Hand-Washing and Infections: Evidence-Based Practice

Using validated and practically proven data for nursing interventions is a mandatory practice to improve patient outcomes and ensure the safety of all the proposed procedures. The topic of this work is searching for evidence to support the issue of the importance of utilizing a special hygienic protocol to protect and nurses against hospital-acquired infections (HAIs) caused by improper adherence to sanitary conditions. As the main intervention mechanism, the promotion of handwashing is proposed. Based on this topic, the clinical problem lies in the frequency of HAIs among patients in medical institutions and the lack of appropriate practice to minimize this issue.

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The research methodology is based on the PICOT question that is designed specifically for this intervention. It is as follows: in nurses and hospitalized patients (P), can the protocol of regular hand-washing (I) compared with the absence of specific procedures (C) reduce the rate of HAIs (O) in 12 months (T)? Utilizing relevant and credible data from academic sources and searching for evidence in favor of the proposed nursing intervention may contribute to improving patient outcomes and reducing the HAIs rate, which is an urgent task.

Systematic Review of the Clinical Question

The considered clinical problem associated with HAIs is significant in the context of nursing practice and is a serious issue. Based on the available data on the extent of the impact of this problem, conclusions can be drawn regarding its negative effects on patients and medical staff in various care settings. For instance, according to Haverstick et al. (2017), in intensive care units, where maintaining proper sanitary conditions is mandatory, the level of HAIs is 1 in 25 patients.

This figure may seem insignificant; however, in terms of a larger number, the statistics are more alarming. The authors argue that in 2011, about 75,000 patients died from HAIs, and this result is a serious reason for urgent interventions (Haverstick et al., 2017). Therefore, the considered clinical problem requires addressing and comprehensive measures.

Preventive strategies to support HAIs in various care settings are usually based on similar principles of intervention. In particular, as Fernando, Gray, and Gottlieb (2017) note, cleanliness techniques promoted in most medical institutions are a standard measure to counteract the development of harmful microorganisms causing. Nevertheless, pathogenic bacteria can cause different diseases and be the result not only of unfair cleaning but also insufficiently careful work to ensure sterility on the part of medical personnel.

Antimicrobial practices after surgical interventions are aimed at preventing the development of complications, but if they are used improperly or inadequately, associated problems can occur, for instance, sepsis. Accordingly, it is crucial to promote both sanitation interventions and comprehensive protection prescribed by job descriptions for nursing and medical personnel.

Hygiene as the main method of combating HAIs is one of the main practices involving regular hand washing. Karaoglu and Akin (2018) confirm the aforementioned facts about the risk of developing such infections in clinical settings and argue that the rate of HAIs in intensive care units is significantly higher than in other departments. Accordingly, hand hygiene should be a compulsory practice in such units since not only the reputation of a particular clinic can suffer if certain cases of patients’ infection are identified, but the total number of complications may increase.

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Based on the findings cited, such a clinical problem as HAIs has negative consequences for both patients and medical personnel. Therefore, promoting sound prevention strategies is a mandatory technique for most healthcare facilities.

Systematic Review Description and Error Analysis

The conducted systematic review has enough relevant information in order to assert the significance of the proposed clinical problem. Similar studies show that HAIs in care facilities are dangerous for both patients and medical staff.

In addition, intervention strategies also coincide and provide for the promotion of such special hygienic practices like regular hand washing and following sanitary protocols. As a method of searching for academic sources, certain keywords were used, in particular, “hospital-required infections,” “handwashing,” “hygiene,” and “protocol.” The relevance of the proposed peer-reviewed sources is due to their recent publications and references to credible resources.

When conducting an error analysis, it is essential to note that in some studies, the vocabulary is not academic enough. For instance, Haverstick et al. (2017) use informal words like “so” and make grammatical errors in prepositions (“assist with”). Another common mistake is mixing British and American English, which is found in the study by Fernando et al. (2017). The authors use the form of the British version in verbs (“optimize”) but place commas incorrectly, separating all homogeneous members without exception with punctuation marks (Fernando et al., 2017).

