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Running head: hand hygiene compliance1
hand hygiene compliance8Hand Hygiene Education
Implementation and Nurses Compliance in Reducing
Nosocomial Infections
Grand Canyon University NRS-490
March 31, 2019
Background
Hygiene is a very crucial factor in prevention of infection in
any health care facility. Also, compliance of handwashing
ensures patients safety, aids in the treatment and recovery of
hospitalized patients. Hand hygiene is important action
performed by healthcare works to prevent transmission of
healthcare associated infection (Smiddy, O’Connell & Creedon,
2015). Health care professionals such as doctors, nurses,
physical therapist and laboratory technicians, take the
responsibility of providing efficient, effective and quality care
that will improve the health of their patients.
The purpose of this paper is to discuss the change proposal
project components the author has been working on throughout
the course. The goal of health care works rendering a quality,
effective and efficient care to their patient in the health care
setting will be difficult to achieve if the rate handwashing
adherence is below expectation. Unclean healthcare
environments harbor germs that can cause disease, thereby
placing the patient at risk of developing infection instead of
recovering from their present health condition. Healthcare
providers inability to comply with hand hygiene is one the main
reason patient develop hospital acquired infections (HAIs).
Healthcare employees have the lives of patient in their hands
therefore, hand hygiene should not by any means be neglected
or dominated out in any healthcare facility.
Approximately 250 health care specialists in a Metro Detroit
facility happened to be watched and assessed directly; prior to
the start of the exercise, participants were selected based on
their hand washing comprehension and compliance. Partakers
expresses that they observed improvement on handwashing
practices and that most nurses complied to hand washing
guidelines evidenced by some significant reductions in the rate
of transmission of HAIs within the healthcare facility. HAIs are
the infections a patient acquire during the period of
hospitalization. The result of the research showed a huge
decrease in the spread of nosocomial infections due to progress
of hand hygiene training and nurses’ compliance to
handwashing protocols. These infections mostly manifest during
or after 48 hours of admission or thirty days after discharge
from the hospital or health-care facility. The author of this
research study sees HAIs as a dangerous disease with many
complications. Because inadequate handwashing practices by
healthcare workers are the main cause of spread of hospital
acquire infections, it is important to educate staff members on
proper hand hygiene, implement plan to encourage hand hygiene
compliance in the healthcare settings. Blood-stream, ulcers /
surgical wounds, CAUTI and respiratory infections are the most
common types of HAIs
Problem Statement
Good hand hygiene practice is one of the essential factors in
planting an end to cross infections and HAIs. However
inadequate handwashing among healthcare providers leads to
transmission of infection from one patient to another and they
end up contacting the infection and it keeps spreading. (Hinz,
McGee, Huitema, Dickinson, & Van Enk, 2014). The necessity
of handwashing and adherence in the hospital setting is to
facilitate the reduction of HAIs. Some healthcare corporations
that are known to be very compliant with handwashing
guidelines maintains the high hygiene level and generally have
a good treatment that guarantees powerful healthcare system
that assist with the standard health and wellbeing of patients. In
order to secure patient safety, all health care environment
should be kept clean at any given time. When health care
facilities are clean, micro organism have no place to grow
which will prevent or reduce the extent at which nosocomial
infections spreads.
Healthcare workers in Detroit Medical Center were examined
for a reduction in nosocomial infections via hand hygiene
teaching and adherence monitoring. The writer noted that most
healthcare workers do not adhere to handwashing because of
lack of education. Some of them complained that they don’t
have time to practice hand hygiene as a result of lack of
handwashing equipment, high patient ratio, skin irritation and
lack of hand hygiene monitoring. Nosocomial infection is
defined as infection a patient contracted during their stay in the
hospital (Thoa et al., 2015). This infection is very harmful and
can jeopardize patient safety. Nosocomial infection is very
common and occurs everyday in the hospital, while it can be
avoided if the healthcare workers are compliant with hand
hygiene protocols within the facility and when providing patient
care. Evidence has shown that facilities where caregivers do not
practice adequate hand hygiene results to distribution of
nosocomial infections.
When healthcare workers neglect handwashing, they pose
dangers of acquiring infection to patients and others. Nurses are
the closest to patients and their hands are always on the patient
when providing care therefore, inadequate hand hygiene is the
leading cause of spread of nosocomial infection. This problem
is the reason why the researcher wants to know if in an acute
care setting healthcare providers(P) will implement hand
hygiene education and compliance (I) on hand hygiene
practice(C) to decrease nosocomial infections (O) within four
weeks period(T).
Purpose of the Change Proposal
It is the responsibility of all healthcare providers to advocate
for every patient to make sure that each person obtains safe,
efficient, effective and quality healthcare services. Also,
healthcare providers should endeavor to work as a team to
provide solution that will improve the overall well-being of the
patient. Moreover, it will be difficult to accomplish this aim if
the healthcare environment increases the chance of contracting
the infection as a result of noncompliance of hand hygiene
practices. Handwashing practice is the cheapest and simple
precaution that prevents spread of nosocomial infections in the
hospital and healthcare workers must observe adequate
handwashing while rendering patient care. There are so many
explanations for noncompliance of handwashing among
healthcare workers such as, unawareness, working overtime
which may cause burnout. Additionally, laying emphasis on the
change proposal which targets to encourage compliance of hand
hygiene and education will inspire healthcare workers to
observe hygiene at its peak, therefore reducing the rate at which
nosocomial infection is being transmitted. Reducing expenses
and medical cost utilized to treat complication developed from
nosocomial infection is one of the objectives for the proposed
change. The hand hygiene program is an effective strategy in
reducing the incidence of hospital-acquired infections and is
cost-effective (Thoa et al., 2015).
Nosocomial infection delays treatment in the hospital but when
the rate of spread is reduced, the hospital will have brief length
of stay patient are hospitalized because the process of treatment
will be faster and not delayed. This will make bed available for
other patient who need it for critical conditions. With few ill
patients in the healthcare settings nurses, doctors, lab
technicians and other healthcare providers will pay attention
and take them serious thereby achieving the aim of providing
safe, effective, efficient and quality healthcare services. World
Health Organization published guidance on a standardized
multistep technique to promote coverage of all surfaces of the
hands with hand hygiene product, estimating 20–30 seconds for
hand rubbing, Wash hands with warm or cold water. “There is
no evidence that warm water is superior to cold water, although
tepid water may be better tolerated” (Ellignson et al.2014).
PICOT
Many researchers use this acronym PICOT to expand their
research question(s). P- signifies problem/population/patents, I-
represent intervention to fix the problem, C- denotes
comparison or opposite of the intervention. O- means the
outcome and finally T symbolizes the timeframe used to achieve
the desired outcome(s). utilizing the project change proposal,
the recognized population provided in this research comprises
of healthcare workers in the acute care setting. Intervention in
the study is the implementation of education on hand hygiene.
Comparison is the hand hygiene practice compliance. The
study’s outcome is the decrease in spread of nosocomial
infection and the time to achieve this is four weeks. The PICOT
used for the change proposal identified is for healthcare workers
in the acute care setting(P), hand hygiene education
implementation(I) and compliance to hand hygiene practices(C)
decreasing nosocomial infections (O) for the period of four
weeks (T).
Literature Search Strategy Employed
The author utilized the research plan to search for literature
from various database that is linked to the project topic.
Essential information related to the topic were gathered from
the numerous research plan. The researcher used PICOT to
create the research question, this makes it easy to select vital
evidence on techniques in which healthcare providers in the
acute care setting can prevent the spread of nosocomial
infection and comply to hand hygiene guidelines. The authors
concentration was focused on identifying some current studies
in respect to education on handwashing compliance and
prevention of nosocomial infections. Cochrane and MEDLINE
are outstanding database online question that was used for the
search plan.
Evaluation of the Literature
High quality research literature was used to conduct this study
which is pertinent to the problem statement, for example, Lawal
et al., (2018) article is the research study learning about hand
hygiene practices in the healthcare facility in a semi-urban
setting, reply to the research question on how the knowledge
and practices of hand hygiene among healthcare worker
decrease nosocomial infection. Nurses knowledge on the correct
technique involved in hand hygiene is deficient. Niyonzima, V.,
Brennaman, L., & Beinempaka, F. (2018) article is the research
study on availability and suitability of essential hand washing
facilities, assess essential handwashing practice compliance
among healthcare workers. The choice of literature the
researcher used is in line with the statement of problem hence
supplying essential data to the research study.
Applicable Change or Nursing Theory Utilized
Non-compliance of adequate hand hygiene practices among
acute care nurses illustrates that it is crucial to have an
intervention available to help improve the knowledge of
healthcare workers on the importance of hand hygiene and
adherence. Since substantial number of healthcare workers
response is poor, the change applied can assist in reducing the
problem which requires finding out why the acknowledgment to
adequate hand hygiene practice is deficient. Nurses will be well
informed and educated on the benefits of hand hygiene if they
are aware and implement the theories in behavioral changes
which is very vital in successful program application of
decreasing the rate of nosocomial infections. Knowing hand
hygiene behavior assumes and predict attitude of an individual
with the help of planned behavioral theory.
Proposed Implementation Plan
It is very imperative to practice the standard precautions that
will help promote hand hygiene. Hand hygiene compliance is
the basis of infection control programs (Phan et al., 2018). The
author suggested intervention for this research includes,
explaining the importance of educating healthcare providers to
carry out hand hygiene protocols appropriately while providing
patient care. Seminars on hand hygiene compliance should be
conducted to help nurses to work together as a team and come
up with the thoughts that can assist with the practice of hand
washing such as wearing gloves, placing hand sanitizers at the
major locations like patient’s door, hallway, breakroom, around
the computer and the nurse’s station.
