Running head: LITERATURE REVIEW LITERATURE REVIEW Literature Review: Hand washing and Hospital-Associated Infections Name Walden University Course Name April 3, 2016 Literature Review: Hand washing and Hospital-Associated Infections Most Hospital associated infections are alleged to be transmitted via the hands of Healthcare providers mainly through direct contact when the medical practitioner’s hands transfer the pathogens between individuals or between an environmental reservoir and an individual (Al-Khawaldeh, Al-Hussami, & Darawad, 2015). The purpose of this study is to find out whether there is sufficient evidence to indicate whether there is need for further research on hand washing with regards to the infections that patients are susceptible to in the case of contaminated contact. The evidence from the various studies and nursing journals were carefully assessed to ensure that salient information regarding the research study area were present and were relevant to the study. The researcher took into consideration the ethical issues that are involved in research. The identities of the sample population were not released at any given time and they gave consent for the use of the information retrieved from them (Newcomb, 2010). Furthermore, most of the information used was from journal articles that allow for others to reference the works and findings of the research and, thus, the researcher could include the research material in the literature review (Fouka & Mantzorou, 2011). Synthesis on the Current State of Knowledge Despite the relative simplicity of hand hygiene procedure, the adherence rates to the standard recommendations remain unacceptably low; well below 50% (Bukhari et al., 2011). The reasons for non-compliance with hand washing are low staff to patient ratios, lack of appropriate hand washing equipment, insufficient knowledge about risks and procedures, allergies to some hand washing products, the casual attitude of healthcare practitioners (HCPs) and time factors (Pfoh, Dy, & Engineer, 2013). Patients are likely to suffer infections that arise from inconsistent hygiene practices especially those that are supposed to undergo an operation and have undergone a surgical operation. The United Stated Department of Infectious Diseases estimated the incidence of hospital-acquired infections by 4.5% and with a 5% fatality in 2014 translating to a huge economic impacts (Al-Khawaldeh et al., 2015). One of the main contradictions is the fact that; despite the numerous hand washing guidelines that have been adopted by a majority of health facilities, the compliance by the health care providers remains low despite the practice being one of the simplest and most effective ways of preventing hospital-acquired infections (Bukhari et al., 2011). Some studies point of knowledge, attitude and practice as the primary factors affecting hand hygiene practices while other researches show that even if the healthcare workers from ...

1. Running head: LITERATURE REVIEW
LITERATURE REVIEW
Literature Review: Hand washing and Hospital-Associated
Infections
Name
Walden University
Course Name
April 3, 2016
Literature Review: Hand washing and Hospital-Associated
Infections
Most Hospital associated infections are alleged to be
transmitted via the hands of Healthcare providers mainly
through direct contact when the medical practitioner’s hands
transfer the pathogens between individuals or between an
environmental reservoir and an individual (Al-Khawaldeh, Al-
Hussami, & Darawad, 2015). The purpose of this study is to

2. find out whether there is sufficient evidence to indicate whether
there is need for further research on hand washing with regards
to the infections that patients are susceptible to in the case of
contaminated contact. The evidence from the various studies
and nursing journals were carefully assessed to ensure that
salient information regarding the research study area were
present and were relevant to the study. The researcher took into
consideration the ethical issues that are involved in research.
The identities of the sample population were not released at any
given time and they gave consent for the use of the information
retrieved from them (Newcomb, 2010). Furthermore, most of
the information used was from journal articles that allow for
others to reference the works and findings of the research and,
thus, the researcher could include the research material in the
literature review (Fouka & Mantzorou, 2011).
Synthesis on the Current State of Knowledge
Despite the relative simplicity of hand hygiene procedure, the
adherence rates to the standard recommendations remain
unacceptably low; well below 50% (Bukhari et al., 2011). The
reasons for non-compliance with hand washing are low staff to
patient ratios, lack of appropriate hand washing equipment,
insufficient knowledge about risks and procedures, allergies to
some hand washing products, the casual attitude of healthcare
practitioners (HCPs) and time factors (Pfoh, Dy, & Engineer,
2013). Patients are likely to suffer infections that arise from
inconsistent hygiene practices especially those that are
supposed to undergo an operation and have undergone a surgical
operation.
The United Stated Department of Infectious Diseases estimated
the incidence of hospital-acquired infections by 4.5% and with a
5% fatality in 2014 translating to a huge economic impacts (Al-
Khawaldeh et al., 2015). One of the main contradictions is the
fact that; despite the numerous hand washing guidelines that
have been adopted by a majority of health facilities, the
compliance by the health care providers remains low despite the
practice being one of the simplest and most effective ways of