Finally, another common type of error that manifests itself in the study by Karaoglu and Akin (2018) is repetitions. The authors use the word “nurses” often, without replacing it with synonyms, for instance, junior medical personnel, which creates a feeling of text overload (Karaoglu & Akin, 2018). However, despite the presented errors, the quality of research is high, and the significance of the proposed hypotheses proves their credibility.

Evidence-Based Case Summary

In order to find the most accurate rationale in support of the proposed method for solving the clinical problem, an individual study should be reviewed. As a background for analysis, the article “Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses’ Hand Washing” by Fox et al. (2015) will be utilized. This research is quantitative and presents the results of the intervention in digital correlations, which provides a clear picture of the value of the work done.

The evaluation of this article will be carried out by analyzing its findings, validity, and reliability. Also, the methodology will be considered, including data collection mechanisms, sample, and potential bias. The assessment of the proposed study will allow summarizing the possible application of the findings to personal nursing practice. Also, it will give an opportunity to determine the relevance of the considered intervention strategy in relation to the clinical problem associated with HAIs.

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As the key objective of this study, the importance of a hand hygiene protocol is considered to evaluate the role of this practice in the context of reducing HAIs and improving sanitary management among nurses. Fox et al. (2015) argue that in the United States, about 2.5 million cases of HAIs occur annually (p. 217). Therefore, the authors conduct a 12-month study aimed at identifying appropriate preventive work involving increased attention to hygienic standards (Fox et al., 2015).

According to the results of the study, it has been clinically proven that adhering to the rules of handwashing made it possible to reduce the rate of acquired infections, although the outcomes were not significant. The authors note that introducing such a protocol in care settings can improve the quality of nursing assistants and allow junior medical personnel to hone their skills in proper sanitary management (Fox et al., 2015). In order to assess the progress of the study, it is essential to consider such aspects of work as the methodology, the type of sample, and the principle of data collection among the target population.

Study’s Approach, Sample Size, and Population

The study under consideration is quantitative since all the results are demonstrated in quantitative terms. As a methodology, an experimental design is applied to test the hypothesis of the importance of a handwashing protocol in reducing HAIs among patients and nurses. The focus is on the two types of potential diseases – “central catheter-associated bloodstream infection and catheter-associated urinary tract infection” (Fox et al., 2015, p. 216). The proposed 12-month analysis is aimed at introducing an appropriate practice in care settings and subsequent evaluating the effectiveness of such intervention through the compilation of digital correlations. As assessment criteria, the indicators of illness severity are utilized, as well as the age, gender, and types of patients’ diseases.

The sampling principle was based on the choice of patients with three health problems types – cardiac (34-39%), surgical (12-14%), and ordinary medical diagnoses (the overwhelming majority – about 50%) (Fox et al., 2015, p. 218). Since the study was long, the number of participants in the program varied over 12 months (from 12 to 27). The total number of nurses was calculated in a ratio of 1 to 2, respectively. The study in question corresponds with the type of quality improvement program, and there was no need to obtain informed consent from the participants.

Application of the Evidence to Personal Practice

The evidence obtained during the review of the presented research may be applied to personal nursing practice since the tools and mechanisms for accomplishing the task are relevant in different care settings. For instance, Fox et al. (2015) apply for an electronic medical record recalling the need to perform all sanitary and hygienic procedures. Using this approach in modern conditions helps to utilize technological advances rationally and not to miss any of the stages of the intervention. Also, as one of the steps of the study, the authors mention a nursing audit stage as a prerequisite (Fox et al., 2015).

This principle of organizing control over the introduction of specific tools is an effective practice that encourages the participation of healthcare workers in achieving the most positive results. In general, the method of constant adherence to the provisions of the protocol is a successful method of increasing personal responsibility and motivation to improve patient outcomes.

Outcomes: Validity and Reliability

The adoption of the protocol within the framework of the study under consideration has a solid and proven background. Fox et al. (2015) structured the entire program so that the nurses involved could be adequately trained to understand the importance of the proposed procedures and their significance in the context of the clinical problem. Also, according to the results of the 12-month intervention, 96.5% of the total number of patients (2326) in a specific care setting participated in the study, which indicated that the results obtained were sufficiently reliable (Fox et al., 2015, p. 222). In addition, such a study has no analogs in duration, and this peculiarity is an incentive to maintain the stable implementation of all the protocol’s provisions. Therefore, the validity and reliability of the measures taken are high.

