing
infection and cross
contamination.
Limitation:
Interviewing the
nurses and the
management
individually was
time-consuming
thereby,
hampering the
progress of the
research.
Shea & Shaw
(2012)
Descriptive study
is used that
includes both
primary and
secondary data
collection
technique
The management
of the veterinary
hospitals
It has been seen
that many of the
clinical settings are
using video
recording for
observing the
appropriateness of
hand hygiene
techniques.
video recording
help in monitoring
the effective
implementation of
hand hygiene in
the clinical
Strength: The
data has been
collected from
various
secondary
resources that
included data and
information from
the past. As a
result, it was able
to compare the
rate of successful
implementation

12IMPLEMENTING EVIDENCE FOR PRACTICE
settings.
However,
the management
fails to monitor the
video recording on
a regular basis
thereby, providing
an opportunity for
the nurses to
conduct non-
compliance in
terms of hand
hygiene.
of hand hygiene
in the past and
the present.
Limitation:
Primary data
collection was
not used due to
which the
reasons for
inappropriate
implementation
of hand hygiene
is still unknown.
Critically reviewing the study and findings
According to the article by Stone et al., (2012), a study conducted over four years
suggested that infection free clinical settings could be ensured by following the hand hygiene
protocol appropriately. However, as argued by Huis et al., (2013), only hand hygiene does not
determine microorganisms free clinical settings. The study conducted over four years saw that
the spread and infection of Staphylococcus aureus were largely controlled by implementing
proper hand washing protocols. As commented by Srigley et al., (2014), bare hands are full of
microorganisms that cause infections in the clinical settings. Therefore, the nurses and the
healthcare professionals need to ensure they maintain the sterilizing techniques in order to

13IMPLEMENTING EVIDENCE FOR PRACTICE
prevent the onset and spread of infections. Hand hygiene can be ensured by the washing of hands
by soaps and alcohols. It can be seen in the study that both soaps and alcohols have been used in
the clinical settings of Wales and England for washing of hands.
In the article Ellingson et al., (2014), the various methods of preventing infections related
to healthcare through hand hygiene is discussed. According to Ellingson et al., (2014), the
method of washing hand by soaps and wearing gloves immediately is the most effective method
of ensuring hand hygiene. However, as argued by Freeman et al., (2014), washing hand by 90%
alcohol ensures hand hygiene, as microorganisms are unable to survive in 90% alcohol.
Therefore, washing hands with 90% alcohol and wearing gloves immediately helps in preventing
infections in the clinical settings. On the other hand, the nurses and the healthcare professionals
also need to wash hands by alcohol after treating the patient. This is because there are chances
that microorganisms from the patients are spread in the clinical settings. Therefore, the nurses
and the healthcare professionals’ needs to wash hands both before and after treating patients by
alcohol for prevents infections in the clinical settings.
In the article written by Anderson et al., (2014), hand washing is considered as one of the
best methods of preventing site infections in hospital settings. According to Edmonds et al.,
(2012), washing of hands by alcohol helps in preventing infections. However, as argued by
Higgins & Hannan (2013), other than hand hygiene, other hygienic protocols need to be followed
in order to prevent diseases. According to the article by Anderson et al., (2014), infections
through hands are easily spread in the blood of the patients, if not maintained inaccurately. The
patients in the clinical settings already lack immunity and are more vulnerable to infections.
Therefore, the nurses and the healthcare professionals need to wash hands according to the
protocols in order to prevent the spread of infections through the blood stream. While conducting

