Hand Hygiene Report: U1112475, NUR2300, Semester 3

This report, authored by Balwinder Singh, U1112475, for NUR2300, delves into the critical importance of hand hygiene in preventing healthcare-associated infections (HAI). It begins by defining HAI and highlighting their prevalence and associated risks, including increased morbidity, mortality, and healthcare costs. The report then poses a research question, using the PICO framework, to investigate whether hand hygiene can reduce HAI incidence. A systematic review of literature, utilizing databases such as NCBI, Google Scholar, and PubMed, is conducted to gather evidence. The report critically appraises a selected research article using the CASP tool, evaluating its methodology and findings. The report also summarizes recommendations from the World Health Organization (WHO) for effective hand hygiene practices, including proper handwashing techniques, the use of alcohol-based hand rubs, and the importance of education and training for healthcare workers. The report concludes by emphasizing the need for consistent hand hygiene protocols to minimize the spread of infections and improve patient outcomes. The report uses several research articles to support the findings and analysis.

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

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Introduction
There are various kinds of diseases which are obtained during the period when a person is
getting a treatment in the hospital. Such kind of disease is called as Health care-associated
infections (HAI). Around hundreds of millions of patients get affected to the HAI each year.
Acquiring HAI, lead to rise of several critical diseases, rise in the duration of stay, rise in various
health disabilities which ultimately increases the costs of family and lead to a tremendous
financial burden on the healthcare system and sometimes it may result in death of the individual
(Ellingson et al., 2014). As a result of the nature of the diseases, HAI are caused by many factors
linked to systems and processes of delivery of care and also the human behavior which is tagged
by the literacy, political and economic restraints on systems and nations, and often on societal
culture and ideas. Though, there are several infections which can be prevented. The spread of the
HAI occurs as a result of the spread of health care-associated microorganisms which takes place
through a direct or indirect touch with the infected fluids, air and through a common vehicle
(Chen et al., 2013). There are several research papers which show that the healthcare workers
often spoil their hands or gloves by coming in contact with the Gram-negative bacilli, S. aureus,
enterococci or C. difficile (Marchaim & Kaye, 2017).
Hand hygiene is a very essential strategy to reduce the incidence of the Health care-
associated infections. It is a simple and very effective approach, though its lack of compliance
among the healthcare professionals is the main reason behind the incidence of HAI worldwide. It
has already been proved that hand hygiene is a significant asset in preventing the spread of the
HAI among patients. Therefore, this study will describe what a HAI is and how hygiene hands
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can prevent the spread of the HAI. It will develop a research question which will be answered
through critical analysis using the CASP tool.
Search Strategy
To initiate gathering of information on hand hygiene, it is necessary to develop a research
question. The PICO strategy will be used to develop the question.
PICO
 P - Health care-associated infections (HAI)
 I – Hand Washing
 C - No hand washing, or other solutions, alcohol based hand rub
 O – Decrease in the rate of HAI
Can hand hygiene approach reduce the incidence of the HAI by increasing the compliance rate
among the healthcare?
A systematic review has been conducted on understanding the effectiveness of hand hygiene in
the reduction of HAI and to answer the research question. Different online databases and
websites have been used to search for the literature studies such as NCBI, Google Scholar,
Cinahl, PubMed, and Medline. Few keywords were used in order to search for the articles in an
easy way, which are Hand Washing, Hand hygiene, Healthcare-associated infections (HAI) and
compliance of Hand hygiene guidelines by the healthcare staffs. The chosen articles are –
1. Allegranzi, B., Conway, L., Larson, E., & Pittet, D. (2014). Status of the implementation of
the World Health Organization multimodal hand hygiene strategy in United States of
America health care facilities. American journal of infection control, 42(3), 224-230.
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2. Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change
within multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.
3. Chen, L. F., Carriker, C., Staheli, R., Isaacs, P., Elliott, B., Miller, B. A., ... & Rhodes, L.
(2013). Observing and improving hand hygiene compliance implementation and refinement
of an electronic-assisted direct-observer hand hygiene audit program. Infection Control &
Hospital Epidemiology, 34(2), 207-210.
4. Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., ... &
VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through hand
hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960.
