NUR2300 Report: Evidence-Based Practice on Hand Hygiene

This report delves into the critical role of hand hygiene in healthcare, employing an evidence-based practice approach to address the clinical issue of Healthcare Associated Infections (HAIs). It begins by outlining the significance of hand hygiene in preventing HAIs within healthcare settings, particularly in Australia, where the prevalence of such infections poses a significant concern. The report poses a clinical question regarding the effectiveness of hygiene interventions in eradicating HAIs and outlines the PICO framework to guide the investigation. An extensive evidence search was conducted, encompassing articles from 2014 to 2019, sourced from databases like Science Direct, Taylor and Francis, and BMC, to gather relevant data. The analysis includes a critical appraisal of the selected articles, synthesizing the best available evidence to support recommendations for practice changes. The report concludes by emphasizing the importance of evidence-based practices for nursing professionals and the application of this practice to improve patient outcomes. It also highlights the barriers to implementing evidence-based practices and suggests future research directions to enhance hand hygiene protocols and infection control measures.

RUNNING HEAD: HAND HYGIENE 0
Evidence-Based Practice
Student’s Details-
9/13/2019

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Contents
Introduction......................................................................................................................................2
Outline of the Clinical issue............................................................................................................2
Clinical Question.............................................................................................................................2
Evidence Search...............................................................................................................................3
Literature Synthesis of the Best Evidence.......................................................................................3
Critical Appraisal.........................................................................................................................4
Synthesis of Body of Evidence....................................................................................................4
Recommendation for Practice change and Research.......................................................................5
Conclusion.......................................................................................................................................5
References........................................................................................................................................7

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Introduction
Evidence-based practice is associated with the gaining knowledge by the use of a
scientific tool for increasing the efficiency of the decisions taken by the professionals (Dang &
Dearholt, 2017). It includes the synthesis of the best evidence by the collection of data from
various sources which can be applied in the professional life (Townsend & Morgan, 2017). The
report is being prepared on the evidence based approach for the nursing practice and the clinical
issue for this report is “Hand Hygiene”. The report discusses the prevalence and risk factors
associated with the hand hygiene and the synthesis and the evidence search for this clinical issue.
Lastly recommendation is included to determine the possible changes and improvements
regarding the hand hygiene.
Outline of the Clinical issue
In my workplace, I derived the clinical dilemma of hand hygiene and the issue has a huge
importance in the healthcare settings. In the description of this clinical issue, it can be analyzed
that hand hygiene is associated with Healthcare Associated Infections (HAI). In Australia, there
is prevalence of healthcare associated infections in the hospitals which are caused due to surgical
wound leading to bloodstream infections wherein some cases have led to the death (Russo,
Cheng, Richards, Graves, & Hall, 2015). It is difficult to analyze the prevalence of HAI without
a surveillance program. Rather, Carbapenemase producing Enterobacteriaceae (CPE) is the
emerging bacteria that has given the generation of an untreatable bacteria that has caused death
of many patients into the hospitals due to lack of infection control. Further, these risk can be
improved through interventions and given due importance to the hand hygiene in the hospitals
(van Dijk, et al., 2019). The evidence based approach for healthcare associated infections will be
helpful in the identification and improvement of the care given to patients and also reducing the
number of diseases that are caused due to the infections.
Clinical Question
Does maintenance and improvements in the hygiene factors are helpful in the eradication
of Healthcare Associated Infections?

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Domain:
P- Risk of the infections and bacteria due to lack of infection control in hospitals
I- Hygiene interventions in the hospitals
C- Comparison of the new changes with the previous culture
O- Reduced infections
Hygiene Interventions for the reduction in the infections and also promoting sanitization
and hygiene related measures to remove the risk of disease caused by such infections. The
diagnosis includes the precautionary measures for the prevention of infections from nurse to
patients and patients to nurse. Nurses are an actual planned subdivision of healthcare
professionals is more probable to have more recurrent interaction with patients. The delivery of
patient hygiene is one of the most frequently achieved nursing care doings, making them
regularly uncovered to blood and other bodily fluids of the enduring. The evidence derived from
this investigation will deliver the basis for references for the alteration of the standard careful
component of their exercise with a view to meaningfully recover their agreement with hospital
infection control strategies.
Evidence Search
For the identification of Healthcare Associated Infections in the healthcare settings in
order to remove the infectious bacteria for promoting the health of the patients, I have made an
evidence search plan. In this, I have selected 6 articles from 2014 to 2019 that are highly relevant
to my clinical question. However, the journal articles are being selected from Science Direct,
Taylor and Francis and BMC which are the sources that are used for my evidence search. In this,
both qualitative and quantitative methods are used for the determination of the accurate
evidences. The data collected is relevant to my clinical question as it promotes and identifies the
major reasons for the emergence of the healthcare associated infections in the healthcare system
in Australia. Moreover, the investigations in this evidence are conducted to determine the factors
that can lead to the diseases and the possible interventions that could be taken for the eradication
of the infections that can cause within the hospitals in Australia. Further, in the whole analysis
and evidence search, the major focus is on the healthcare settings in Australia. A total of 315