3. preventing hospital-acquired infections (Bukhari et al., 2011).
Some studies point of knowledge, attitude and practice as the
primary factors affecting hand hygiene practices while other
researches show that even if the healthcare workers from some
developing countries would love to adopt best practices for
hand hygiene, financial resources is a major factor (Bukhari et
al., 2011; Pfoh, Dy, & Engineer, 2013)
In the recent past, studies in Croatia indicated that when it came
to general hygiene especially hand washing when caring for
patients at the health care centers most of the nurses and other
health care providers did not meet the set of the World Health
Organization (WHO) hygiene standards (Krleza et al., 2015). In
addition, the inconsistent aseptic handling of capillary blood
sampling especially dirty and infected hands reduced the
chances of getting accurate analysis from the blood sample tests
carried out (Krleza et al., 2015). Consequently,
recommendations for promotion of hygiene are proposed by the
researchers that include washing of the hands so as to reduce
contamination of the blood samples that are collected.
Research also indicates that every year at least 290 000 surgical
site infections are caused by the health care associated
infections (Tsai & Caterson, 2014). Every year at least 1.7
million patients suffer tertiary infections that are as a result of
health care associated infections. Furthermore, the results
indicate that the health care system spends at least $45 billion
every year on the treatment of surgical site infections that are
caused due to health care associated infection (Tsai & Caterson,
2014). These statistics are staggering in terms of the amount of
money that is spent on resultant infections that can easily
prevented. Furthermore, hand washing is considered as one of
the major causes of surgical site infections especially during
post-operation health care provisions (Tsai & Caterson, 2014).
Most of the health care officials are usually overwhelmed with
the long hours of working shifts that some of the essential
aseptic procedures are overlooked during caring for the
patients’ wounds (Aiken, Karuri, Wanyoro, & Macleod, 2012).

4. According to Aiken et al (2012), most of the surgeries carried
out in Sub- Saharan Africa are usually high risk because of the
challenges that the health care providers face when it comes to
maintenance of hygiene in the course of their work.
Furthermore, the research indicated that some of the
disinfectants that are to be used pre and post operation are not
readily available given the high costs health centers incur when
purchasing them (Kargupta et al., 2015). Alternatives such as
alcohol and other aerosolized forms of disinfectants would be
more appropriate in disinfecting the hands because they are
readily available and are abundant in quantity. Therefore, it was
suggested that the hospitals resort to using some of the cheap
methods of disinfecting their instruments and well as using
alcohol runs as hand wash given that it is cheap and it is readily
available (Aiken et al., 2012). Furthermore, during post-
operation care hygiene is paramount given that it hastens the
recovery of patients and it further reduces their susceptibility to
surgical site infections that are the key cause of some of the
mortality cases witnessed in Sub Saharan Africa (Aiken et al.,
2012)
Intravenous medication delivery has also been noted to suffer
contamination especially given that some of the health care
providers practice inconsistent aseptic techniques (Moureau &
Flynn, 2015). Aseptic techniques include washing of the hands,
disinfection of the needleless connectors, and use of anti-
infective agents so as to reduce the risk of contamination;
intravenous infections that have occurred as a result of
contamination of the needleless connectors (Moureau & Flynn,
2015). The fact that the intravenous medication delivery is
directly in contact with the veins of a person it increases the
chance of infections that can be severe and in some cases fatal;
therefore, it is important for consistent aseptic techniques to be
carried out so as to ensure that the cases of contamination of
intravenous medication delivery reduced to a minimum
(Moureau & Flynn, 2015).
Preliminary Conclusions