It is recommended to perform hand hygiene before touch a
patient, before clean procedure, after touching a patient, when
hands are visibly dirty and after touching the environment (Lau,
Tang, Mak & Leung, 2014). These strategies will enhance hand
hygiene compliance among healthcare workers. The success of
this project was assessed using quiz, posters and monitors. The
study is evaluated every week for consecutive four weeks to
check the progress of hand hygiene training and compliance
protocols likewise decrease of hospital acquired infections.
Results are compared every week with initial result at the
beginning of the project and summarized. There was reduction
in nosocomial infection because of compliance of adequate hand
hygiene.
Potential Barriers to Plan Implementation
Negligence, laziness and non-compliance to adequate hand
hygiene protocol are among the behaviors that hinders the
success of the proposed change to encourage the standard rules
of adequate hand hygiene in the acute care setting. It might be
difficult for healthcare providers to adjust to the change thereby
delaying the intended plan to enhance sanitation. Leaders and
managers should provide support, filter ideas, and remove
barriers to implementation of best practices identified by
positive deviants for improving hand hygiene compliance
(Marra & Edmond, 2014). Healthcare providers are to be
prompted of their duty to render safe, effective, efficient and
quality patient care. To achieve this goal, it is imperative to
comply to hand hygiene practices.
Evidence of Revision
Evidence based practice is an approach which involves many
stages that require thorough check and finances to function
well. My mentor and I will make a detailed budget of how the
method will work. Everything should be planned within the
budget made by the financial manager. Every step is taken
keenly for the practice to function well. Since my project is on
hand hygiene, the finances of the evidence-based practice will
be high. Money is needed to set up a facility more hand
sanitizer dispensers and portable hand sanitizers and pocket
hand lotions stationed at work stations which is conducive for
nurses who use the area. The finances may come from donors,
well-wishers, investors and the government.
Conclusion
To goal of standard health care service is to improve patient
outcome, safety and wellbeing and not to expose them to
nosocomial infection. Globally, nosocomial infection is a major
concern in the healthcare setting and the key cause of poor
handwashing, which can be prevented by adequate hand hygiene
practices. Hand hygiene is the most cost effective, inexpensive
and easiest measures toe reduce or prevent nosocomial infection
in the healthcare settings. Hand hygiene education should be
encouraged in the acute care setting to reduce the rate
individual contracts and transmit nosocomial infection.
References
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.
Hinz, K. L., McGee, H.M., Huitema, B. E., Dickenson, A. M., &
Van Enk, R. A., (2014).
Observer accuracy and behavior analysis: Data collection
procedures on hand hygiene compliance in a neurovascular unit.
American Journal of Infection Control, 42 (10),
1067-1073.
Lau, T., Tang, G., Mak, K. L., & Leung, G. (2014).
Moment‐specific compliance with hand hygiene. The clinical
teacher, 11(3), 159-164.
Lawal, T. O., Monsudi, K. F., Zubayr, B. M., Michael, G. C.,
Duru, C., Ibrahim, Z. F., & Aliyu, I. (2018). Hand hygiene
practices among nurses in health facility in a semi-urban
setting. International Journal of Health & Allied Sciences, 7(3),
191.
Marra, A. R., & Edmond, M. B. (2014). New technologies to
monitor healthcare worker hand hygiene. Clinical Microbiology
and Infection, 20(1), 29-33.
Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018).
Practice and compliance of essential handwashing among
healthcare workers at a regional referral hospital in Uganda: A
quality improvement and evidence-based practice. Canadian
Journal of Infection Control, 33(1), 33-38.
Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo,
H. T., Theorell-Haglow, J., & Gordon, C. J. (2018). An
educational intervention to improve hand hygiene compliance in
Vietnam. BMC infectious diseases, 18(1), 116.
Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T.,
Wertheim, H. F., & Son, N. T. (2015). Cost-effectiveness of a
hand hygiene program on health care–associated infections in
intensive care patients at a tertiary care hospital in Vietnam.
American journal of infection control, 43(12), e93-e99.
Appendix A
Quiz on hand hygiene
1. Hand washing noncompliance among healthcare providers
can be transmitted through inadequate hand hygiene?
A. True
B. False
2. it is recommended to wash hand with soap and water for how
long?
A. 30 Seconds
B. 10 Seconds
C. 20 Seconds
D. 5 Seconds
3. When is the right time to perform hand hygiene? Select all
that apply.
A. Before eating
B. After coughing, sneezing or nose blowing
C. After using the bathroom
D. Before and after each patient care
E. All of the above
4. How can transmission of germs be avoided?
A. Wearing mask
B. Avoid touching sick people
C. Practicing hand hygiene
D. Staying away from others
5. Healthcare provided are required to wash their hand before
each patient contact?
A. True
B. False
6. Hand hygiene education implementation encourage hand
washing practice adherence?
A. True
B. False
Appendix B
Author- Brain Grease Retrieved from www.1st-in-
handwashing.com Hand washing Poster
Rate of Nosocomial Infections Before Implementation of Hand
Hygiene Education
Week 1Week 2Week 3Week4200400500600Week 1Week 2Week
3Week4180300480500Week 1Week 2Week
3Week4160240440400Week 1Week 2Week
3Week4120220420380
Rate of Nosocomial Infections After Implementation of Hand
Hygiene Education
Week 1Week 2Week 3Week 41408010080Week 1Week 2Week
3Week 4120608060Week 1Week 2Week 3Week
4100406040Week 1Week 2Week 3Week 480204020
Rubic_Print_FormatCourse CodeClass CodeAssignment
TitleTotal PointsNRS-490NRS-490-O500Benchmark - Capstone
Project Change Proposal300.0CriteriaPercentageUnsatisfactory
0-71% (0.00%)Less Than Satisfactory 72-75%
(75.00%)Satisfactory 76-79% (79.00%)Good 80-
89% (89.00%)Excellent 90-100%
(100.00%)CommentsPoints
EarnedContent60.0%Background5.0%Background section is not
present.Background section is present, but incomplete or
otherwise lacking in required detail.Background section is
present. Some minor details or elements are missing but the
omission(s) do not impede understanding.Background section is
present and complete. The submission provides the basic
information required.Background section is present, complete,
and incorporates additional relevant details and critical thinking
to engage the reader.Problem Statement5.0%Problem statement
is not present.Problem statement is present, but incomplete or
otherwise lacking in required detail.Problem statement is
present. Some minor details or elements are missing but the
omission(s) do not impede understanding.Problem statement is
present and complete. The submission provides the basic
information required.Problem statement is present, complete,
and incorporates additional relevant details and critical thinking
to engage the reader.Change Proposal Purpose5.0%Purpose of
change proposal is not present.Purpose of change proposal is
present, but incomplete or otherwise lacking in required
detail.Purpose of change proposal is present. Some minor
details or elements are missing but the omission(s) do not
impede understanding.Purpose of change proposal is present and
complete. The submission provides the basic information
required.Purpose of change proposal is present, complete, and
incorporates additional relevant details and critical thinking to
engage the reader.PICOT5.0%PICOT is not present.PICOT is
present, but incomplete or otherwise lacking in required
detail.PICOT is present. Some minor details or elements are
missing but the omission(s) do not impede
understanding.PICOT is present and complete. The submission
provides the basic information required.PICOT is present,
complete, and incorporates additional relevant details and
critical thinking to engage the reader.Literature Search
Strategy5.0%Literature search strategy is not present.Literature
search strategy is present, but incomplete or otherwise lacking
in required detail.Literature search strategy is present. Some
minor details or elements are missing but the omission(s) do not
impede understanding.Literature search strategy is present and
complete. The submission provides the basic information
required.Literature search strategy is present, complete, and
incorporates additional relevant details and critical thinking to
engage the reader.Literature Evaluation5.0%Literature
evaluation is not present.Literature evaluation is present, but
incomplete or otherwise lacking in required detail.Literature
evaluation is present. Some minor details or elements are
missing but the omission(s) do not impede
understanding.Literature evaluation is present and complete.
The submission provides the basic information
required.Literature evaluation is present, complete, and
incorporates additional relevant details and critical thinking to
engage the reader.Utilization of Change or Nursing Theory
(2.2)5.0%Theory utilization is not present.Theory utilization
content is present, but incomplete or otherwise lacking in
required detail.Theory utilization content is present. Some
minor details or elements are missing but the omission(s) do not
impede understanding.Theory utilization content is present and
complete. The submission provides the basic information
required.Theory utilization content is present, complete, and
incorporates additional relevant details and critical thinking to
engage the reader.Proposed Implementation Plan with Outcome
Measures (3.2)5.0%Implementation plan is not
present.Implementation plan is present, but incomplete or
otherwise lacking in required detail.Implementation plan is
present. Some minor details or elements are missing but the
omission(s) do not impede understanding.Implementation plan
is present and complete. The submission provides the basic
information required.Implementation plan is present, complete,
and incorporates additional relevant details and critical thinking
to engage the reader.Identification of potential barriers to plan
implementation, and a discussion of how these could be
overcome (2.3)5.0%Identification of potential barriers to plan
implementation and /or discussion component is not
present.Identification of potential barriers to plan
implementation with a discussion component is present, but is
incomplete or otherwise lacking in required detail.Identification
of potential barriers to plan implementation with a discussion
component is present. Some minor details or elements are
missing but the omission(s) do not impede
understanding.Identification of potential barriers to plan
implementation with a discussion component is present and
complete. The submission provides the basic information
required.Identification of potential barriers to plan
implementation with a discussion component is present,
complete, and incorporates additional relevant details and
critical thinking to engage the reader.Appendices Inclusive of
Practice Immersion Clinical Documentation
(1.2)5.0%Appendices are not present.Appendices are present,
but incomplete or otherwise lacking in required
detail.Appendices are present with minor elements missing that
do not impede understanding.Appendices are present and
complete. The submission provides the basic information
required.Appendices are present, complete, and incorporates
additional relevant details and critical thinking to engage the
reader.Evidence of Revision 10.0%Final paper does not
demonstrate incorporation of feedback or evidence of revision
on research critiques.Incorporation of research critique
feedback or evidence of revision is incomplete.Incorporation of
research critique feedback and evidence of revision are
present.Evidence of incorporation of research critique feedback
and revision is clearly provided.Evidence of incorporation of
research critique feedback and revision is comprehensive and
thoroughly developed.Organization and
Effectiveness30.0%Thesis Development and
Purpose10.0%Paper lacks any discernible overall purpose or
organizing claim.Thesis is insufficiently developed or vague.