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credentials were recognized through the literature exploration. Founded on first level selection
and headings and executive summaries, 150 studies were accepted and 20 studies were reclaimed
for full text review. Upon full text appraisal, a further 12 articles were accepted, and 6 met the
addition standards for the synthesizing the review. Additionally, the articles designated are on
the basis of Australian based population. Given the difference in the methods of sample, data
collection and examination, these areas are appraised by research query. Studies that are
pertinent to questions are obtainable twice, to provide for an general appraisal of the indication
available for investigation query.
Literature Synthesis of the Best Evidence
The evidence table in the attached file explains the key information derived from the
various sources.
Critical Appraisal
For the determination of the best evidence of hand hygiene for Healthcare Associated
Infections, journal articles are relevant to the search. Firstly, the article selected is describing the
features of the hygiene program from the healthcare associated infections and it is analyzed that
approximately 200 00 HAIs occur from care families and can have adverse effects (BN, 2015).
This can be removed from effective infection control program that was highly successful for
meeting the compliances of hand hygiene. The second article is effective for the reduction and
prevention from pathogens that can cause serious disease. This promotes the concept of hand
hygiene and isolation for the purpose of reducing the hospital acquired infections (Huang,
Stewardson, & Grayson, 2014).
Further, the third article is the relevant source as it is describing the significance of hand
hygiene in veterinary and human hospitals (Mann, 2017). In this, the barriers of improving
sanitation are reduced. The forth article discusses the methicillin-resistant staphylococcus aureus
rates that can cause the emergence of infectious disease. The intervention is being undertaken on
the hand hygiene and preventing the infectious diseases (Marimuthu, Pittet, & Harbarth, 2014).
Fifth article is used for the evaluation cost associated in the Australian Hand Hygiene Initiative
which is the safety program being incorporated by the Hand Hygiene Australia. The research in
this article is being made from collecting data from 50 largest public hospitals from Australia

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(Page, et al., 2014). The sixth article being discusses the comparison of automated hand hygiene
with the human hygiene. The search is made from the feedback of automated systems in order to
improve the compliances. The automated system included the hand hygiene events and defects
(Angela Kwok, Juergens, & McLaws, 2016).
Redway and Fawdar investigated the drying efficiency of paper towels, hot air dryers,
and jet air dryers and in the study they perceived that paper towels and jet air dryers are almost
equally efficient at drying hands during clinical practice. Furthermore, Patrick conducted a study
in washrooms wherein he observed that single-serve cloth towels are installed in clinics however,
not used by the nurses and practitioners. Similarly in this context, Knights reported hot air dryers
only attain 55% of hand dehydration. However, cloth towels and paper cloths attains more than
90% of dehydration (Huang C. M., 2012). A hand sanitation intervention may not always
outcome in a decrease in HAIs due to letdown of full saturation of the contact factor, eg, the
intervention communication. The “Australian National Hand Hygiene Initiative” inaugurated in
2009 and requisite HCWs at 521 hospitals to have assumed and implicit the online teaching
about “My Five Moments” and joined in-service training (study issues). Therefore, the greatest
likely clarification is that error in gauging the study issue (hand hygiene) twisted an overinflated
rate of development or that the study issue was not related with this specific outcome issue.
Synthesis of Body of Evidence
For the adopted evidence strategy, the important evidences are being undertaken from the
journal articles that clearly addresses the clinical question. The clinical question seeks to promote
the hand hygiene programs that can be a crucial step for the reduction of the healthcare
associated infections. The HAI have major prevalence into the hospitals or the healthcare settings
in Australia and the removal of such infections is crucial for the healthcare departments. Thus,
the evidences identified have the capability to determine the causes of such infections also a fair
explanation of the effects of such infections on the patients and healthcare departments.
Moreover, the evidences are contributing to the hand hygiene initiative which is the major
sanitation step to be taken for the eradication of Healthcare Associated Infections. The articles
are majorly discussing upon the hand hygiene in Australia and also the major infections and
bacteria that are emerging to the infections in the hospitals. Thus the evidences are relevant and
addressing the clinical question.