5. This study has the primary objective of identifying and
assessing the behaviors and factors affecting the practice of a
simple intervention that is “hand hygiene” as practiced by
healthcare practitioners (Davies, 2011). The study question
is;does hand washing and appropriate staff dressing among the
surgical ward nurses reduce cross infection during patient
management? Research identifies the factors that motivate and
those that affect the hand washing practice among health care
providers (Davies, 2011). The gaps identified are meant to
assist the healthcare management team and infection control
units to develop appropriate measures for the implementation of
hand washing policies and a translated reduction in the rates of
hospital acquired infections (Davies, 2011).
summary
There is a need for strategies that emphasize or remind the
health care practitioners about hand washing; these include
pinning of charts about hand washing at strategic points,
provision of sufficient hand hygiene products, periodic classes
on hand washing and an introduction of penalties for non-
compliance.
Citation
Type of Study
Design Type
Framework/Theory
Setting
Key Concepts/Variables
Findings
Hierarchy of Evidence Level
Aiken, A. M., Karuri, D. M., Wanyoro, A. K., & Macleod, J.
(2012). Interventional studies for preventing surgical site
infections in sub-Saharan Africa. International Journal of
Surgery, 242-249. Doi: 10.1016/j.ijsu.2012.04.004
Type of Study:
Quantitative

6. Design Type:
Systematic review
Framework/Theory: Interventional studies can reduce the post
surgical site infections
Sub-Saharan Africa
Post-operative surgical site infections increase the risk of
mortality.
Use of single dose pre-operative antibiotic prophylaxis reduces
the chances or the risk of surgical site infections during post-
operation care.
Alcohol-based hand rubs served as low cost and readily
available alternatives to the traditional surgical hand wash.
Level V
Kargupta, R., Hull, G. J., Rood, K. D., Galloway, J., Matthews,
C. f., Dale, P. S., & Sengupta, S. (2015). Foaming Betadine
Spray as a potential agent for non-labor-intensive preoperative
surgical site preparation. Annals of Clinical Microbiologicaland
Antimicrobials. doi: 10.1186/s12941-015-0076-2
Type of Study: Quantitative Research
Design Type:
Experimental Research

7. Framework/Theory:
Effective Surgical Site preparations allows for faster and
uncomplicated recovery
Setting:
Clinical based experiments
Concepts:
Importance of surgical site preparation
Findings
Surgical Site preparation reduces risk of surgical site infections
pre and post surgical operation.
Aerosolized form of antisepticdelivery was more efficient that
traditional forms of the
Alcohol-based hand rubs served as low cost and readily
available alternatives to the traditional surgical hand wash.
Level II
Citation
Study
Design Type
Framework/Theory
Setting
Key Concepts/Variables
Findings
Hierarchy of Evidence Level
Krleza, J. L., Dorotic, A., Gruznov, A., & Maradin, M. (2015).
Capillary blood sampling: national recommendations on behalf

8. of the Croatian Society of Medical Biochemistry and Laboratory
Medicine. Biochemia Medica, 335-358.
doi: 10.11613/BM.2015.034
Type of Study: Qualitative Research
Design Type: Cross-sectional
Framework/Theory:
Capillary blood sampling is important in receiving the best
sample tests.
Croatian hospitals.
Concepts:
Best capillary blood handling gives better and accurate results
of the tests being undertaken
Independent Variable: Aseptic techniques
Dependent Variable: Sample test results
Controlled Variable:
Capillary blood samples
Few hospitals complied with the WHO requirements for
capillary blood sample handling.
Alcohol use in hand washing reduces sample contamination.
Aseptic techniques in blood sampling handling increases test
results accuracy
Level III
Moureau, N. L., & Flynn, J. (2015, May 14). Disinfection of

9. Needleless Connector Hubs: Clinical Evidence Systematic
Review. Nursing Research and Practice. Doi:
http://dx.doi.org/10.1155/2015/796762
Type of Study: Qualitative Research
Design Type: Systematic Research
Framework/Theory: Break in aseptic techniques increases the
chances of contracting infections resulting from the
contaminations of the catheters.
Different Nursing databases were used in the experiment that
had relevant literature concerning the area of study
Concepts:
Needleless connectors are responsible for at least 50% of
infections through because of inconsistent aseptic processes.
Controlled Variable:
Capillary blood samples
Aseptic techniques reduced the chances of contaminating
intravenous medication while treating a patient.
Passive disinfection caps reduced the risks of contaminating the
catheters used for intravenous medication delivery
Level III
Tsai, D. M., & Caterson, E. J. (2014, October 11). Current
preventive measures for health-care associated surgical site
infections: a review. Patient Safety in Surgery. Doi:
10.1186/s13037-014-0042-5
Type of Study