5. Pfoh, E., Dy, S., & Engineer, C. (2013). Interventions to improve hand hygiene compliance:
brief update review. Making health care safer II: An updated critical analysis of the evidence
for patient safety practices.
Reviewing and synthesizing the evidence
Rationale for selecting this articles
Healthcare-associated infection (HCAI) has become a very terrible and dangerous disease
that is threatening the lives of millions of individuals worldwide. Every year, hundred million
individuals die just due to the infections acquired from the healthcare settings. Acquiring HAI,
lead to rise of several critical diseases, rise in the duration of stay, rise in various health
disabilities which ultimately increases the costs of family and lead to a tremendous financial
burden on the healthcare system and sometimes it may result in death of the individual. Even
after different researchers conducted research to understand the importance of the hand hygiene,
researchers and healthcare systems have consistently failed in implementing this policy widely
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and it has caused a hug gap causing lack of hand hygiene compliance. Hand hygiene compliance
is still lacking in several developing and developed countries.
Thus, these articles were chosen because these articles give different interventions to
improve hand hygiene compliance (Pfoh, Dy & Engineer, 2013), recommend different strategies
to prevent healthcare-associated infections through hand hygiene (Ellingson et al., 2014), uses an
electronic-assisted direct-observer hand hygiene audit program to observe the improvement of
hand hygiene compliance (Chen et al., 2013) and provides various other information regarding
hand hygiene and HAI. The selected research papers will help in answering the research question
and will prove that hand hygiene is a successful way for reducing the frequency of hospital-
related infections by healthcare professionals. A critical appraisal will be done of a research
paper through the CASP tool in order to answer the research question.
CASP
For the critical appraisal the following article has been chosen –
Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change within
multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.
 Did the review address a clearly focused question?
This research article has clearly addressed the PICO research question as this review précises
different available research papers signifying a system change are highly required which can
be initiated through the help of a multi-modal hand hygiene improvement strategy.
 Did the authors look for the right type of papers?
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Yes, the authors have used those papers which provide information regarding the hand
hygiene practices of the healthcare professionals and describe the factors that suggest a need
in system change.
 Do you think all the important, relevant studies were included?
Yes, the authors have included those papers which provide information regarding the hand
hygiene practices of the healthcare professionals and describe the factors that suggest a need
in system change. The paper has included those papers also which demonstrate the factors
responsible for lack of hand hygiene compliance.
 Did the review’s authors do enough to assess quality of the included studies?
Yes, authors conducted the study very thoroughly and did enough to assess the quality of the
included studies.
 If the results of the review have been combined, was it reasonable to do so?
Yes, combination of the different results of diverse review was reasonable to do as by
combining the results, it efficiently answered the PICO research question and was able to
decide that a system change is required to improve hand hygiene in healthcare.
 What are the overall results of the review?
The following article chose 121articels to conduct a literature review. The review concluded
that a system change is required starting from the alcohol hand rub. The paper suggested that
to attain continued development, critical aspects have to be considered.
 How precise are the results?
Since this paper was a literature review and the data which have been provided or the
research articles selected for this review are outdated. So the precision of the results cannot
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be related with current day. Though, at the end of the paper it has been stated that the
researchers did not find any conflict of interest.
 Can the results be applied to the local population?
Yes, even though the data used in the paper corresponds to the time-frame of 1989 – 2012,
the data provided gives the idea about which factors cause a lack of hand hygiene
compliance, and also provides few strategies to improve the hand hygiene compliance.
 Were all important outcomes considered?
Yes, all the important outcomes have been considered.
 Are the benefits worth the harms and costs?
Yes, the benefits or the interventions are worth the harms and costs.
Recommendation
World Health Organization has recommended certain strategies to improve the hand hygiene
compliance and reduce the rate of hospital associated infections (WHO, 2016). The
recommendations include -
 Hands should be washed by soap and water when there are visible dirty stains of blood or
other body fluids present; also after using the toilet hands should be washed. When there is a
significant possibility or confirmed exposure to possible spore-forming pathogens, including
C. difficile outbreaks then hands should be washed with soap and water as it is a preferred
means of hand washing.
 Before giving medicines to a patient or preparing food for them, it is necessary to clean the
hand using the alcohol-based hand rub approach or hands can be washed using plain or
antimicrobial soap and water.