Purpose is not clear.Thesis is apparent and appropriate to
purpose.Thesis is clear and forecasts the development of the
paper. Thesis is descriptive and reflective of the arguments and
appropriate to the purpose.Thesis is comprehensive and contains
the essence of the paper. Thesis statement makes the purpose of
the paper clear.Argument Logic and
Construction10.0%Statement of purpose is not justified by the
conclusion. The conclusion does not support the claim made.
Argument is incoherent and uses noncredible sources.Sufficient
justification of claims is lacking. Argument lacks consistent
unity. There are obvious flaws in the logic. Some sources have
questionable credibility.Argument is orderly, but may have a
few inconsistencies. The argument presents minimal
justification of claims. Argument logically, but not thoroughly,
supports the purpose. Sources used are credible. Introduction
and conclusion bracket the thesis. Argument shows logical
progression. Techniques of argumentation are evident. There is
a smooth progression of claims from introduction to conclusion.
Most sources are authoritative.Clear and convincing argument
presents a persuasive claim in a distinctive and compelling
manner. All sources are authoritative.Mechanics of Writing
(includes spelling, punctuation, grammar, language
use)10.0%Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.Frequent and repetitive
mechanical errors distract the reader. Inconsistencies in
language choice (register) or word choice are present. Sentence
structure is correct but not varied.Some mechanical errors or
typos are present, but they are not overly distracting to the
reader. Correct and varied sentence structure and audience-
appropriate language are employed.Prose is largely free of
mechanical errors, although a few may be present. The writer
uses a variety of effective sentence structures and figures of
speech.Writer is clearly in command of standard, written,
academic English.Format10.0%Paper Format (use of
appropriate style for the major and assignment)5.0%Template is
not used appropriately, or documentation format is rarely
followed correctly.Appropriate template is used, but some
elements are missing or mistaken. A lack of control with
formatting is apparent.Appropriate template is used. Formatting
is correct, although some minor errors may be present.
Appropriate template is fully used. There are virtually no errors
in formatting style.All format elements are correct.
Documentation of Sources (citations, footnotes, references,
bibliography, etc., as appropriate to assignment and
style)5.0%Sources are not documented.Documentation of
sources is inconsistent or incorrect, as appropriate to
assignment and style, with numerous formatting errors.Sources
are documented, as appropriate to assignment and style,
although some formatting errors may be present.Sources are
documented, as appropriate to assignment and style, and format
is mostly correct. Sources are completely and correctly
documented, as appropriate to assignment and style, and format
is free of error.Total Weightage100%
Running Head: PICOT STATEMENT PAPER1
PICOT STATEMENT PAPER5
PICOT Statement Paper
Grand Canyon University
12/17/19
-this is not correct. See the notes & feedback I gave you.
The First Line Is Your Title, Centered, Non-Bolded, Not
Underlined
Hand hygiene (HH) is an essential tool in reducing the spread of
infections among patients and the healthcare professionals in
the clinical setting. Multiple studies have however showed that
healthcare professionals do not comply with the HH guidelines
provided by the World Health Organization. This has led to
increased healthcare related infections resulting in increased
mortality rates. There are various factors that lead to non-
compliance of the World Health Organization guidelines such as
work environment and behavioral motivational factors. This
shows that more needs to do in creating awareness among
healthcare professionals about the importance of hand hygiene
and patient safety (Anna, & Sobala, 2013).
PICOT Statement
For patients and healthcare workers in the hospital (p) does
hand washing using soap and water (I) compared to an alcohol
hand-based rub (C) reduce hospital acquired infection (O)
within a period of stay in the hospital (T)? You got it!
Evidence Based
Solution
Multiple studies show that hand washing protocol in the
healthcare setting is very effectual in reducing healthcare
related infections. The practice of cleaning hand before and
after attending patients can help to reduce the spread of germs
in hospitals. Healthcare professionals wash their hands more
than half times they should on average (Deochand & Deochand,
2016). This increases the chances of spreading healthcare
acquired infection (Deochand & Deochand, 2016). While hand
washing protocol is useful, alcohol-based solution is more
effective as it kills most of the germs that can be transmitted in
the healthcare setting (Deochand & Deochand, 2016). Since
alcohol-based solution is a bit expensive, patients and
healthcare workers should reduce the spread of germs by
complying with the hand washing protocol (Deochand &
Deochand, 2016).
Nursing Intervention
Nurses interact with patients more often than other healthcare
professionals and this exposes them to hospital acquired
infections. For this reason, nurses should ensure all their
practices are based on patient education, nursing research and
are evidence based. Nurses should apply universal precautions
to ensure they work in a safe environment (Sung-Ching et al.,
2013). Under the universal precaution guidelines, nurse
practitioners must wear protective gear before coming into
contact with any patient (Sung-Ching et al., 2013). Nurses must
also wash their hands before and after interacting with patients.
Alcohol based solution can be used as a substitute (Sung-Ching
et al., 2013).
Patient Care
Patients are very vulnerable to hospital acquired infections.
Healthcare providers should create awareness among patients
about the importance of hand hygiene. Patients must clean their
hands regularly in the healthcare setting. They should also ask
those people visiting them to ensure that they clean their hand
before visiting and after living patient wards. This ensures that
visitors to not spread diseases to the patients and also the
patients do not infect those visiting them. Healthcare workers
must put the necessary measures to facilitate the hand washing
protocol (Chatfield et al., 2016).
Healthcare Agency
The healthcare agency must ensure their facilities have enough
hand washing points to facilitate hand washing protocol.
Patients and healthcare professionals will not be able to clean
their hands as required if there are not enough areas designated
for hand washing. Healthcare providers should also provide
alcohol-based solutions in case there is any issue to do with the
designated hand washing points. The agency should also ensure
that all patients understand the importance of HH while in the
healthcare setting. This plays a significant role in reducing the
spreading of healthcare related infections (Dyson et al., 2013).
Healthcare agencies should also train their healthcare
professionals to increase compliance to the hand washing
protocol (Dyson et al., 2013).
Nursing Practice
Combining hand washing protocol and alcohol-based solutions
can help prevent most of the hospital acquired infections
increasing patient safety and better overall patient outcomes
(Sendall, McCosker & Halton, 2019). When patient maintain
hand hygiene it will be difficult for them to spread hospital
acquired infection. The same applies to healthcare
professionals. A safe healthcare environment depends on the
ability of both the patients and healthcare professionals to
comply with the hand washing protocol. Increasing awareness
of the importance of HH in the hospitals may increase
compliance to the WHO guidelines reducing the spread of
infections (Sendall, McCosker & Halton, 2019).
A conclusion statement is a comprehensive assessment of the
paper. It does not include references or any new ideas. It is the
author’s conclusion.
References you must cite a doi if you have one
Anna, G. P & Sobala, W. (2013). Observance of hand washing
procedures performed by the medical personnel before patient
contact part 1 Retrieved from international journal of
occupational medicine and environmental health 2013
Chatfield, S. L., Nolan, R., Crawford, H., & Hallam, J. S.
(2016). Experiences of hand hygiene among acute care nurses:
An interpretative phenomenological analysis. SAGE open
medicine, 4, 2050312116675098.
Deochand, N., & Deochand, M. E. (2016). Brief Report on
Hand-Hygiene Monitoring Systems: A Pilot Study of a
Computer-Assisted Image Analysis Technique. Journal of
environmental health, 78(10). Doi?
Dyson, J., Lawton, R., Jackson, C., & Cheater, F. (2013).
Development of a theory-based instrument to identify barriers
and levers to best hand hygiene practice among healthcare
practitioners. Implementation Science, 8(1), 111. Doi?
Sendall, M. C., McCosker, L. K., & Halton, K. (2019). Cleaning
Staff’s Attitudes about Hand Hygiene in a Metropolitan
Hospital in Australia: A Qualitative Study. International journal
of environmental research and public health, 16(6), 1067. Doi?
Sung-Ching, P., Tien, K. L., Hung, I., Yu-Jiun, L., Wang-Huei,
S., Wang, M. J., & Yee-Chun, C. (2013). Compliance of Health
Care Workers with Hand Hygiene Practices: Independent
Advantages of Overt and Covert Observers. PLoS One, 8(1),
e53746. Doi?
WEEK 6 ASSIGNMENT
Literature Review
Professor’s Name
Student’s Name
Course Title
Date
Introduction
Hand hygiene (HH) is a good way of preventing hospital
acquired infections (HAI) among healthcare professionals,
patients and those visiting them. However, studies show that
patient and healthcare professionals are non-compliant to the
HH standards set by the World Health Organization. This has
increased the spread of HAI among patients in the healthcare
system increasing their hospital stay. This paper analyzes the
existing research on the topic to determine how it supports the
PICOT statement for this study. The paper will also compare the
sample population, research question and limitations of the
existing research.
Picot Statement
For patients and healthcare workers in the hospital (p) does
hand washing using soap and water (I) compared to an alcohol
hand-based rub (C) reduce hospital acquired infection (O)
within a period of stay in the hospital (T)?