10. Qualitative Study
Design Type
Mixed method
Framework/Theory
Healthcare Associated infections are very costly to not only to
the hospital but to the patients.
Various nursing database were used with literature concerning
the salient issues on Healthcare associated infections.
Exemplary hygiene ensures that healthcare associated infections
are reduced if employed at every stage.
Independent variable : Maintenance of hygiene
Dependent variable :
Healthcare Associated Infections
Surgical site infections lead to at least 290 000 Healthcare
associated infections and cause about 8000 deaths every year.
$45 billion is spent annually to treat healthcare associated
infections that could have been prevented.
Level V

11. References
Aiken, A. M., Karuri, D. M., Wanyoro, A. K., & Macleod, J.
(2012). Interventional studies for preventing surgical site
infections in sub-Saharan Africa. International Journal of
Surgery, 242-249. Doi: 10.1016/j.ijsu.2012.04.004
Al-Khawaldeh, O., Al-Hussami, M., & Darawad, M. (2015).
Influence of Nursing Students Handwashing Knowledge,
Beliefs, and Attitudes on Their Handwashing Compliance.
Scientific Research Publishing. Doi:
http://dx.doi.org.ezp.waldenulibrary.org/10.4236/health.2015.75
068
Bukhari, S., Hussain, W., Banjar, A., Almaimani, W., Karima,
T., & Fatani, M. (2011). Hand hygiene compliance rate among
healthcare professionals. PubMed - NCBI. Ncbi.nlm.nih.gov.
Retrieved 1 April 2016, from
http://www.ncbi.nlm.nih.gov/pubmed/21556474
Davies, K. S. (2011). Formulating the evidence-based practice
question: A review of the frameworks. Evidence-Based library
and information Practice, 6 (2), 75–80. Retrieved from
https://ejournals.library.ualberta.ca/index.php/EBLIP/article/vie
wFile/9741/8144
Fouka, G., & Mantzorou, M. (2011). What are the major ethical
issues in conducting research? Is there a conflict between the
research ethics and the nature of nursing? Health Science
Journal, 3-14.
Kargupta, R., Hull, G. J., Rood, K. D., Galloway, J., Matthews,

12. C. f., Dale, P. S., & Sengupta, S. (2015). Foaming Betadine
Spray as a potential agent for non-labor-intensive preoperative
surgical site preparation. Annals of Clinical Microbiologicaland
Antimicrobials. doi: 10.1186/s12941-015-0076-2
Krleza, J. L., Dorotic, A., Gruznov, A., & Maradin, M. (2015).
Capillary blood sampling: national recommendations on behalf
of the Croatian Society of Medical Biochemistry and Laboratory
Medicine. Biochemia Medica, 335-358.
DOI: 10.11613/BM.2015.034
Moureau, N. L., & Flynn, J. (2015, May 14). Disinfection of
Needleless Connector Hubs: Clinical Evidence Systematic
Review. Nursing Researcj and Practice. Moureau, N. L., &
Flynn, J. (2015, May 14). Disinfection of Needleless Connector
Hubs: Clinical Evidence Systematic Review. Nursing Research
and Practice. Doi: http://dx.doi.org/10.1155/2015/796762
Newcomb, P. (2010). Evolving fairness in research on human
subjects. Journal of Child and Adolescent Psychiatric Nursing,
123-124. doi: 10.1111/j.1744-6171.2010.00233.x
Pfoh, E., Dy, S., & Engineer, C. (2013). Interventions to
improve hand hygiene compliance: Brief update review. Agency
for healthcare research and quality (US). doi: 10.1136/bmjqs-
2012-001769
Polit, D., & Beck, C. T. (2012). research: Generating and
assessing evidence for nursing practice. Philadephia, PA:
Lippincott Williams and Wilkins.
Tsai, D. M., & Caterson, E. J. (2014, October 11). Current
preventive measures for health-care associated surgical site
infections: a review. Patient Safety in Surgery. Doi:
10.1186/s13037-014-0042-5