Graphic data used to display the findings of the study more conveniently prove the relevance of the protocol in practice. Although some indicators did not change significantly, for instance, the rate of central catheter-associated bloodstream infection in patients, the achievements are obvious. In particular, Fox et al. (2015) argue that during the implementation of the protocol in a specific care setting, nurses’ hand-washing rate increased. This improvement is valuable in the context of medical personnel’s compliance with sanitary conditions and serves as an example of effective training.

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Potential Bias

Despite careful preparation and evidence obtained during the study, some limitations may be observed in the process of the researchers’ work. For instance, the form of bias is the lack of information about patients concerning the features of their isolation, which could have additional justification for supporting the protocol. Also, the absence of consent to participate in the project may be associated with a restriction.

In particular, those nurses who were involved did not know who made all the observations and how exactly their work and performance indicators were evaluated, which was a bias formally. As one of the limitations, it is possible to mention the research within the framework of only one individual care setting. If Fox et al. (2015) had conducted a wider range of interventions, this would probably have made the results of their work even more reliable due to information obtained from various departments. Nevertheless, in general, the proposed forms of bias did not affect the quality of work significantly and did not become obstacles to receiving reliable data.

Level of Evidence Identified

The level of evidence obtained in the review process is sufficient to conclude that the proposed hand-washing protocol is relevant to reduce the rate of HAIs among patients and junior medical personnel. As valuable tools for substantiating specific hypotheses, Fox et al. (2015) apply convenient statistical mechanisms that make it possible to display the findings, in particular, correlational tables and diagrams.

Also, the authors discuss all the numerical data, which is an additional credible base (Fox et al., 2015). On the example of this work, it can be argued that the significance of compliance with sanitary and hygienic standards in care settings is high, which coincides with the stated objectives of the study. Consent from a specific review board to conduct this research confirms the need to solve the proposed clinical problem and the relevance of the methodology chosen as the key approach to all the activities.


Implementing a special protocol to promote hygiene among patients and nurses is an important practice when solving the issue of HAIs spread in care settings, and the review of relevant sources gives a valuable rationale. The involved academic research proves that the clinical problem in question creates difficulties for all stakeholders. The detailed analysis of the study dedicated to the process of minimizing HAIs allows answering the aforementioned PICOT question and provides a rationale in support of the importance of working in this direction. Assessment outcomes may be used in personal nursing practice to improve individual health management skills.


Fernando, S. A., Gray, T. J., & Gottlieb, T. (2017). Healthcare-acquired infections: Prevention strategies. Internal Medicine Journal, 47(12), 1341-1351. Web.

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. Web.

Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017). Patients’ hand washing and reducing hospital-acquired infection. Critical Care Nurse, 37(3), e1-e8. Web.

Karaoglu, M. K., & Akin, S. (2018). Effectiveness of hygienic hand washing training on handwashing practices and knowledge: A nonrandomized quasi-experimental design. The Journal of Continuing Education in Nursing, 49(8), 360-371. Web.

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StudyCorgi. (2021, July 9). Hand-Washing and Infections: Evidence-Based Practice. Retrieved from https://studycorgi.com/hand-washing-and-infections-evidence-based-practice/

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"Hand-Washing and Infections: Evidence-Based Practice." StudyCorgi, 9 July 2021, studycorgi.com/hand-washing-and-infections-evidence-based-practice/.

1. StudyCorgi. "Hand-Washing and Infections: Evidence-Based Practice." July 9, 2021. https://studycorgi.com/hand-washing-and-infections-evidence-based-practice/.


StudyCorgi. "Hand-Washing and Infections: Evidence-Based Practice." July 9, 2021. https://studycorgi.com/hand-washing-and-infections-evidence-based-practice/.


StudyCorgi. 2021. "Hand-Washing and Infections: Evidence-Based Practice." July 9, 2021. https://studycorgi.com/hand-washing-and-infections-evidence-based-practice/.


StudyCorgi. (2021) 'Hand-Washing and Infections: Evidence-Based Practice'. 9 July.

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