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 During the surgical procedures, the healthcare professionals should remove their rings,
bracelets, watches and other accessories to prevent the spread of the germs.
 Sinks should be used to wash hands and prevent the splashes of blood or other microbial
stains via water.
 Surgical hand antiseptic care should be done either with an appropriate antimicrobial soap or
with an appropriate hand rub with alcohol, especially with a substance that ensures
continuous operation, before wearing sterile gloves.
 Provide HCWs with appropriate hand hygiene products which have low potential for
irritation.
 To increase HCW's approval of hand hygiene products, seek their suggestions regarding the
skin tolerance, smell, and scent of any of the items being considered. Comparative tests can
be of great help throughout this step.
 Certain learning programs such as the information regarding the hand care practices to
decrease the danger of irritant contact dermatitis and other skin damage should be
incorporated in the education programmes for HCWs.
 It is necessary for the healthcare management system to keep data on the allergic reactions of
their HCWs and according to that they should alternative and suitable hand hygiene products
in the health-care setting.
 Supply HCWs with hand lotions or creams to reduce the incidence of hand antiseptic or
handwashing irritant causing dermatitis.
 Wear gloves, if blood or other possibly contagious products, mucous membranes or intact
skin are fairly likely to come into contact with it.
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 When wearing gloves, change or remove gloves during the patient care from an infected
body site to some other body position in one patient or in the surroundings (along with the
nonintact skin, mucous membrane or medical device).
 Throughout hand hygiene initiatives for HCWs, a particular focus should be put on
the causes that actually impact behaviour, and not only the form of hand hygiene products.
The approach should be multi-faceted and multimodal and should involve preparation and
organizational assistance.
 Enlighten HCWs about the kinds of hand-contamination during the patient care procedure
and the pros and cons of different methods of washing their hands Observe and provide
qualitative reviews in accordance with approved standards in hand hygiene through HCWs.
Encourage patient-family and HCW partnerships to improve health care hand hygiene.
Conclusion
The inconsistent structures and approaches which mitigate optimum adherence to hand
hygiene end up causing avoidable damage for patients undergoing healthcare. In order to ensure
that no individual is ultimately affected with non-compliance by hand hygiene, globally
organized efforts (in some instances campaigns) must be taken into account to encourage and
preserve change in hand hygiene, manage the problem at the national level and guarantee
the successful application of legislation that has an impact on hand hygiene. The presence of
recommendations in itself does not enhance consistency with hand hygiene. Therefore, a strong
local supplement has been shown to be the additional catalyst of a centrally coordinated
campaign or plan, which involves reporting and reviews, goals and regulations. In general,
increase awareness of the problem and make it a priority, which could not be understood in the
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absence of a concerted national effort. A strategic plan should be addressed for changes in hand
hygiene to flourish in an overall health & infection control policy. Eventually, the best way to
prevent transfers of pathogenes is to have sanitation by hand If available, the best way to protect
oneself and patients would be to wash hands thoroughly with soap and water. When soap and
water are not accessible then an acceptable form of hand hygiene is the correct use of a hand
sanitizer. The ultimate goal of fostering a strong culture of medical care is to strengthen hand
hygiene habits.
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References
Al Salman, J. M., Hani, S., de Marcellis-Warin, N., & Isa, S. F. (2015). Effectiveness of an
electronic hand hygiene monitoring system on healthcare workers’ compliance to
guidelines. Journal of infection and public health, 8(2), 117-126.
Allegranzi, B., Conway, L., Larson, E., & Pittet, D. (2014). Status of the implementation of the
World Health Organization multimodal hand hygiene strategy in United States of
America health care facilities. American journal of infection control, 42(3), 224-230.
Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change within
multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.
Chen, L. F., Carriker, C., Staheli, R., Isaacs, P., Elliott, B., Miller, B. A., ... & Rhodes, L. (2013).
Observing and improving hand hygiene compliance implementation and refinement of an
electronic-assisted direct-observer hand hygiene audit program. Infection Control &
Hospital Epidemiology, 34(2), 207-210.