13. Walden University M.S. in Nursing
Formative Evaluation Criteria for Applications and Formal
Papers
Categories and Criteria
Points
QUALITY OF WORK SUBMITTED - 35 Possible Points
1. The extent to which work meets the assigned criteria and
work reflects graduate level critical and analytic thinking
(0-30 Points)
Assignment exceeds expectations. All topics are addressed with
a minimum of 75% containing exceptional breadth and depth
about each of the assignment topics.
25-30
Assignment meets expectations. All topics are addressed with a
minimum of 50% containing good breadth and depth about each
of the assignment topics.
20-24
Assignment meets most of the expectations. One required topic
is either not addressed or inadequately addressed.
16-19
Assignment superficially meets some of the expectations. Two
or more required topics are either not addressed or inadequately
addressed.
0-15
2. Purpose of the paper is clear
(0-5 Points)
A clear and comprehensive purpose statement is provided which
delineates all required criteria.
5

14. Purpose of the assignment is stated, yet is brief and not
descriptive.
4
Purpose of the assignment is vague.
1-3
No purpose statement was provided.
0
ASSIMILATION AND SYNTHESIS OF IDEAS - 50 Possible
Points
The extent to which the work reflects the student’s ability to-
1. Understand and interpret the assignment’s key concepts
(0-10 Points)
Demonstrates the ability to critically appraise and intellectually
explore key concepts.
9-10
Demonstrates a clear understanding of key concepts.
8
Shows some degree of understanding of key concepts.
5-7
Shows a lack of understanding of key concepts, deviates from
topics.
0-4
2. Apply and integrate material in course resources (i.e. video,
required readings, and textbook) and credible outside resources
(0-20 Points)
Demonstrates and applies exceptional support of major points

15. and integrates 2 or more credible outside sources, in addition to
3-4 course resources to support point of view.
15-20
Integrates specific information from 1 credible outside resource
and 3 to 4 course resources to support major points and point of
view.
10-14
Minimally includes and integrates specific information from 2-3
resources to support major points and point of view.
3-9
Includes and integrates specific information from 0 to 1
resource to support major points and point of view.
0-2
3. Synthesize (combines various components or different ideas
into a new whole) material in course resources (i.e. video,
required readings, and textbook) by comparing different points
of view and highlighting similarities, differences, and
connections. (0-20 Points)
Synthesizes and justifies (defends, explains, validates,
confirms) information gleaned from sources to support major
points presented. Applies meaning to the field of advanced
nursing practice.
18-20
Summarizes information gleaned from sources to support major
points, but does not synthesize.
16-17
Identifies but does not interpret or apply concepts, and/or
strategies correctly; ideas unclear and/or underdeveloped.
14-15

16. Rarely or does not interpret, apply, and synthesize concepts,
and/or strategies.
0-13
This assignment provides an opportunity to apply psychological
theory in the exploration of a book or film. Students choose a
film or book of special interest. The book or film should have
content that can be meaningfully explored through application
of psychological theory and research. Students can look at some
of the later chapters in the text that deal with emotion,
motivation, personality, the development of the individual over
the life span, health and stress, and psychological disorders and
treatment, so that they have a more complete idea of different
concepts that might apply.
Students might pick a movie or book in which the main
character suffers from a psychological disorder or is merely
trying to cope with the everyday stress of life. Students might

17. discuss defense mechanisms or refer to developmental stages in
the person's life that might have been important, or consider the
effects of abuse, alcoholism and addiction, etc. Students can
approach the subject matter from different perspectives—
psychoanalytical, biological, behavioral, cognitive, and/or
sociocultural. They can discuss the role emotion, memory, or
motivation plays in the character's development, or the
importance of the environment, and influences such as racism
and sexism.
This is a research-based paper, and the film or book provides
only the backdrop for research on a psychological topic. You
should use at least one psychological, peer-reviewed reference
in addition to the textbook.
The paper should be 1,200 to 1,500 words and in APA format. I
was thinking of a movie on Good Will Hunting or something
similar. Let me know if this is something you are interesting in
and if 45 dollars is a reasonable price.
Running Head:IDENTIFYING A RESEARCHABLE PROBLEM
1
IDENTIFYING A RESEARCHABLE PROBLEM
9
Identifying a Researchable Problem
Name
Institution
Course Name
April 3, 2016