14IMPLEMENTING EVIDENCE FOR PRACTICE
the study, the authors gathered data by interviewing the nurses and the healthcare professionals.
This allowed the researcher to consider the viewpoints and opinions of the nurses and the
healthcare professionals. However, on the contrary, interviewing the management of the clinical
settings would have provided a better understanding, as the researcher would have been able to
know to what extent hand hygiene is followed and implemented in the hospital settings.
The article by Kirkland et al., (2012), discusses the impact of hand hygiene as the
initiative undertaken by the healthcare organizations in reducing infections. As commented by
Godoy et al., (2012), hand hygiene has been known to reduce diseases related to healthcare.
However, as argued by Kirkland et al., (2012), it has been repeatedly seen that healthcare
professionals have failed in following hand hygiene appropriately. According to this article, it is
mainly due to the negligence of the management of the hospital and the lack of appropriate
leadership. Washing of hands by chemical agents such as alcohol helps in killing the
microorganisms. As mentioned by Lebovic, Siddiqui & Muller (2013), alcohol with more than
70% concentration is an ideally stronger solution that coagulates the protein in the
microorganisms. Because of protein coagulation, the cells become inactive thereby, leading to
their death. The rate of cell death due to the use of alcohol is extremely faster thereby, ensuring
effective sanitation.
In the article by Anderson & Weese (2012), the effectiveness of the educational
campaign is analysed in order to increase hand hygiene in a veterinary hospital. Within the
healthcare settings, educational campaigns are conducted in order to spread awareness about
hand hygiene. As commented by Jasper, Le & Bartram (2012), the majority of the nurses and the
healthcare professionals attend the educational campaigns in order to gain knowledge about
clinical settings. However, as argued by White et al., (2012), few numbers of people working in

15IMPLEMENTING EVIDENCE FOR PRACTICE
the clinical settings apply the lessons taught in the educational campaign. Apart from the
humans, the effectiveness of hand hygiene is also applicable for the animal veterinary. As
mentioned by Olson et al., (2012), the rate of sincerity within the individuals in much less when
it comes to implementing hand hygiene effectively. However, it has been seen that hand hygiene
helps in reducing infection and cross contamination.
The article by Shea & Shaw (2012) discusses monitoring hand hygiene services and its
effectiveness in the clinical settings. It has been seen that many of the clinical settings are using
video recording for observing the appropriateness of hand hygiene techniques. As commented by
Shea & Shaw (2012), video recording help in monitoring the effective implementation of hand
hygiene in the clinical settings. However, as criticized by (), the management fails to monitor the
video recording on a regular basis thereby, providing an opportunity for the nurses to conduct
non-compliance in terms of hand hygiene.
Relating key implications of reviewed evidence to the identified clinical problems
According to the article by Stone et al., (2012), the key implication include that the
infections caused by Staphylococcus aureus can be easily prevented by properly following the
hand hygiene protocols. However, it has been also discussed in the article that the nurses and the
healthcare professionals fail to follow the hand hygiene protocols. As commented by Greene et
al., (2012), bare hands possess the innumerable number of microorganisms or germs that lead to
infection thereby, resulting in fatal conditions. The key issues identified in the article that makes
it difficult to follow the hand hygiene procedure is lack of sincerity among the nurses and the
healthcare professionals. As a result, the basic infection caused by bacteria Staphylococcus
aureus is difficult to prevent in hospitals.

16IMPLEMENTING EVIDENCE FOR PRACTICE
According to the article by Ellingson et al., (2014), the key implication highlights the
various strategies of hand hygiene that helps in preventing infections. In spite of being aware of
the significance of hand hygiene, the major issue is practicing hand hygiene on a regular basis.
As commented by Borchgrevink, Cha & Kim (2013), practicing and implementing hand hygiene
daily while working in the clinical setting helps hardly noticed. However, as criticized by
Allengranzi et al., (2013), many of the nurses have been seen practicing and implementing hand
hygiene while working in the clinical setting. The issues lie with the sincerity of the nurses.
Many of the nurses are seen to be reluctant with the way they wash their hands while handling
the medical equipment and taking care of the patients. The nurses seem to compromise with the
way the hands need to be washed actually.
In the article by Anderson et al., (2014), the key implication suggests hand hygiene
techniques in preventing surgical site infections in acute hospital settings. According to the
article, it can be said the patients in the clinical settings are vulnerable to various kinds of
infections. As commented by Harrop et al., (2012), the patients have a low resistance of
immunity compared to healthy people around. Therefore, the patients in the hospital settings
develop infections compared to others. However, the key issue in maintaining hand hygiene in
surgical site is lack of sufficient knowledge. The training programs conducted for the nurses and
the associated healthcare professionals fail to have a successful impact on them. As a result, they
tend to develop a sense of negligence towards their duties and responsibilities.
In the article by Kirkland et al., (2012), the main implication suggest the benefits of hand
hygiene and its implementation as an initiative undertaken by the clinical settings to prevent
healthcare-associated infections. However, the key issue associated with this initiative is the lack
of interest, sincerity and urge to ensure the implementation of the practice. As commented by