Comparison of Research Questions
One of the studies on the topic aimed to determine the
effectiveness on providing educational programs among nurses
to increase compliance with HH guidelines (Daisy & Sreedevi,
2015). Another study on the topic focused on determining how
the observation of HH can reduce the rate of infections in
hospitals (Fox et al., 2015). A study conducted in 2017 aimed to
determine the hand washing procedures used by healthcare
professionals before making any contact with their patients in
hospitals (Knighton, 2017). Another study conducted in 2018,
aimed to determine how providing training programs for nurse
could improve adherence to HH (Graveto et al., 2018). These
research questions all focus on how compliance to HH
guidelines in healthcare systems can improve patient outcomes.
A study conducted in 2015 aimed to aim to determine the
effectiveness of HH in large healthcare organizations in
Vietnam (Thoa et al., 2015). Another study aimed to explore the
procedures and practices of HH among healthcare professionals
in hospitals (Lawal et al., 2018). A research done in 2018 aimed
determine the availability of necessary hand washing tools ,
compliance among nurses and access to essential hand washing
tools on surgical general wards, intensive care unit and medical
education (Niyonzima, Brennaman & Beinempaka, 2018).
Another similar study conducted in 2018 aimed to review the
experiences of HH among nurses working in the acute care
department (Phan et al., 2018). These research questions in one
way or the other provide significant insights that support the
current PICOT statement.
Comparisons of sample population
The existing studies have been conducted in different
environment with different sample sizes. The first study
conducted in 2015 has a sample size of 60 nurses working in
various private healthcare facilities (Daisy & Sreedevi, 2015).
The second research was conducted within two hospitals. The
third study has a sample size of 120 medical personnel among
them being physicians and nurses. This represented more than
twice the population of the previous studies combined. Another
study done in 2018 was conducted among various healthcare
personnel working at an intensive care unit. This study had a
significant lower population as compared to the previous three
studies (Graveto et al., 2018).
The fifth study was conducted in fifteen critical care unit and
two intensive care units (Thoa et al., 2015). This allowed the
researchers to explore different aspects associated with HH
comprehensively. Another study conducted in 2018 involved
113 nurse practitioners and was done in 12 weeks (Lawal et al.,
2018). Another research was done in five units that handle
critically ill patients in surgical wards, ICU and medical
emergency units (Niyonzima, Brennaman & Beinempaka, 2018).
The final study was conducted among eight nurses in various
departments in United States healthcare facilities (Phan et al.,
2018). The sample populations included in each of these studies
were enough to present the desired findings. However, the
studies that had bigger population provided more reliable
findings.
Comparison of limitations
Each of the studies that were reviewed had their own
limitations. The first time used a labor intensive approach that
led to a lot of time wastage (Daisy & Sreedevi, 2015). The
sample population of the second study was very small and the
results found may not represent the general population (Fox et
al., 2015). The third study had an improper representation of the
target population and this led to inability of researchers to
control the environment (Knighton, 2017). The fourth study was
a review and therefore had a lot of biasness issue to deal with.
This approach also made it difficult for researchers to identify
all data connected to their research question (Graveto et al.,
2018). This has significant impacts on the findings of the study.
The fifth study had limited ability to compare as groups used
where not alike (Thoa et al., 2015). This presented significant
threats to the internal validity of the study. The sixth study had
an improper representation of the target population and there
was difficulty in the process of analyzing data (Lawal et al.,
2018). The seventh research was limited by the fact that
behaviors could not be analyzed over a given period of time
(Niyonzima, Brennaman & Beinempaka, 2018). It also did not
help in determining cause or effect and allowed for conflict of
interest that could have affected the findings. The eighth study
used a labor intensive approach which made it difficult to
investigate various aspects among the groups selected (Phan et
al., 2018). It also was time consuming and interpretations were
widely limited.
Conclusion
In conclusion, the studies that have been reviewed in this paper
support the PICOT statement. Most of the studies had a good
sample size which allowed their findings to be reliable. It is
recommended that healthcare organizations implement HH
programs to create awareness among burses on the importance
of hand hygiene. Healthcare organizations should also develop
educational programs to increase adherence to HH guidelines
among nurses. This study will help to advance knowledge on the
importance of using hand washing protocol in HH and lay
grounds for future studies.
References
Daisy, V. T., & Sreedevi, T. R. (2015). Effectiveness of a
Multi-Component Educational Intervention on Knowledge and
Compliance with Hand Hygiene among Nurses in Neonatal
Intensive Care Units. International Journal of Nursing
Education, 7(4), 98-103.
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P.,
Nelson, C., ... & Bader, M. K. (2015). Use of a patient hand
hygiene protocol to reduce hospital-acquired infections and
improve nurses’ hand washing. American Journal of Critical
Care, 24(3), 216-224.
Knighton, S. (2017). The Use of Instructional Technology to
Increase Independent Patient Hand Hygiene Practice of
Hospitalized Adults in an Acute Care Setting. In Open forum
infectious diseases (Vol. 4, No. suppl_1, pp. S411-S412). US:
Oxford University Press.
Graveto, J. M. G. D. N., Rebola, R. I. F., Fernandes, E. A., &
Costa, P. J. D. S. (2018). Hand hygiene: nurses’ adherence after
training. Revista brasileira de enfermagem, 71(3), 1189-1193.
Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo,
H. T., Theorell-Haglow, J., & Gordon, C. J. (2018). An
educational intervention to improve hand hygiene compliance in
Vietnam. BMC infectious diseases, 18(1), 116.
Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T.,
Wertheim, H. F., & Son, N. T. (2015). Cost-effectiveness of a
hand hygiene program on health care–associated infections in
intensive care patients at a tertiary care hospital in
Vietnam. American journal of infection control, 43(12), e93-
e99.
Lawal, T. O., Monsudi, K. F., Zubayr, B. M., Michael, G. C.,
Duru, C., Ibrahim, Z. F., & Aliyu, I. (2018). Hand hygiene
practices among nurses in health facility in a semi-urban
setting. International Journal of Health & Allied Sciences, 7(3),
191.
Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018).
Practice and compliance of essential handwashing among
healthcare workers at a regional referral hospital in Uganda: A
quality improvement and evidence-based practice. Canadian
Journal of Infection Control, 33(1), 33-38.
Topic 9 DQ 2
Sustaining change can be difficult, as there are many variables
that can affect implementation. One critical component of EBP
is to ensure that practice change is part of an organization's
culture so it will continue to impact outcomes over time. Name
two potential barriers that may prevent your EBP change
proposal from continuing to obtain the same desired results 6
months to a year from now, and your strategies for overcoming
these barriers.
Re: Topic 9 DQ 2
The great challenge of today’s world is providing efficient and
high-quality healthcare treatments to patients. EBP is the
problem-solving perspective for taking decisions on the basis of
current best evidence. It is not the part of a research; however,
it belongs to quality and standard improvement. (Wong, 2015).
There are many barriers that may prevent EBP change proposal
from continuing. One of them is ability to approach and
evaluate evidences. (Harding, 2014) The well-designed projects
will always base on evidences to check what works and what
doesn’t? To overcome this issue, it is better to get feedback
through surveys or if it is already implemented then record your
own results to evaluate. Good evidence is the one which
includes all details like what we want to know, what the
objective is and in what context does these evidences needed?
The other is cultural or personal values. Patients might refuse to
get recommended treatments due to socials, cultural or religious
factors. A nurse practitioner described the culture barrier as
actuality that is the cause of worst nursing practice. (Yates,
2015).
There must be the culture that allow practice with evidences
that keep us up to date. This issue doesn’t only regard patient
but also the values of organization matters a lot. Somehow
professional advancement among nurses is undermined because
of cultural attitudes of hospital system and that needs to work
on.
References:
Harding, K. E.‐T. (2014). Not enough time or a low priority?
Barriers to evidence‐based practice for allied health clinicians.
Journal of Continuing Education in the Health Professions ,
224-231.
Wong, C. S. (2015). Evidence-based practices for children,
youth, and young adults with autism spectrum disorder: A
comprehensive review. Journal of Autism and Developmental
Disorders.
Yates, M. J. (2015). From a Provider's Perspective: Integrating
Evidence-Based Practice into the Culture of a Social Service
Organization. Child Welfare, 87.
SAMPLE GUIDELINE FROM INSRUCTOR
Title of Your Paper
Your Name
Submitted to Your Professor Here
Name of Your Class
Grand Canyon University
June 20, 2015
Title of Your Paper
The issue of nursing incivility and its effect on a healthy
workplace are disturbing. The nursing profession and the safety
of the patients nurses care for, are at risk when nursing
incivility is allowed. The purpose of this paper is to define
nursing incivility, explore the effects on the workplace and
patient care, and identify resolutions.
Defining Nursing Incivility
Nursing incivility is not easily defined and it can be vague and
passive. One definition of workplace incivility is "low intensity
deviant behavior with ambiguous intent to harm the target, in
violation of workplace norms for mutual respect" (Laschinger,
Wong, Cummings, & Grau, 2014, p. 6). Some examples of this
deviant behavior include “dismissing an employee's ideas or
opinions, making derogatory or demeaning remarks about
individuals at work, and excluding people from unit-based
social activities” (Laschinger et al, 2014, p. 6).
Antecedents
The nursing profession has a history of incivility. “Nurses eat
their young has been a well known but dark secret within the
nursing profession” (Hippeli, 2009).
Pros and Cons of Nursing Incivility
It is difficult to identify any positives from nursing incivility.
Disrespectful and uncivil behavior should never be allowed.
The question then becomes “why is this still a problem?” The
answer lies in what would be considered “pros”.
Pros
Addressing the behavior of incivility has risks.
Cons
The costs of nurse training, turnover, and lost productivity as a
result of nursing incivility has been well documented.