18. Identifying a Researchable Problem
Hundreds of millions of patients worldwide are affected by
healthcare associated infections every year. The infections lead
to severe illnesses, long-term disabilities, prolonged hospital
stays and added costs to patients, their families, and the
healthcare system. Hand hygiene is the primary action to reduce
the number of healthcare-acquired infections; a simple action
maybe, but the compliance rates among the healthcare providers
is the main problem. The purpose of this paper is to provide a
summary on the issue of handwashing non compliance amongst
healthcare workers and its relation to nosocomial infections.
This paper will also generate five questions and describe how
they are analyse for feasibility, as well as a PICOT question and
a description of its variable. Additionally, ten keywords will be
developped to help conduct the literature search.
Problem Identification
A crucial factor in selecting a problem is its significance to
nursing and evidence from the study should have potential to
contribute meaningfully to nursing practice ( Polit & Beck,
2012). Nurses comprises of 55% of the healthcare workforce
and number more than 3 million, as such represent the most
critical group in hand higiene compliance as they spent the most
time with the patients (McGonigle & Mastrian, 2012). Hand

19. hygiene is a critical practice aimed at keeping the hands clean
and free from pathogens or reduce the amounts before
performing any medical procedure or touching a patient.
Practicing hand hygiene is important in the prevention of cross
infection in clinical settings. Healthcare workers need an easy
to use, timely access to both skin protection and hand hygiene
for good hand hygiene practice.
Studies show that most nosocomial infections are transmitted
through the hands of healthcare practitioners. It is well-known
that better hand hygiene practices among healthcare workers
play a critical role in the prevention of transmission of
infectious agents (Pittet, Allegranzi & Boyce, 2009). The
practice of hand washing is one of the most effective ways of
preventing the transmission of infectious diseases, but despite
the implementation of the Centers for Disease Control and
Prevention guidelines for hand hygiene, the compliance among
health practitioners remains low (Pittet, Allegranzi & Boyce,
2009).
Hand washing is a critical element of patient safety as it
prevents healthcare associated infections as well as the spread
of antimicrobial resistance. The promotion of hand hygiene,
therefore, presents a common challenge that calls for a
multimodel strategy. Healthcare worker’s adherence to hand
washing guidelines is poor and calls for a behavior change.
Most studies have recommended multimodal strategies that
include education of healthcare workers, audit and performance
feedback practices, increased supply of water and soap,
reminders, use of automated sinks and the use of alcohol-based
hand rub (Pfoh, Dy, & Engineer, 2013).
Hospital-acquired infections carry a far-reaching and real threat
to every individual admitted to hospitals. The pathogens from
the hands of the healthcare workers are readily transmitted to
the patients hence hand hygiene practices substantially reduce
this chance. Evidence-based guidelines for hand hygiene in
clinical practice are very clear, but the compliance remains
internationally low (Bukhari et al., 2011).

20. Significance of the Problem of Nursing Practice
Hand hygiene is considered as the most simple and the most
effective way of preventing hospital-acquired infections.
Despite the milestones and achievements made in epidemiology
and infection control, the hygiene message has not been
consistently translated into medical practice, and the healthcare
workers adherence to the guidelines for hand hygiene is
unacceptably low. (Bukhari et al., 2011). The average
compliance with the hand washing guidelines varies from the
patient wards, among health care workers categories and based
on the working conditions, but also varies according to the
different definitions used in different studies (Pittet, Allegranzi,
& Boyce, 2009).
Compliance with hand-washing recommendations is a very
significant measure in the prevention of hospital-associated
infections. Studies report that transmission of pathogens from
the hands of healthcare workers is one of the primary sources of
cross-infection in clinical settings and can be prevented by
proper hand hygiene practices (Bukhari et al., 2011). There are
cases of very low or insufficient compliance rates in developing
and developed countries with the mean baseline rates of
between 5% and 89% making an overall average of 38.7%
(Bukhari et al., 2011).
Variation in hand washing behavior across healthcare workers
and hospital wards suggests the need for a strategic educational
program. Nosocomial infections are a significant cause of
complications in the ICU; and hand-washing being the single
most effective preventive measure, the compliance rates remain
low (Bukhari et al., 2011). The association between
handwashing non-compliance and surgical wards may also
suggest a fact that understaffing reduces the quality of patient
care. Hand washing has a proven benefit in the prevention of
cross-infection. Hence the compliance, especially in the surgical
and ICU wards, is paramount (Royal Pharmaceutical Society,
2014).
Studies and estimations by the World Health Organization