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Recommendation for Practice change and Research
There are factors could impact the evidence-based practice and act as barrier to it. The
factors such as dissemination, management of innovation and problems in the assessment of the
evidences found (Behague, Tawiah, Rosato, Some, & Morrison, 2009). The difficulty of
assessment criteria and the problems with the examination of the evidences are the hindrances in
the evidence-based strategy. In the evidence search of hand hygiene, it is difficult to calculate the
extent of infections found in the hospitals of Australia as there are numerous hospital and there is
a difficulty in the assessment of infectious diseases to be calculated. Therefore, it can be said that
in the anticipation of the HAI, cost is involved and also if the intervention is made through
innovation then there can be a possibility of not accepting the changes or the interventions (Stone
& Zibulsky, 2015). Further, this evidence based practice can be applied for the nursing practice
so that they can have a clear idea of the diseases and severe consequences of lack of infection
control. The nurse can get up to date information and the application of this practice brings
discipline and more safety of patients. For, the nursing studies, four criteria are focused upon
which are relevance, validity, reliability and the outcome of the research made. Also, the nursing
professionals used qualitative and quantitative search for the objective of making improvements
into the patient care. The nurse can compare the current professional with the new evident
research for the purpose of analyzing the situations that they can improve and enhance the health
of the patients through the use of evidences and enhanced outcomes for patients.
Conclusion
It is concluded that evidence based practice is crucial for the nursing professional for
finding out the best evidence that could lead to the improved patient outcomes. Also, this
practice has been used to identify the cause and prevalence of a clinical issue so that better
initiatives could be taken to improve the outcomes. The report is based upon the evidence based
practice of Healthcare Associated Infections in the healthcare setting of Australia and promoting
the hand hygiene initiative. Also, the report clearly identifies the clinical issue of HAI by
determining the prevalence and risk associated with HAI. Further, a clinical question is
addressed with the use of PICO framework. Further, critical analysis of the evidences by
assessing the key findings of the sources that are being collected from the journal articles.

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Recommendation of evidence based practice is also analyzed and the method and process of the
application of this practice on nursing also explained.

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References
Angela Kwok, Y., Juergens, C., & McLaws, M.-L. (2016). Automated hand hygiene auditing
with and without an intervention. American Journal of Infection Control, 44(12), 1475-
1480.
Behague, D., Tawiah, C., Rosato, M., Some, T., & Morrison, J. (2009). Evidence-based policy-
making: the implications of globally-applicable research for context-specific problem-
solving in developing countries. Social Science & Medicine, 69(10), 1539-1546.
BN, J. B. (2015). Characteristics of a successful hospital hand hygiene program: an Australian
perspective. Healthcare infection, 20(3-4), 101-107.
Dang, D., & Dearholt, S. (2017). Johns Hopkins nursing evidence-based practice: Model and
guidelines. Sigma Theta Tau.
Huang, C. M. (2012). The Hygienic Efficacy of Different Hand-drying methods: A Review of
the evidence. Mayo Clinic Proceedings, 87(8), 791-798.
Huang, G. L., Stewardson, A. J., & Grayson, M. L. (2014). Back to basics: hand hygiene and
isolation. Current opinion in infectious disease, 27(4), 379-389.
Mann, A. (2017). The importance of hand hygiene. Veterinary Nursing Journal, 32(3), 82-85.
Marimuthu, K., Pittet, D., & Harbarth, S. (2014). The effect of improved hand hygiene on
nosocomial MRSA control. Antimicrobial Resistance and Infection Control, 3(34).
Page, K., Barnett, A., M., C., Brain, D., Martin, E., Fulop, N., & Graves, N. (2014). Costing the
Australian National Hand Hygiene Initiative. Journal of Hospital Infection, 88(3), 141-

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148.
Russo, P., Cheng, A., Richards, M., Graves, N., & Hall, L. (2015). Healthcare-associated
infections in Australia: time for national. Australian Health Review, 39, 37-43.
Stone, S., & Zibulsky, J. (2015). Maltreatment, academic difficulty, and systems‐involved youth:
Current evidence and opportunities. Psychology in the Schools, 52(1), 22-39.
Townsend, M., & Morgan, K. (2017). sychiatric mental health nursing: Concepts of care in
evidence-based practice. FA Davis.
van Dijk, M., Mulder, S., Erasmus, V., van Beeck, A., Vermeeren, J., Liu, X., & Vos, M. (2019).
A multimodal regional intervention strategy framed as friendly competition to improve
hand hygiene compliance. Infection Control & Hospital Epidemiology, 40(2), 187-193.

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Appendices

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