Davis, R., Parand, A., Pinto, A., & Buetow, S. (2015). Systematic review of the effectiveness of
strategies to encourage patients to remind healthcare professionals about their hand
hygiene. Journal of Hospital Infection, 89(3), 141-162.
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.
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Hübner, N. O., Hübner, C., Wodny, M., Kampf, G., & Kramer, A. (2010). Effectiveness of
alcohol-based hand disinfectants in a public administration: impact on health and work
performance related to acute respiratory symptoms and diarrhoea. BMC infectious
diseases, 10(1), 250.
Kapil, R., Bhavsar, H. K., & Madan, M. (2015). Hand hygiene in reducing transient flora on the
hands of healthcare workers: an educational intervention. Indian journal of medical
microbiology, 33(1), 125.
Marchaim, D., & Kaye, K. (2017). Infections and antimicrobial resistance in the intensive care
unit: Epidemiology and prevention. Prieiga per internetą https://www. uptodate.
com/contents/infectionsand-antimicrobial-resistance-in-the-intensive-care-unit-
epidemiology-and-prevention.
Musu, M., Lai, A., Mereu, N. M., Galletta, M., Campagna, M., Tidore, M., ... & Mura, P. (2017).
Assessing hand hygiene compliance among healthcare workers in six Intensive Care
Units. Journal of preventive medicine and hygiene, 58(3), E231.
Nair, S. S., Hanumantappa, R., Hiremath, S. G., Siraj, M. A., & Raghunath, P. (2014).
Knowledge, attitude, and practice of hand hygiene among medical and nursing students at
a tertiary health care centre in Raichur, India. ISRN preventive medicine, 2014.
Pfoh, E., Dy, S., & Engineer, C. (2013). Interventions to improve hand hygiene compliance:
brief update review. Making health care safer II: An updated critical analysis of the
evidence for patient safety practices.
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Sickbert-Bennett, E. E., DiBiase, L. M., Willis, T. M. S., Wolak, E. S., Weber, D. J., & Rutala,
W. A. (2016). Reduction of healthcare-associated infections by exceeding high
compliance with hand hygiene practices. Emerging infectious diseases, 22(9), 1628.
Ward, M. A., Schweizer, M. L., Polgreen, P. M., Gupta, K., Reisinger, H. S., & Perencevich, E.
N. (2014). Automated and electronically assisted hand hygiene monitoring systems: a
systematic review. American journal of infection control, 42(5), 472-478.
Willmott, M., Nicholson, A., Busse, H., MacArthur, G. J., Brookes, S., & Campbell, R. (2016).
Effectiveness of hand hygiene interventions in reducing illness absence among children
in educational settings: a systematic review and meta-analysis. Archives of disease in
childhood, 101(1), 42-50.
World Health Organization. (2016). WHO guidelines on hand hygiene in health care. First
Global Patient Safety Challenge. Clean Care is Safer Care. Geneva: WHO; 2009.
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Marking Rubric
Criteria
Part 1 – Evidence
(30 marks total)
High
Distinction
Distinction Credit Pass Unsatisfactory Marks
Awarded
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Identification and justification
of clinical issue related to hand
hygiene
(5 marks)
A highly
developed
discussion of the
importance of hand
hygiene and
infection control
(very well
supported by
quality and recent
literature, may
include global and
Australian
context).
A highly
developed
discussion
demonstrating a
very clear main
focused area of
hand hygiene
relevant to nursing.
An excellent
ability to discuss
the significance of
the main focus
area with quality
and relevant
supporting
literature with
background
information.
A well-developed
discussion of the
importance of hand
hygiene and
infection control
(supported by
quality and recent
literature).
A very good
discussion
demonstrating a
clear main focus
area of hand
hygiene relevant to
nursing.
A very good ability
to discuss the
significance of the
main focus area
with quality and
relevant literature.
A good discussion
of the importance
of hand hygiene
and infection
control (some
literature cited).
A good discussion
demonstrating a
clear main focus
area of hand
hygiene relevant
to nursing.
A good attempt to
discuss the
significance of the
main focus area
with quality and
relevant literature.
A satisfactory
overview of why
hand hygiene is
important.
A satisfactory
attempt at
identifying one
main focus area
of hand hygiene
relevant to
nursing.
Some attempt at
discussing the
importance of
needing to
address the focus
area in health
care.