Stakeholders
The two main stake holders identified for the issue of nursing
incivility is the nursing profession and governing bodies.
Nursing Profession
The nursing profession as a whole, has a duty to maintain its
credibility and continue the integrity.
Governing Bodies
In 2008, the Joint Commission released a sentinel event alert
regarding behaviors that undermine a culture of safety (Joint
Commission, 2008).
Plan of Action
Hippelli wrote this about nursing incivility: “professional
nurses recognize the problem but are convinced that they are
not part of the problem or the problem needs to be solved by
somebody else” (Hippelli, 2009, p. 187).
Outcomes
Obtaining outcomes can be done through education.
Proposed Funding
Considering that staff turnover due to a hostile workplace is
costly, the benefits of establishing a healthy workplace
environment is easy to calculate.
Conclusion
In conclusion, a toxic workplace costs the patient and the
profession of nursing.
References
American Nurses Association. (2010). Nursing: Scope and
standards of practice. (2nd ed.). Silver Spring, MD:
nursebooks.org.
Centers for Disease Control. (2014). Workplace safety & health
topics: Workplace violence. Retrieved from
http://www.cdc.gov/niosh/topics/violence/training_nurses.html.
Hippeli, F. (2009). Nursing: does it still eat its young, or have
we progressed beyond this?. Nursing Forum, 44(3), 186-188.
doi:10.1111/j.1744-6198.2009.00141.
Joint Commission. (2008). Behaviors that undermine a culture
of safety. [Data file]. Retrieved from
http://www.jointcommission.org/assets/1/18/SEA_40.PDF.
Khadjehturian, R. E. (2012). Stopping the Culture of Workplace
Incivility in Nursing. Clinical Journal Of Oncology Nursing,
16(6), 638-639. doi:10.1188/12.CJON.638-639.
Lachman, V.D. (2014). Ethical Issues in the Disruptive
Behaviors Of Incivility, Bullying, and Horizontal/Lateral
Violence. MEDSURG Nursing, 23(1), 56-60.
Laschinger, H.S., Wong, C. A., Cummings, G. G., & Grau, A. L.
(2014). Resonant Leadership and Workplace Empowerment: The
Value of Positive Organizational Cultures in Reducing
Workplace Incivility. Nursing Economic$, 32(1), 5-44.
Occupational Safety and Health Administration. (2015).
Guidelines for preventing workplace violence for healthcare and
social service workers [Data file]. Retrieved from
https://www.osha.gov/Publications/osha3148.pdf.
Riffkin, R. (2014). Americans rate nurses highest on honesty,
ethical standards. Gallup. Retrieved from
http://www.gallup.com/poll/180260/americans-rate-nurses-
highest-honesty-ethical-standards.aspx.

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  • 1. Running head: hand hygiene compliance1 hand hygiene compliance8Hand Hygiene Education Implementation and Nurses Compliance in Reducing Nosocomial Infections Grand Canyon University NRS-490 March 31, 2019 Background Hygiene is a very crucial factor in prevention of infection in any health care facility. Also, compliance of handwashing ensures patients safety, aids in the treatment and recovery of hospitalized patients. Hand hygiene is important action performed by healthcare works to prevent transmission of healthcare associated infection (Smiddy, O’Connell & Creedon, 2015). Health care professionals such as doctors, nurses, physical therapist and laboratory technicians, take the responsibility of providing efficient, effective and quality care that will improve the health of their patients. The purpose of this paper is to discuss the change proposal project components the author has been working on throughout the course. The goal of health care works rendering a quality, effective and efficient care to their patient in the health care setting will be difficult to achieve if the rate handwashing
  • 2. adherence is below expectation. Unclean healthcare environments harbor germs that can cause disease, thereby placing the patient at risk of developing infection instead of recovering from their present health condition. Healthcare providers inability to comply with hand hygiene is one the main reason patient develop hospital acquired infections (HAIs). Healthcare employees have the lives of patient in their hands therefore, hand hygiene should not by any means be neglected or dominated out in any healthcare facility. Approximately 250 health care specialists in a Metro Detroit facility happened to be watched and assessed directly; prior to the start of the exercise, participants were selected based on their hand washing comprehension and compliance. Partakers expresses that they observed improvement on handwashing practices and that most nurses complied to hand washing guidelines evidenced by some significant reductions in the rate of transmission of HAIs within the healthcare facility. HAIs are the infections a patient acquire during the period of hospitalization. The result of the research showed a huge decrease in the spread of nosocomial infections due to progress of hand hygiene training and nurses’ compliance to handwashing protocols. These infections mostly manifest during or after 48 hours of admission or thirty days after discharge from the hospital or health-care facility. The author of this research study sees HAIs as a dangerous disease with many complications. Because inadequate handwashing practices by healthcare workers are the main cause of spread of hospital acquire infections, it is important to educate staff members on proper hand hygiene, implement plan to encourage hand hygiene compliance in the healthcare settings. Blood-stream, ulcers / surgical wounds, CAUTI and respiratory infections are the most common types of HAIs Problem Statement Good hand hygiene practice is one of the essential factors in planting an end to cross infections and HAIs. However
  • 3. inadequate handwashing among healthcare providers leads to transmission of infection from one patient to another and they end up contacting the infection and it keeps spreading. (Hinz, McGee, Huitema, Dickinson, & Van Enk, 2014). The necessity of handwashing and adherence in the hospital setting is to facilitate the reduction of HAIs. Some healthcare corporations that are known to be very compliant with handwashing guidelines maintains the high hygiene level and generally have a good treatment that guarantees powerful healthcare system that assist with the standard health and wellbeing of patients. In order to secure patient safety, all health care environment should be kept clean at any given time. When health care facilities are clean, micro organism have no place to grow which will prevent or reduce the extent at which nosocomial infections spreads. Healthcare workers in Detroit Medical Center were examined for a reduction in nosocomial infections via hand hygiene teaching and adherence monitoring. The writer noted that most healthcare workers do not adhere to handwashing because of lack of education. Some of them complained that they don’t have time to practice hand hygiene as a result of lack of handwashing equipment, high patient ratio, skin irritation and lack of hand hygiene monitoring. Nosocomial infection is defined as infection a patient contracted during their stay in the hospital (Thoa et al., 2015). This infection is very harmful and can jeopardize patient safety. Nosocomial infection is very common and occurs everyday in the hospital, while it can be avoided if the healthcare workers are compliant with hand hygiene protocols within the facility and when providing patient care. Evidence has shown that facilities where caregivers do not practice adequate hand hygiene results to distribution of nosocomial infections. When healthcare workers neglect handwashing, they pose dangers of acquiring infection to patients and others. Nurses are the closest to patients and their hands are always on the patient when providing care therefore, inadequate hand hygiene is the
  • 4. leading cause of spread of nosocomial infection. This problem is the reason why the researcher wants to know if in an acute care setting healthcare providers(P) will implement hand hygiene education and compliance (I) on hand hygiene practice(C) to decrease nosocomial infections (O) within four weeks period(T). Purpose of the Change Proposal It is the responsibility of all healthcare providers to advocate for every patient to make sure that each person obtains safe, efficient, effective and quality healthcare services. Also, healthcare providers should endeavor to work as a team to provide solution that will improve the overall well-being of the patient. Moreover, it will be difficult to accomplish this aim if the healthcare environment increases the chance of contracting the infection as a result of noncompliance of hand hygiene practices. Handwashing practice is the cheapest and simple precaution that prevents spread of nosocomial infections in the hospital and healthcare workers must observe adequate handwashing while rendering patient care. There are so many explanations for noncompliance of handwashing among healthcare workers such as, unawareness, working overtime which may cause burnout. Additionally, laying emphasis on the change proposal which targets to encourage compliance of hand hygiene and education will inspire healthcare workers to observe hygiene at its peak, therefore reducing the rate at which nosocomial infection is being transmitted. Reducing expenses and medical cost utilized to treat complication developed from nosocomial infection is one of the objectives for the proposed change. The hand hygiene program is an effective strategy in reducing the incidence of hospital-acquired infections and is cost-effective (Thoa et al., 2015). Nosocomial infection delays treatment in the hospital but when the rate of spread is reduced, the hospital will have brief length of stay patient are hospitalized because the process of treatment will be faster and not delayed. This will make bed available for
  • 5. other patient who need it for critical conditions. With few ill patients in the healthcare settings nurses, doctors, lab technicians and other healthcare providers will pay attention and take them serious thereby achieving the aim of providing safe, effective, efficient and quality healthcare services. World Health Organization published guidance on a standardized multistep technique to promote coverage of all surfaces of the hands with hand hygiene product, estimating 20–30 seconds for hand rubbing, Wash hands with warm or cold water. “There is no evidence that warm water is superior to cold water, although tepid water may be better tolerated” (Ellignson et al.2014). PICOT Many researchers use this acronym PICOT to expand their research question(s). P- signifies problem/population/patents, I- represent intervention to fix the problem, C- denotes comparison or opposite of the intervention. O- means the outcome and finally T symbolizes the timeframe used to achieve the desired outcome(s). utilizing the project change proposal, the recognized population provided in this research comprises of healthcare workers in the acute care setting. Intervention in the study is the implementation of education on hand hygiene. Comparison is the hand hygiene practice compliance. The study’s outcome is the decrease in spread of nosocomial infection and the time to achieve this is four weeks. The PICOT used for the change proposal identified is for healthcare workers in the acute care setting(P), hand hygiene education implementation(I) and compliance to hand hygiene practices(C) decreasing nosocomial infections (O) for the period of four weeks (T). Literature Search Strategy Employed The author utilized the research plan to search for literature from various database that is linked to the project topic. Essential information related to the topic were gathered from the numerous research plan. The researcher used PICOT to
  • 6. create the research question, this makes it easy to select vital evidence on techniques in which healthcare providers in the acute care setting can prevent the spread of nosocomial infection and comply to hand hygiene guidelines. The authors concentration was focused on identifying some current studies in respect to education on handwashing compliance and prevention of nosocomial infections. Cochrane and MEDLINE are outstanding database online question that was used for the search plan. Evaluation of the Literature High quality research literature was used to conduct this study which is pertinent to the problem statement, for example, Lawal et al., (2018) article is the research study learning about hand hygiene practices in the healthcare facility in a semi-urban setting, reply to the research question on how the knowledge and practices of hand hygiene among healthcare worker decrease nosocomial infection. Nurses knowledge on the correct technique involved in hand hygiene is deficient. Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018) article is the research study on availability and suitability of essential hand washing facilities, assess essential handwashing practice compliance among healthcare workers. The choice of literature the researcher used is in line with the statement of problem hence supplying essential data to the research study. Applicable Change or Nursing Theory Utilized Non-compliance of adequate hand hygiene practices among acute care nurses illustrates that it is crucial to have an intervention available to help improve the knowledge of healthcare workers on the importance of hand hygiene and adherence. Since substantial number of healthcare workers response is poor, the change applied can assist in reducing the problem which requires finding out why the acknowledgment to adequate hand hygiene practice is deficient. Nurses will be well informed and educated on the benefits of hand hygiene if they are aware and implement the theories in behavioral changes