17IMPLEMENTING EVIDENCE FOR PRACTICE
Visser et al., (2014), the nurses and the healthcare professionals working in the clinical setting
attend the training session as a mandate but lack to learn and understand the significance of the
training. As a result, while working in the clinical setting they tend to avoid or forget to ensure
hand hygiene before attending the patients and handling the medical equipment. Therefore, it
becomes difficult to prevent infections in the clinical settings.
According to the article by Anderson & Weese (2012), the key implication states the
significance of video observation of the hand hygiene process within the clinical setting.
Implementing video recording of the hand hygiene will provide an opportunity for the
management to monitor to whether the hand hygiene procedure is accurately practiced in the
clinical setting. However, the key issue identified is that the nurses in the petting zoo lack
sincerity in implementing the practice. As a result, the animals are largely affected by fungal and
bacterial infections thereby, making them severely ill. Additionally, in spite of having the facility
of video recording in the petting zoo, the regular monitoring of the videos are hardly noticed. As
a result, the nurses get enough opportunity of compromising with the hand hygiene technique.
According to the article by Shea & Shaw (2012), the key implication suggests that
educational campaigns help in effective implementation of hand hygiene in the clinical settings.
However, the key issue identified in accordance with the main implication suggests the lack of
urgency among the people attending the educational campaigns. In spite of attending the
educational campaigns, the nurses fail to ensure hand hygiene in their daily practice.
Identifying the key barriers and facilitators to implementation
After reviewing the articles, one of the key barriers in ensuring hand hygiene in the
clinical settings is the negligence on the part of the management. The management fails to

18IMPLEMENTING EVIDENCE FOR PRACTICE
strictly monitor and adhere to the implementation of hand hygiene (Lau et al., 2012). As a result,
while taking care of the patients and working the clinical settings, they tend not to implement
hand hygiene properly. Due to lack of strictness from the management, the nurses have the scope
of performing non-compliance with the hand hygiene protocols. As a result, the infections are
easily spread in the clinical settings due to which both the patients and the individuals working
are affected.
Another key barrier in ensuring hand hygiene in the clinical settings is the reluctance
nature within the nurses. In spite of knowing the significance of hand hygiene in the clinical
settings, the nurses fail to follow it while taking care of the patients (Salama et al., 2013). As a
result, basic bacterial and fungal diseases are spread in the clinical settings that otherwise could
have been easily prevented. However, on the contrary, it has been seen that the nurses follow
hand hygiene technique to a certain extent. As a result, the infections are spread in small amounts
in the clinical settings. Unable to prevent the diseases due to improper implementation of hand
hygiene technique, the rate of infection that could have been easily prevented is largely seen in
the clinical settings.
Another key barrier in ensuring hand hygiene in the clinical settings that prevent the
spread of infections is lack of effective monitoring by the management. In spite of having CCTV
recording in the clinical settings, the management hardly reviews and monitors the recording of
the footage (Al-Tawfiq et al., 2013). As a result, they are unable to catch the non-compliance
conducted by the nurses in the clinical settings. The nurses and the healthcare professionals are
fully aware of the fact that the management does not monitor the recording of the footage
accurately and regularly. As a result, they do not have the fear of being caught or being punished
when caught. However, on the contrary, some of the nurses do follow hand hygiene techniques