Unable to make links
between hand hygiene
and infection control.
No relevance of
discussion towards
nursing. No real
identification of a
focus area of hand
hygiene.
5 4 3 2.5 0 /5
Development of a concise
clinical question related to
A very well
designed clinical
A well designed
clinical question
A good clinical
question with
A satisfactory
attempt at
Question not phrased
as a question. No clear
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hand hygiene
(10 marks)
question which is
concise and
searchable, and is
clearly phrased as
a question. A well
identified and
discussed
framework with
which the clinical
question was
developed (and
referenced
accordingly, e.g.
PICO, SPIDER).
A very accurate
identification of
the type of clinical
question was
developed in line
with
type/domain/and
related study
designs.
which is concise.
Student identified
a framework used
(e.g. PICO,
SPIDER).
A good attempt at
identifying which
type of clinical
question was
developed in line
with
type/domain/and
related study
designs.
most aspects clear
and related to the
issue of hand
hygiene. Student
may have referred
to a framework
used to develop
the question.
A good attempt at
identifying which
type of clinical
question was
developed in line
with
type/domain/and
related study
designs.
developing a
clinical question.
Some issues may
be around lack of
conciseness.
Question may be
too complex.
Question may be
somewhat
unrelated to hand
hygiene. Appears
to be written
more as a
background rather
than foreground
question.
Some attempt at
identifying a type
or domain.
relevance to hand
hygiene. No real
attempt at using a
framework to guide
the development of the
question. No
identification of the
type of clinical
question in line with
type/domain.
10 - 8.5 8.5 - 7.5 7.5 – 6.5 6.5 - 5 0 /10
Locating, Retrieving and
Justifying Evidence
(15 marks)
Describes at a very
high standard,
tailored approach
to effectively and
efficiently search
for evidence (e.g.
use of Boolean
operators, search
criteria, and is
referenced
Outlines a well-
designed efficient
search strategy for
finding evidence
supported by
academic
literature.
Demonstrates a
very good ability
to locate and
Outlines a good
approach to
finding evidence.
Demonstrates an
ability to locate
and retrieve 5
primary sources
of evidence that
relate to the
clinical question.
Outlines a
satisfactory
overview of a
way in which the
evidence was
searched.
Student located 5
primary sources
of evidence that
related closely to
There was no real
evidence of a
considered approach to
finding quality
evidence to answer the
clinical question.
Irrelevant information
was retrieved, poor
quality, non-research.
The approach or lack
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appropriately).
Demonstrates at a
very high standard,
the processes and
decision making
used to locate and
retrieve 5 primary
sources of
evidence that relate
to the clinical
question.
Demonstrates a
high level of
understanding of
the hierarchy of
evidence and
where the evidence
collected fits
within that
hierarchy.
Ability to correctly
identify primary
research evidence
as either
quantitative or
qualitative or
mixed method
(explanation is
well supported by
relevant academic
literature, e.g. due
to having certain
characteristics).
retrieve 5 primary
sources of
evidence that relate
to the clinical
question.
A very good
attempt at
identifying where
each primary
source of evidence
fits within a
hierarchy of
evidence.
Discusses a very
good rationale/
decision making
process as to why
that evidence was
chosen.
Ability to correctly
identify primary
research evidence
as either
quantitative or
qualitative or
mixed method.
Attempts to
identify where
each primary
source of
evidence fits
within a hierarchy
of evidence.
A good attempt to
identify primary
research evidence
as either
quantitative or
qualitative or
mixed method.
the clinical
question.
Some attempt at
identifying where
evidence fitted
within a hierarchy
of evidence, but
may not be
accurate.
Somewhat
lacking in any
rationale as to the
search strategy.
May or may not
correctly identify
the research
evidence
according to
methodology.
thereof was not
supported by any
recommended
approach outlined in
the literature. Student
unable to demonstrate
what they had found,
why they had selected
it, or the quality of the
research based on a
hierarchy. No clear
understanding of
primary sources of
evidence and whether
any evidence would be
considered
appropriate.