  • 7. which is very vital in successful program application of decreasing the rate of nosocomial infections. Knowing hand hygiene behavior assumes and predict attitude of an individual with the help of planned behavioral theory. Proposed Implementation Plan It is very imperative to practice the standard precautions that will help promote hand hygiene. Hand hygiene compliance is the basis of infection control programs (Phan et al., 2018). The author suggested intervention for this research includes, explaining the importance of educating healthcare providers to carry out hand hygiene protocols appropriately while providing patient care. Seminars on hand hygiene compliance should be conducted to help nurses to work together as a team and come up with the thoughts that can assist with the practice of hand washing such as wearing gloves, placing hand sanitizers at the major locations like patient’s door, hallway, breakroom, around the computer and the nurse’s station. It is recommended to perform hand hygiene before touch a patient, before clean procedure, after touching a patient, when hands are visibly dirty and after touching the environment (Lau, Tang, Mak & Leung, 2014). These strategies will enhance hand hygiene compliance among healthcare workers. The success of this project was assessed using quiz, posters and monitors. The study is evaluated every week for consecutive four weeks to check the progress of hand hygiene training and compliance protocols likewise decrease of hospital acquired infections. Results are compared every week with initial result at the beginning of the project and summarized. There was reduction in nosocomial infection because of compliance of adequate hand hygiene. Potential Barriers to Plan Implementation Negligence, laziness and non-compliance to adequate hand hygiene protocol are among the behaviors that hinders the success of the proposed change to encourage the standard rules
  • 8. of adequate hand hygiene in the acute care setting. It might be difficult for healthcare providers to adjust to the change thereby delaying the intended plan to enhance sanitation. Leaders and managers should provide support, filter ideas, and remove barriers to implementation of best practices identified by positive deviants for improving hand hygiene compliance (Marra & Edmond, 2014). Healthcare providers are to be prompted of their duty to render safe, effective, efficient and quality patient care. To achieve this goal, it is imperative to comply to hand hygiene practices. Evidence of Revision Evidence based practice is an approach which involves many stages that require thorough check and finances to function well. My mentor and I will make a detailed budget of how the method will work. Everything should be planned within the budget made by the financial manager. Every step is taken keenly for the practice to function well. Since my project is on hand hygiene, the finances of the evidence-based practice will be high. Money is needed to set up a facility more hand sanitizer dispensers and portable hand sanitizers and pocket hand lotions stationed at work stations which is conducive for nurses who use the area. The finances may come from donors, well-wishers, investors and the government. Conclusion To goal of standard health care service is to improve patient outcome, safety and wellbeing and not to expose them to nosocomial infection. Globally, nosocomial infection is a major concern in the healthcare setting and the key cause of poor handwashing, which can be prevented by adequate hand hygiene practices. Hand hygiene is the most cost effective, inexpensive and easiest measures toe reduce or prevent nosocomial infection in the healthcare settings. Hand hygiene education should be encouraged in the acute care setting to reduce the rate
  • 9. individual contracts and transmit nosocomial infection. References 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. Hinz, K. L., McGee, H.M., Huitema, B. E., Dickenson, A. M., & Van Enk, R. A., (2014). Observer accuracy and behavior analysis: Data collection procedures on hand hygiene compliance in a neurovascular unit. American Journal of Infection Control, 42 (10), 1067-1073. Lau, T., Tang, G., Mak, K. L., & Leung, G. (2014). Moment‐specific compliance with hand hygiene. The clinical teacher, 11(3), 159-164. Lawal, T. O., Monsudi, K. F., Zubayr, B. M., Michael, G. C., Duru, C., Ibrahim, Z. F., & Aliyu, I. (2018). Hand hygiene practices among nurses in health facility in a semi-urban setting. International Journal of Health & Allied Sciences, 7(3), 191.
  • 10. Marra, A. R., & Edmond, M. B. (2014). New technologies to monitor healthcare worker hand hygiene. Clinical Microbiology and Infection, 20(1), 29-33. Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018). Practice and compliance of essential handwashing among healthcare workers at a regional referral hospital in Uganda: A quality improvement and evidence-based practice. Canadian Journal of Infection Control, 33(1), 33-38. Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo, H. T., Theorell-Haglow, J., & Gordon, C. J. (2018). An educational intervention to improve hand hygiene compliance in Vietnam. BMC infectious diseases, 18(1), 116. Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T., Wertheim, H. F., & Son, N. T. (2015). Cost-effectiveness of a hand hygiene program on health care–associated infections in intensive care patients at a tertiary care hospital in Vietnam. American journal of infection control, 43(12), e93-e99.
  • 11. Appendix A Quiz on hand hygiene 1. Hand washing noncompliance among healthcare providers can be transmitted through inadequate hand hygiene? A. True B. False 2. it is recommended to wash hand with soap and water for how long? A. 30 Seconds B. 10 Seconds C. 20 Seconds D. 5 Seconds 3. When is the right time to perform hand hygiene? Select all that apply. A. Before eating B. After coughing, sneezing or nose blowing C. After using the bathroom D. Before and after each patient care E. All of the above 4. How can transmission of germs be avoided? A. Wearing mask B. Avoid touching sick people C. Practicing hand hygiene D. Staying away from others 5. Healthcare provided are required to wash their hand before each patient contact? A. True B. False 6. Hand hygiene education implementation encourage hand washing practice adherence? A. True B. False
  • 12. Appendix B Author- Brain Grease Retrieved from www.1st-in- handwashing.com Hand washing Poster Rate of Nosocomial Infections Before Implementation of Hand Hygiene Education Week 1Week 2Week 3Week4200400500600Week 1Week 2Week 3Week4180300480500Week 1Week 2Week 3Week4160240440400Week 1Week 2Week 3Week4120220420380
  • 13. Rate of Nosocomial Infections After Implementation of Hand Hygiene Education Week 1Week 2Week 3Week 41408010080Week 1Week 2Week 3Week 4120608060Week 1Week 2Week 3Week 4100406040Week 1Week 2Week 3Week 480204020 Rubic_Print_FormatCourse CodeClass CodeAssignment TitleTotal PointsNRS-490NRS-490-O500Benchmark - Capstone Project Change Proposal300.0CriteriaPercentageUnsatisfactory 0-71% (0.00%)Less Than Satisfactory 72-75% (75.00%)Satisfactory 76-79% (79.00%)Good 80- 89% (89.00%)Excellent 90-100% (100.00%)CommentsPoints EarnedContent60.0%Background5.0%Background section is not present.Background section is present, but incomplete or otherwise lacking in required detail.Background section is present. Some minor details or elements are missing but the omission(s) do not impede understanding.Background section is present and complete. The submission provides the basic information required.Background section is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Problem Statement5.0%Problem statement is not present.Problem statement is present, but incomplete or otherwise lacking in required detail.Problem statement is present. Some minor details or elements are missing but the omission(s) do not impede understanding.Problem statement is present and complete. The submission provides the basic information required.Problem statement is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Change Proposal Purpose5.0%Purpose of
  • 14. change proposal is not present.Purpose of change proposal is present, but incomplete or otherwise lacking in required detail.Purpose of change proposal is present. Some minor details or elements are missing but the omission(s) do not impede understanding.Purpose of change proposal is present and complete. The submission provides the basic information required.Purpose of change proposal is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.PICOT5.0%PICOT is not present.PICOT is present, but incomplete or otherwise lacking in required detail.PICOT is present. Some minor details or elements are missing but the omission(s) do not impede understanding.PICOT is present and complete. The submission provides the basic information required.PICOT is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Literature Search Strategy5.0%Literature search strategy is not present.Literature search strategy is present, but incomplete or otherwise lacking in required detail.Literature search strategy is present. Some minor details or elements are missing but the omission(s) do not impede understanding.Literature search strategy is present and complete. The submission provides the basic information required.Literature search strategy is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Literature Evaluation5.0%Literature evaluation is not present.Literature evaluation is present, but incomplete or otherwise lacking in required detail.Literature evaluation is present. Some minor details or elements are missing but the omission(s) do not impede understanding.Literature evaluation is present and complete. The submission provides the basic information required.Literature evaluation is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Utilization of Change or Nursing Theory (2.2)5.0%Theory utilization is not present.Theory utilization content is present, but incomplete or otherwise lacking in
  • 15. required detail.Theory utilization content is present. Some minor details or elements are missing but the omission(s) do not impede understanding.Theory utilization content is present and complete. The submission provides the basic information required.Theory utilization content is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Proposed Implementation Plan with Outcome Measures (3.2)5.0%Implementation plan is not present.Implementation plan is present, but incomplete or otherwise lacking in required detail.Implementation plan is present. Some minor details or elements are missing but the omission(s) do not impede understanding.Implementation plan is present and complete. The submission provides the basic information required.Implementation plan is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Identification of potential barriers to plan implementation, and a discussion of how these could be overcome (2.3)5.0%Identification of potential barriers to plan implementation and /or discussion component is not present.Identification of potential barriers to plan implementation with a discussion component is present, but is incomplete or otherwise lacking in required detail.Identification of potential barriers to plan implementation with a discussion component is present. Some minor details or elements are missing but the omission(s) do not impede understanding.Identification of potential barriers to plan implementation with a discussion component is present and complete. The submission provides the basic information required.Identification of potential barriers to plan implementation with a discussion component is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Appendices Inclusive of Practice Immersion Clinical Documentation (1.2)5.0%Appendices are not present.Appendices are present, but incomplete or otherwise lacking in required detail.Appendices are present with minor elements missing that