19IMPLEMENTING EVIDENCE FOR PRACTICE
completely in order to prevent infections and cross-contamination while working (Kelcikova,
Skodova & Straka 2012).
On the other hand, another key barrier in ensuring hand hygiene in the clinical setting is
lack of following the protocol and procedure of hand hygiene. As commented by Tromp et al.,
(2012), in the clinical settings, there are certain steps that need to be followed strictly while
washing of the hands. The procedure of hand washing includes the way of applying the soap,
scrubbing the hands and the nails along with the necessary time that is required while conducting
the steps of hand washing. However, the nurses and healthcare professionals tend to avoid the
long procedures of washing hands in order to save time. In order to attend the patients at their
earliest, the nurses and the healthcare professionals tend to compromise with the hand washing
protocols thereby, resulting in cross-contamination.
Describing two evidence-based strategies suitable for facilitating the practice change in
own clinical setting
Evidence-based practice is the most predominant care model used in the clinical settings
that have gained recognition in clinical settings. The use of evidence-based practice helps in
ensuring hand hygiene in the clinical settings. The two evidence-based practice implemented for
improving the working environment for the nurses and the healthcare professionals are
organizational factors and individual factors. As commented by Buysse et al., (2012),
organizations play a crucial role in providing quality service to the patients. The main
organizational factor that will help in bringing change in own clinical setting is a positive
working condition of the clinical setting. According to Melnyk et al., (2012), following and
implementing the protocols of hand hygiene strictly in the clinical settings helps in preventing

20IMPLEMENTING EVIDENCE FOR PRACTICE
diseases. The organizations can ensure that the nurses and the healthcare professionals’ follow
hand hygiene strictly while working in the clinical settings. Therefore, monitoring strictly and
regularly the clinical settings can help in ensuring hand hygiene at work Moreover, the nurses
will be physically and psychologically satisfied that will eventually increase their dedication and
enthusiasm towards care. Thus, the practice at the clinical settings will be enhanced. Another
aspect of considered under the organizational factor is the training provided by the hospital
settings. Based on the training provided to the nurses at a regular interval helps in determining
the effectiveness of hand hygiene in the clinical settings. Thus, ensuring hand hygiene helps in
preventing the onset and spread of diseases in the hospital settings.
On the other hand, individual factors also play a significant role in improving the practice
in the clinical settings. As commented by Rubin & Bellamy (2012), the clinical settings need to
have strict hand hygiene protocols that will help in enhancing the quality of care provided by
them. Sufficient knowledge of the nurses regarding the significance hand hygiene helps in
ensuring infection free clinical setting. Moreover, adequate knowledge within the nurses will
also help in gaining enough confidence. The level of confidence will help the nurses in being
organized within the clinical settings thereby, practicing hand hygiene while proving care.
Conclusion
In this report, it can be concluded that the appropriate hand hygiene helps in preventing
the onset and spread of infection in the hospital settings. Due to improper implementation of
hand washing and hand hygiene, cross-contamination occurs thereby, leading to fatal conditions.
Therefore, issues such as improper washing of hands along with cross contamination have given
rise to the concern regarding ensuring hand hygiene in the clinical settings. A search strategy

21IMPLEMENTING EVIDENCE FOR PRACTICE
using the PICOT structure has been developed in the report that helped in formulating a specific
question in accordance with the identified in the clinical setting. After formulating the question, a
proposed search strategy has been mentioned that helped in finding a relevant article based on
the developed questions. MeSH and CINAHL terms were used for finding the literature that was
further used for the completing the report.
Using MeSH and CINAHL terms, six articles were found that is presented in a tabular
manner in a summarized manner. The table consists of the authors, date, the type of study used,
sample along with concluding the main findings, strengths, and limitations. The quality and
findings of the six studies used for the report were studied critically thereby, relating the key
conclusions of the used articles. The main barriers and facilitators to the implementation were
identified along with suggesting strategies in implement the change. The key barriers included
were ignorance and reluctance among the nurses and the healthcare professionals along with lack
of strictness from the management of the hospitals regarding following hand hygiene.