15 - 13 12.5 – 11.5 11.5 – 10.5 7.5 – 9.5 0 /15
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Criteria
Part 2 – Evidence
Critique/Evaluation
, Synthesis and
Recommendations
(50 marks total)
Critical appraisal/evaluation
of research studies
(15 marks)
Demonstrated an
ability to describe
the importance of
critical approach in
EBP. An excellent
to describe and
apply critical
appraisal
processes/tools to
analyse retrieved
evidence based on
quality, validity,
strength, and
applicability and
the student is able
to clearly evaluate
the evidence (e.g.
CASP checklist,
references what
was used). Student
was able to
substantiate
comments about
research by using
relevant academic
A very good
attempt at using a
critical appraisal
processes/tools to
analyse retrieved
evidence based on
quality, validity,
strength and
applicability. The
student did show a
good ability to
provide rationales
for the appraisal
from relevant
academic
literature. Matched
the type of
appraisal with the
type of study e.g.
qualitative
appraisal used to
evaluate a
qualitative research
paper.
A good attempt at
using a structured
approach to
evaluating
research evidence
using some
criteria. May
have described
some aspects of
the appraisal.
Some
considerations
made to some
evaluation the
research. No
clearly identified
process or criteria
used.
Lacks
demonstration of
understanding of
the need to
critically evaluate
research.
Lack of evidence of
any process used to
evaluate the sources of
evidence.
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literature (e.g. if
bias was identified,
how important this
might be for the
findings).
15 - 13 12.5 – 11.5 11.5 – 10.5 7.5 – 9.5 0 /15
Summary and synthesis of
evidence
(25 marks)
An excellent,
highly developed
critical summary
of the evidence
presented in a
concise, organised
and succinct way.
An excellent
ability to identify
and discuss
differences and
similarities across
ALL of the
primary research
studies, written in
a synthesis style.
An excellent
demonstration of
understanding of
the strengths or
weaknesses across
ALL of the
evidence, written
in a synthesis style.
Student provided
lots of relevant
details about the
studies (e.g. what
A well-developed
summary of the
evidence presented
in a concise,
organised and
succinct way.
Student was able to
describe many
aspects of the
studies (e.g. what
the population of
interest was,
research questions,
research methods
used, common
findings).
A very good
critical ability to
identify and
discuss differences
and similarities
across ALL of the
primary research
studies, written in
a synthesis style.
A very good
demonstration of
understanding of
A good attempt at
describing the
research as a
whole. Some
attempts at
writing in a
synthesis style
were noted.
Student able to
identify all 5
sources of
evidence within
the summary.
Some examples
about both
differences and
similarities as
well as strengths
and weaknesses
were noted.
Student described
the research based
on some details.
Demonstrated
little critical
thinking of the
evidence as a
whole in relation
to the clinical
question. Tends
to describe the
research within
synthesizing it.
Vague or no summary
of the literature.
Student may have
provided no synthesis.
Poor understanding of
the research evidence.
Was not able to
generate ideas.
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the population of
interest was,
research questions,
research methods
used, common
findings).
the strengths or
weaknesses across
ALL of the
evidence, written
in a synthesis style.
25 - 21.5 21 - 19 18.5 – 16.5 16 – 12.5 0 /25
Recommendations for practice
setting
(10 marks)
Based on the
evidence, student
provided excellent,
relevant and clear
recommendations
for the practice
setting. Several
high-quality
recommendations
were made.
Provided an
excellent ability to
argue for the
prioritization of
these
recommendations
based on the
strength and
quality of the
research
(referenced).
Recommendations
were highly related
to improving hand
hygiene and
Based on the
evidence, student
very good
recommendations
for the practice
setting. High
quality
recommendations
were made. A very
good argument of
why the health
service should
adopt the
recommendations
is made.
Recommendations
were highly related
to improving hand
hygiene and
relevant to nursing.
Clearly provided
links between the
evidence to the
clinical question.
Based on the
evidence, student
provided relevant
practical
recommendations
to improve hand
hygiene. for the
practice setting.
At least 1
recommendation
was made and
was relevant to
improving hand
hygiene. May or
may not be clearly
related to what
nurses could do.
Clearly provided
links between the
evidence to the
clinical question.
Student provided
one satisfactory
recommendation
for practice based
on the evidence.
May not be
clearly linked to
nursing. Lack of
links with clinical
question.