  • 16. do not impede understanding.Appendices are present and complete. The submission provides the basic information required.Appendices are present, complete, and incorporates additional relevant details and critical thinking to engage the reader.Evidence of Revision 10.0%Final paper does not demonstrate incorporation of feedback or evidence of revision on research critiques.Incorporation of research critique feedback or evidence of revision is incomplete.Incorporation of research critique feedback and evidence of revision are present.Evidence of incorporation of research critique feedback and revision is clearly provided.Evidence of incorporation of research critique feedback and revision is comprehensive and thoroughly developed.Organization and Effectiveness30.0%Thesis Development and Purpose10.0%Paper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.Argument Logic and Construction10.0%Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling
  • 17. manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)10.0%Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience- appropriate language are employed.Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.Writer is clearly in command of standard, written, academic English.Format10.0%Paper Format (use of appropriate style for the major and assignment)5.0%Template is not used appropriately, or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style.All format elements are correct. Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)5.0%Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Weightage100% Running Head: PICOT STATEMENT PAPER1
  • 18. PICOT STATEMENT PAPER5 PICOT Statement Paper Grand Canyon University 12/17/19 -this is not correct. See the notes & feedback I gave you. The First Line Is Your Title, Centered, Non-Bolded, Not Underlined Hand hygiene (HH) is an essential tool in reducing the spread of infections among patients and the healthcare professionals in the clinical setting. Multiple studies have however showed that healthcare professionals do not comply with the HH guidelines provided by the World Health Organization. This has led to increased healthcare related infections resulting in increased mortality rates. There are various factors that lead to non- compliance of the World Health Organization guidelines such as work environment and behavioral motivational factors. This shows that more needs to do in creating awareness among healthcare professionals about the importance of hand hygiene and patient safety (Anna, & Sobala, 2013). PICOT Statement For patients and healthcare workers in the hospital (p) does hand washing using soap and water (I) compared to an alcohol hand-based rub (C) reduce hospital acquired infection (O) within a period of stay in the hospital (T)? You got it! Evidence Based
  • 19. Solution Multiple studies show that hand washing protocol in the healthcare setting is very effectual in reducing healthcare related infections. The practice of cleaning hand before and after attending patients can help to reduce the spread of germs in hospitals. Healthcare professionals wash their hands more than half times they should on average (Deochand & Deochand, 2016). This increases the chances of spreading healthcare acquired infection (Deochand & Deochand, 2016). While hand washing protocol is useful, alcohol-based solution is more effective as it kills most of the germs that can be transmitted in the healthcare setting (Deochand & Deochand, 2016). Since alcohol-based solution is a bit expensive, patients and healthcare workers should reduce the spread of germs by complying with the hand washing protocol (Deochand & Deochand, 2016). Nursing Intervention Nurses interact with patients more often than other healthcare professionals and this exposes them to hospital acquired infections. For this reason, nurses should ensure all their practices are based on patient education, nursing research and
  • 20. are evidence based. Nurses should apply universal precautions to ensure they work in a safe environment (Sung-Ching et al., 2013). Under the universal precaution guidelines, nurse practitioners must wear protective gear before coming into contact with any patient (Sung-Ching et al., 2013). Nurses must also wash their hands before and after interacting with patients. Alcohol based solution can be used as a substitute (Sung-Ching et al., 2013). Patient Care Patients are very vulnerable to hospital acquired infections. Healthcare providers should create awareness among patients about the importance of hand hygiene. Patients must clean their hands regularly in the healthcare setting. They should also ask those people visiting them to ensure that they clean their hand before visiting and after living patient wards. This ensures that visitors to not spread diseases to the patients and also the patients do not infect those visiting them. Healthcare workers must put the necessary measures to facilitate the hand washing protocol (Chatfield et al., 2016). Healthcare Agency The healthcare agency must ensure their facilities have enough hand washing points to facilitate hand washing protocol. Patients and healthcare professionals will not be able to clean their hands as required if there are not enough areas designated for hand washing. Healthcare providers should also provide
  • 21. alcohol-based solutions in case there is any issue to do with the designated hand washing points. The agency should also ensure that all patients understand the importance of HH while in the healthcare setting. This plays a significant role in reducing the spreading of healthcare related infections (Dyson et al., 2013). Healthcare agencies should also train their healthcare professionals to increase compliance to the hand washing protocol (Dyson et al., 2013). Nursing Practice Combining hand washing protocol and alcohol-based solutions can help prevent most of the hospital acquired infections increasing patient safety and better overall patient outcomes (Sendall, McCosker & Halton, 2019). When patient maintain hand hygiene it will be difficult for them to spread hospital acquired infection. The same applies to healthcare professionals. A safe healthcare environment depends on the ability of both the patients and healthcare professionals to comply with the hand washing protocol. Increasing awareness of the importance of HH in the hospitals may increase compliance to the WHO guidelines reducing the spread of infections (Sendall, McCosker & Halton, 2019). A conclusion statement is a comprehensive assessment of the paper. It does not include references or any new ideas. It is the author’s conclusion.
  • 22. References you must cite a doi if you have one Anna, G. P & Sobala, W. (2013). Observance of hand washing procedures performed by the medical personnel before patient contact part 1 Retrieved from international journal of occupational medicine and environmental health 2013 Chatfield, S. L., Nolan, R., Crawford, H., & Hallam, J. S. (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE open medicine, 4, 2050312116675098. Deochand, N., & Deochand, M. E. (2016). Brief Report on Hand-Hygiene Monitoring Systems: A Pilot Study of a Computer-Assisted Image Analysis Technique. Journal of environmental health, 78(10). Doi? Dyson, J., Lawton, R., Jackson, C., & Cheater, F. (2013). Development of a theory-based instrument to identify barriers and levers to best hand hygiene practice among healthcare practitioners. Implementation Science, 8(1), 111. Doi? Sendall, M. C., McCosker, L. K., & Halton, K. (2019). Cleaning Staff’s Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study. International journal of environmental research and public health, 16(6), 1067. Doi? Sung-Ching, P., Tien, K. L., Hung, I., Yu-Jiun, L., Wang-Huei,
  • 23. S., Wang, M. J., & Yee-Chun, C. (2013). Compliance of Health Care Workers with Hand Hygiene Practices: Independent Advantages of Overt and Covert Observers. PLoS One, 8(1), e53746. Doi? WEEK 6 ASSIGNMENT Literature Review Professor’s Name Student’s Name Course Title Date Introduction Hand hygiene (HH) is a good way of preventing hospital acquired infections (HAI) among healthcare professionals, patients and those visiting them. However, studies show that patient and healthcare professionals are non-compliant to the HH standards set by the World Health Organization. This has increased the spread of HAI among patients in the healthcare
  • 24. system increasing their hospital stay. This paper analyzes the existing research on the topic to determine how it supports the PICOT statement for this study. The paper will also compare the sample population, research question and limitations of the existing research. Picot Statement For patients and healthcare workers in the hospital (p) does hand washing using soap and water (I) compared to an alcohol hand-based rub (C) reduce hospital acquired infection (O) within a period of stay in the hospital (T)? Comparison of Research Questions One of the studies on the topic aimed to determine the effectiveness on providing educational programs among nurses to increase compliance with HH guidelines (Daisy & Sreedevi, 2015). Another study on the topic focused on determining how the observation of HH can reduce the rate of infections in hospitals (Fox et al., 2015). A study conducted in 2017 aimed to determine the hand washing procedures used by healthcare professionals before making any contact with their patients in hospitals (Knighton, 2017). Another study conducted in 2018, aimed to determine how providing training programs for nurse could improve adherence to HH (Graveto et al., 2018). These research questions all focus on how compliance to HH guidelines in healthcare systems can improve patient outcomes. A study conducted in 2015 aimed to aim to determine the
  • 25. effectiveness of HH in large healthcare organizations in Vietnam (Thoa et al., 2015). Another study aimed to explore the procedures and practices of HH among healthcare professionals in hospitals (Lawal et al., 2018). A research done in 2018 aimed determine the availability of necessary hand washing tools , compliance among nurses and access to essential hand washing tools on surgical general wards, intensive care unit and medical education (Niyonzima, Brennaman & Beinempaka, 2018). Another similar study conducted in 2018 aimed to review the experiences of HH among nurses working in the acute care department (Phan et al., 2018). These research questions in one way or the other provide significant insights that support the current PICOT statement. Comparisons of sample population The existing studies have been conducted in different environment with different sample sizes. The first study conducted in 2015 has a sample size of 60 nurses working in various private healthcare facilities (Daisy & Sreedevi, 2015). The second research was conducted within two hospitals. The third study has a sample size of 120 medical personnel among them being physicians and nurses. This represented more than twice the population of the previous studies combined. Another study done in 2018 was conducted among various healthcare personnel working at an intensive care unit. This study had a significant lower population as compared to the previous three
  • 26. studies (Graveto et al., 2018). The fifth study was conducted in fifteen critical care unit and two intensive care units (Thoa et al., 2015). This allowed the researchers to explore different aspects associated with HH comprehensively. Another study conducted in 2018 involved 113 nurse practitioners and was done in 12 weeks (Lawal et al., 2018). Another research was done in five units that handle critically ill patients in surgical wards, ICU and medical emergency units (Niyonzima, Brennaman & Beinempaka, 2018). The final study was conducted among eight nurses in various departments in United States healthcare facilities (Phan et al., 2018). The sample populations included in each of these studies were enough to present the desired findings. However, the studies that had bigger population provided more reliable findings. Comparison of limitations Each of the studies that were reviewed had their own limitations. The first time used a labor intensive approach that led to a lot of time wastage (Daisy & Sreedevi, 2015). The sample population of the second study was very small and the results found may not represent the general population (Fox et al., 2015). The third study had an improper representation of the target population and this led to inability of researchers to control the environment (Knighton, 2017). The fourth study was a review and therefore had a lot of biasness issue to deal with.