21. (WHO) show Healthcare-associated infections affect at least
1.4million patients on the global scale at any given time. In the
surgical units, the burden of hospital acquired infections has
significantly increased, leading to increased morbidity and
mortality. In some instances, multidrug resistant pathogens are
involved or are part of the infection, hence pose a challenge to
effective treatment (Pittet, Allegranzi & Boyce, 2009). Proper
hand hygiene is the simplest, single most important and the
least expensive means of preventing the cross infections. The
WHO and CDC (2009) guidelines on hand hygiene also propose
the use of alcohol base hand rub as a means for routine hand
disinfection.
Questions Related to the Identified Issue
1. What are the hand hygiene practices among Healthcare
workers?
Rationale
It is important to assess the types of hand hygiene practices
commonly used by healthcare workers so as to determine the
choices available and the recommended practices
2. What are the reasons for non-compliance with hand hygiene
practice?
Rationale
It has been noted that there is moderate to low rates of
compliance with standard hand hygiene practices among
healthcare workers. It is, therefore, important to get to know the
reasons behind the non-compliance.
3. What are the alternative hand hygiene practices?
Rationale
There exist more than one hand hygiene techniques from which
healthcare workers can choose preferred as well as the simplest
and most efficient method of hand hygiene practice.
4. What are the disparities in hand hygiene practices among
different healthcare workers?
Rationale
The non-compliance to hand hygiene practices vary across the
various cadres, ages and experience of health personnel. It is

22. important to know the personal factors that are attributed to the
variation between the different categories of health workers.
5. What can be done to improve hand hygiene practices in
healthcare?
Rationale
It is also important to assess the actions that can be taken to
encourage hand hygiene practices in healthcare.
The most appropriate question from the above-related questions
is; does hand washing and appropriate staff dressing among the
surgical ward nurses reduce cross infection during patient
management?
Description of the PICOT Question
The PICOT question is: Does hand washing and proper staff
dressing among the surgical ward nurses reduce cross infection
during patient management? The elements of the table are:
P- (Patient, population, or problem): nurses, hospitalized
patients
I- (Intervention): hand washing and appropriate dressing
C- (Comparison with other treatment/current practice): Nurses
forget to wash their hands when switching from one patient to
the other
O- (Desired outcome): Reduced incidences of cross infection
(Davies, 2011)
Ten Possible Keywords that Could Be Used When Conducting a
Literature Search for PICOT Question and A Rationale for Your
Selections
1. “Hand washing."
Rationale
Knowing the definition and practice of hand washing
2. “Hand hygiene."
Rationale
Alternative comprehensive description of clean hands
3. “Cross-infection”
Rationale
Assessing the effects of poor hand hygiene and its contribution
to transmission of micro-organisms from one person to the

23. other.
4. “Healthcare workers."
Rationale
The population or persons who participate in the study
5. "Healthcare-acquired infections."
Rationale
The results of transmission of micro-organisms through
unhygienic hands
6. “Hand washing guidelines."
Rationale
What are the recommended hand washing practices for
healthcare workers?
7. “Hand washing nonconformance”
Rationale
The percentage of conformity to the hand washing guidelines
8. "Hand hygiene strategies."
Rationale
The methods used to promote hand hygiene
9. "Nosocomial infections"
Rationale
The most common infection transmitted through unhygienic
hands in the ICU
10. “Hand hygiene and cross-infections."
Rationale
Determining hand hygiene and the relationship with cross
infections
Conclusion
Studies consistently show that better hand hygiene reduces the
risks of cross contamination and nosocomial infections in
Hospitals. Since most of the cross infections are thought to be
transmitted through the dirty hands of healthcare workers, an
assessment of the knowledge, attitude and practice of them is
also necessary. Hospital-acquired infections carry a serious and
real threat to all the patients admitted to hospitals, hence the
assessment of healthcare worker’s hand hygiene practices is
equally very significant.

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25. http://dx.doi.org/10.1211/pj.2014.11137491