22IMPLEMENTING EVIDENCE FOR PRACTICE
References
Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M. L., Moro, M. L., ... &
Donaldson, L. (2013). Global implementation of WHO's multimodal strategy for
improvement of hand hygiene: a quasi-experimental study. The Lancet infectious
diseases, 13(10), 843-851.
Al-Tawfiq, J. A., Abed, M. S., Al-Yami, N., & Birrer, R. B. (2013). Promoting and sustaining a
hospital-wide, multifaceted hand hygiene program resulted in significant reduction in
health care-associated infections. American journal of infection control, 41(6), 482-486.
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L.,
... & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care
hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S66-S88.
Anderson, M. E. C., & Weese, J. S. (2012). Video observation of hand hygiene practices at a
petting zoo and the impact of hand hygiene interventions. Epidemiology & Infection,
140(1), 182-190.
Bereket, W., Hemalatha, K., Getenet, B., Wondwossen, T., Solomon, A., Zeynudin, A., &
Kannan, S. (2012). Update on bacterial nosocomial infections. Eur Rev Med Pharmacol
Sci, 16(8), 1039-44.
Borchgrevink, C. P., Cha, J., & Kim, S. (2013). Hand washing practices in a college town
environment. Journal of environmental health, 75(8), 18.

23IMPLEMENTING EVIDENCE FOR PRACTICE
Buysse, V., Winton, P. J., Rous, B., Epstein, D. J., & Lim, C. I. (2012). Evidence-based practice.
Zero Three, 32(2), 25-9.
Choo, K. J. L., Simons, F., & Sheikh, A. (2013). Glucocorticoids for the treatment of
anaphylaxis. Evidence‐Based Child Health: A Cochrane Review Journal, 8(4), 1276-
1294.
Edmonds, S. L., Macinga, D. R., Mays-Suko, P., Duley, C., Rutter, J., Jarvis, W. R., & Arbogast,
J. W. (2012). Comparative efficacy of commercially available alcohol-based hand rubs
and World Health Organization-recommended hand rubs: formulation matters. American
journal of infection control, 40(6), 521-525.
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.
Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J., Wolf, J., ... & Curtis, V.
(2014). Systematic review: hygiene and health: systematic review of handwashing
practices worldwide and update of health effects. Tropical Medicine & International
Health, 19(8), 906-916.
Godoy, P., Castilla, J., Delgado-Rodríguez, M., Martín, V., Soldevila, N., Alonso, J., ... &
González-Candelas, F. (2012). Effectiveness of hand hygiene and provision of
information in preventing influenza cases requiring hospitalization. Preventive medicine,
54(6), 434-439.

24IMPLEMENTING EVIDENCE FOR PRACTICE
Greene, L. E., Freeman, M. C., Akoko, D., Saboori, S., Moe, C., & Rheingans, R. (2012). Impact
of a school-based hygiene promotion and sanitation intervention on pupil hand
contamination in Western Kenya: a cluster randomized trial. The American journal of
tropical medicine and hygiene, 87(3), 385-393.
Harrop, J. S., Styliaras, J. C., Ooi, Y. C., Radcliff, K. E., Vaccaro, A. R., & Wu, C. (2012).
Contributing factors to surgical site infections. Journal of the American Academy of
Orthopaedic Surgeons, 20(2), 94-101.
Higgins, A., & Hannan, M. M. (2013). Improved hand hygiene technique and compliance in
healthcare workers using gaming technology. Journal of Hospital Infection, 84(1), 32-37.
Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2016). Wong's Essentials of Pediatric
Nursing-E-Book. Elsevier Health Sciences.
Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., & van Achterberg, T. (2013).
Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand
hygiene guidelines: a cluster randomised trial. International journal of nursing studies,
50(4), 464-474.
Jasper, C., Le, T. T., & Bartram, J. (2012). Water and sanitation in schools: a systematic review
of the health and educational outcomes. International journal of environmental research
and public health, 9(8), 2772-2787.
Kelcíkova, S., Skodova, Z., & Straka, S. (2012). Effectiveness of hand hygiene education in a
basic nursing school curricula. Public Health Nursing, 29(2), 152-159.