  • 27. This approach also made it difficult for researchers to identify all data connected to their research question (Graveto et al., 2018). This has significant impacts on the findings of the study. The fifth study had limited ability to compare as groups used where not alike (Thoa et al., 2015). This presented significant threats to the internal validity of the study. The sixth study had an improper representation of the target population and there was difficulty in the process of analyzing data (Lawal et al., 2018). The seventh research was limited by the fact that behaviors could not be analyzed over a given period of time (Niyonzima, Brennaman & Beinempaka, 2018). It also did not help in determining cause or effect and allowed for conflict of interest that could have affected the findings. The eighth study used a labor intensive approach which made it difficult to investigate various aspects among the groups selected (Phan et al., 2018). It also was time consuming and interpretations were widely limited. Conclusion In conclusion, the studies that have been reviewed in this paper support the PICOT statement. Most of the studies had a good sample size which allowed their findings to be reliable. It is recommended that healthcare organizations implement HH programs to create awareness among burses on the importance of hand hygiene. Healthcare organizations should also develop educational programs to increase adherence to HH guidelines
  • 28. among nurses. This study will help to advance knowledge on the importance of using hand washing protocol in HH and lay grounds for future studies. References Daisy, V. T., & Sreedevi, T. R. (2015). Effectiveness of a Multi-Component Educational Intervention on Knowledge and Compliance with Hand Hygiene among Nurses in Neonatal Intensive Care Units. International Journal of Nursing Education, 7(4), 98-103. Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., ... & Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224. Knighton, S. (2017). The Use of Instructional Technology to Increase Independent Patient Hand Hygiene Practice of
  • 29. Hospitalized Adults in an Acute Care Setting. In Open forum infectious diseases (Vol. 4, No. suppl_1, pp. S411-S412). US: Oxford University Press. Graveto, J. M. G. D. N., Rebola, R. I. F., Fernandes, E. A., & Costa, P. J. D. S. (2018). Hand hygiene: nurses’ adherence after training. Revista brasileira de enfermagem, 71(3), 1189-1193. Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo, H. T., Theorell-Haglow, J., & Gordon, C. J. (2018). An educational intervention to improve hand hygiene compliance in Vietnam. BMC infectious diseases, 18(1), 116. Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T., Wertheim, H. F., & Son, N. T. (2015). Cost-effectiveness of a hand hygiene program on health care–associated infections in intensive care patients at a tertiary care hospital in Vietnam. American journal of infection control, 43(12), e93- e99. Lawal, T. O., Monsudi, K. F., Zubayr, B. M., Michael, G. C., Duru, C., Ibrahim, Z. F., & Aliyu, I. (2018). Hand hygiene practices among nurses in health facility in a semi-urban setting. International Journal of Health & Allied Sciences, 7(3), 191. Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018). Practice and compliance of essential handwashing among healthcare workers at a regional referral hospital in Uganda: A quality improvement and evidence-based practice. Canadian
  • 30. Journal of Infection Control, 33(1), 33-38. Topic 9 DQ 2 Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization's culture so it will continue to impact outcomes over time. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers. Re: Topic 9 DQ 2 The great challenge of today’s world is providing efficient and high-quality healthcare treatments to patients. EBP is the problem-solving perspective for taking decisions on the basis of current best evidence. It is not the part of a research; however, it belongs to quality and standard improvement. (Wong, 2015). There are many barriers that may prevent EBP change proposal from continuing. One of them is ability to approach and evaluate evidences. (Harding, 2014) The well-designed projects will always base on evidences to check what works and what doesn’t? To overcome this issue, it is better to get feedback through surveys or if it is already implemented then record your own results to evaluate. Good evidence is the one which
  • 31. includes all details like what we want to know, what the objective is and in what context does these evidences needed? The other is cultural or personal values. Patients might refuse to get recommended treatments due to socials, cultural or religious factors. A nurse practitioner described the culture barrier as actuality that is the cause of worst nursing practice. (Yates, 2015). There must be the culture that allow practice with evidences that keep us up to date. This issue doesn’t only regard patient but also the values of organization matters a lot. Somehow professional advancement among nurses is undermined because of cultural attitudes of hospital system and that needs to work on. References: Harding, K. E.‐T. (2014). Not enough time or a low priority? Barriers to evidence‐based practice for allied health clinicians. Journal of Continuing Education in the Health Professions , 224-231. Wong, C. S. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders. Yates, M. J. (2015). From a Provider's Perspective: Integrating Evidence-Based Practice into the Culture of a Social Service Organization. Child Welfare, 87.
  • 32. SAMPLE GUIDELINE FROM INSRUCTOR Title of Your Paper Your Name Submitted to Your Professor Here Name of Your Class Grand Canyon University June 20, 2015 Title of Your Paper The issue of nursing incivility and its effect on a healthy workplace are disturbing. The nursing profession and the safety of the patients nurses care for, are at risk when nursing incivility is allowed. The purpose of this paper is to define nursing incivility, explore the effects on the workplace and patient care, and identify resolutions. Defining Nursing Incivility
  • 33. Nursing incivility is not easily defined and it can be vague and passive. One definition of workplace incivility is "low intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect" (Laschinger, Wong, Cummings, & Grau, 2014, p. 6). Some examples of this deviant behavior include “dismissing an employee's ideas or opinions, making derogatory or demeaning remarks about individuals at work, and excluding people from unit-based social activities” (Laschinger et al, 2014, p. 6). Antecedents The nursing profession has a history of incivility. “Nurses eat their young has been a well known but dark secret within the nursing profession” (Hippeli, 2009). Pros and Cons of Nursing Incivility It is difficult to identify any positives from nursing incivility. Disrespectful and uncivil behavior should never be allowed. The question then becomes “why is this still a problem?” The answer lies in what would be considered “pros”. Pros Addressing the behavior of incivility has risks. Cons The costs of nurse training, turnover, and lost productivity as a result of nursing incivility has been well documented. Stakeholders The two main stake holders identified for the issue of nursing
  • 34. incivility is the nursing profession and governing bodies. Nursing Profession The nursing profession as a whole, has a duty to maintain its credibility and continue the integrity. Governing Bodies In 2008, the Joint Commission released a sentinel event alert regarding behaviors that undermine a culture of safety (Joint Commission, 2008). Plan of Action Hippelli wrote this about nursing incivility: “professional nurses recognize the problem but are convinced that they are not part of the problem or the problem needs to be solved by somebody else” (Hippelli, 2009, p. 187). Outcomes Obtaining outcomes can be done through education. Proposed Funding Considering that staff turnover due to a hostile workplace is costly, the benefits of establishing a healthy workplace environment is easy to calculate. Conclusion In conclusion, a toxic workplace costs the patient and the profession of nursing. References American Nurses Association. (2010). Nursing: Scope and
  • 35. standards of practice. (2nd ed.). Silver Spring, MD: nursebooks.org. Centers for Disease Control. (2014). Workplace safety & health topics: Workplace violence. Retrieved from http://www.cdc.gov/niosh/topics/violence/training_nurses.html. Hippeli, F. (2009). Nursing: does it still eat its young, or have we progressed beyond this?. Nursing Forum, 44(3), 186-188. doi:10.1111/j.1744-6198.2009.00141. Joint Commission. (2008). Behaviors that undermine a culture of safety. [Data file]. Retrieved from http://www.jointcommission.org/assets/1/18/SEA_40.PDF. Khadjehturian, R. E. (2012). Stopping the Culture of Workplace Incivility in Nursing. Clinical Journal Of Oncology Nursing, 16(6), 638-639. doi:10.1188/12.CJON.638-639. Lachman, V.D. (2014). Ethical Issues in the Disruptive Behaviors Of Incivility, Bullying, and Horizontal/Lateral Violence. MEDSURG Nursing, 23(1), 56-60. Laschinger, H.S., Wong, C. A., Cummings, G. G., & Grau, A. L. (2014). Resonant Leadership and Workplace Empowerment: The Value of Positive Organizational Cultures in Reducing Workplace Incivility. Nursing Economic$, 32(1), 5-44. Occupational Safety and Health Administration. (2015). Guidelines for preventing workplace violence for healthcare and social service workers [Data file]. Retrieved from https://www.osha.gov/Publications/osha3148.pdf.
  • 36. Riffkin, R. (2014). Americans rate nurses highest on honesty, ethical standards. Gallup. Retrieved from http://www.gallup.com/poll/180260/americans-rate-nurses- highest-honesty-ethical-standards.aspx.