Recommendation
does seem to be
practical within a
health setting.
Lacking any
supporting reason
for making the
recommendation.
No recommendations
to improve hand
hygiene are made.
Balwinder Singh, U1112475, NUR2300

20HAND HYGIENE
relevant to nursing.
Clearly provided
links between the
evidence to the
clinical question.
10 - 8.5 8.5 - 7.5 7.5 – 6.5 6.5 - 5 0 /10
Criteria
Academic Writing
and Communication
(20 marks total)
High
Distinction
Distinction Credit Pass Unsatisfactory
Ability to apply scholarly
presentation of work
(5 marks)
An excellent
assignment written
using a clear
introduction, body
and conclusion.
High level of
demonstrated
ability to apply
correct formatting,
style, and word
count
requirements.
Overall, a very
well written
assignment with a
clear introduction,
body and
conclusion.
An overall good
ability to apply
correct formatting,
style, and word
count
requirements.
Ability to write a
clear introduction,
body and
conclusion.
Ability to apply
correct
formatting, style,
and word count
requirements.
Covered most of
the formatting
requirements.
Satisfactory
attempt at
presenting this
work. May have
some structure
but may not be
clear. Some
issues with
formatting, style
and adhering to
word count.
Followed a
number of
formatting
requirements, but
not all.
The assignment
demonstrated a lack of
structure. Major issues
with formatting, style
and significantly
under/over word
count.
5 4 3 2.5 0 /5
Referencing An excellent
ability to use APA
A very good ability
to use APA 6th
Overall a good
attempt applying
Satisfactory
attempt at
Very poor or non-
Balwinder Singh, U1112475, NUR2300

21HAND HYGIENE
(5 marks) 6th referencing
consistently and
accurately
throughout the
assignment. No
mistakes noted.
Full reference list
provided.
referencing
consistently and
accurately
throughout the
assignment. Very
few mistakes
noted.
APA throughout
the assignment,
minimal errors.
referencing.
Multiple errors.
existent referencing,
or incorrect
referencing style.
5 4 3 2.5 0 /5
Use of academic literature
(5 marks)
Student able to
demonstrate
excellent breadth
and depth of
reading beyond the
primary research
articles evidenced
with in-text
referencing and
reference list. For
example, use of
research texts,
credible
government
reports, clinical
guidelines. Used
up to an additional
5 sources of
credible
information.
A very attempt
overall to read and
apply knowledge
from beyond the
research articles.
A good attempt at
using additional
sources of
academic
literature for the
assignment. Used
academic quality
literature.
Some attempt at
integrating
information
beyond the 5
articles, but was
limited. Used
maybe 1 or 2
additional
sources.
No use of additional
literature.
5 4 3 2.5 0 /5
Writing and language An excellent
standard of
A very good
standard of
A good standard
of applying
A satisfactory
standard of
Lack of clarity. Poor
writing distracts from
Balwinder Singh, U1112475, NUR2300

22HAND HYGIENE
(5 marks) applying English
grammar and
spelling
conventions.
Written in a highly
developed,
scholarly,
academic style.
Highly consistent
and accurate us of
non-discriminatory
and culturally safe
language.
An outstanding
ability to present a
clear and concise
logical flow of
ideas. Very
readable.
application of
English grammar
and spelling
conventions, with
minimal errors.
Written in a highly
developed,
scholarly,
academic style.
Highly consistent
and accurate us of
non-discriminatory
and culturally safe
language.
A very good ability
to present a clear
and concise logical
flow of ideas. Very
readable.
English grammar
and spelling
conventions.
Written in a
scholarly,
academic style.
Consistent and
accurate us of
non-
discriminatory
and culturally safe
language.
A good ability to
present a logical
flow of ideas.
standard of
applying English
grammar and
spelling
conventions.
Has attempted to
write in an
academic rather
than informal
style.
Non-
discriminatory
and culturally
safe language.
May have some
issues with flow
of ideas.
the content and makes
it difficult for the
reader to understand.
Poor phrasing.
Significant issues with
flow of ideas, often
illogical. Informal,
subjective style of
writing.
5 4 3 2.5 0 /5
Total Marks
/100
Balwinder Singh, U1112475, NUR2300