Hygiene as an Evidence-Based Practice


Hospital-acquired infections are associated with a high level of patient morbidity and mortality. According to Shiva (2014), nearly 1.5 million hospitalized individuals around the globe suffer from the healthcare-related infections, and about 37 percent of patients referring to intensive care units catch them. Hospital personnel is considered to play a significant role in the dissemination of microorganisms from one patient to another. At the same time, the recent research evidence indicates a major association between proper hand hygiene and the decreased risk of transmission of pathogens (McLaws, 2015). Based on this, it is possible to assume that a regular implementation of the basic hygiene practices including hand washing may help to decrease infection-related morbidity in patients and improve the overall patient safety in hospitals.

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The PICOT question selected for the study is as follows: in nursing personnel and hospitalized individuals (P), how do regular hand-washing and other hygiene procedures (I) can reduce the incidence of healthcare-associated infections in patients (O) compared to the lack of hygiene practices (C)? In order to answer the formulated question, we will review three recent academic articles, evaluate the evidence provided by their authors, and summarize findings in the following paragraphs.

Literature Review

According to Fox et al. (2015), hospital-acquired infections are responsible for 90 thousand preventable deaths merely in the United States, and financial costs over U.S. $ 4.5 billion per year. At the same time, the improvement of hand hygiene is considered one of the most efficient methods allowing hospitals to eliminate the issues associated with infections.

The term “hand hygiene” a range of activities performed to cleanse hands – washing hands by using regular or antibacterial soaps, and alcohol-based agents, as well as antiseptic rubs (Shiva, 2014). Such simple procedures help health practitioners to remove contaminants, pathogens, and transient flora. According to Shiva (2014), alcohol-based hand rub is more effective than hand-washing with ordinary soap and allows reducing bacterial counts more efficiently. These findings are consistent with the evidence provided by McLaws (2015) who claims that alcohol-based hand rub is more feasible than hand-washing with soap and is thus recommended for the routine use before touching a patient, after the contact with him or her, and after the contact with the zone of the patient’s hospitalization.

The researchers emphasize the importance of a standardized approach to personal hygiene within hospital settings and their endeavors aimed at the prevention of healthcare-associated infections. Continual supervision is regarded as one of the most important factors for the encouragement of health practitioners’ compliance with hygiene activities. Shiva (2014) recommends using such supervision methods as direct observations, self-reports, automated monitoring systems, etc. Among the mentioned surveillance techniques, direct observations by trained personnel or patients are considered to be the best (Shiva, 2014). However, to ensure that nurses adhere to hygiene practices, supervisors should first provide them with sufficient knowledge regarding the issue, attempt to raise the awareness of the importance of patient safety culture, and regularly purchase all the necessary hygiene products.

It is possible to say that the problems associated with the lack of hygiene practice are harder to address in the patient population than in nurses due to the organizational difficulties because sometimes patients’ ability to practice hand hygiene may be challenged due to reduced mobility, unavailability of the required supplies, and so on (Fox et al., 2015). Thus, it is not enough simply to educate patients on health risks and benefits of adequate hygiene procedures. To achieve sustainable positive results in the reduction of hospital-acquire infections’ incidence, personnel should monitor and report patient activities, and provide assistance if necessary. In their study, Fox et al. (2015) suggest using a patient hand hygiene protocol specifically designed to control ICU patients’ safety. According to the protocol, the nurses participated in the study were required to assist patients with their hygiene procedures three times a day. They used electronic reminders allowing them to fulfill the duty on time. Moreover, the regular medical records and comments were used to monitor the adherence to the protocol. Fox et al. (2015) state that the given prevention strategy is potentially lifesaving. Additionally, it was observed that regular monitoring and reporting involved in the intervention program fostered the increase in nurses’ compliance with hand-washing procedures from 48 percent to 75 percent after the training period (Fox et al., 2015). The findings emphasize the significance of a holistic, hospital-wide approach to the enforcement of compliance with hygiene procedures and prevention of dissemination of hospital-acquired infections.


The results of the literature review make it clear that adequate and regular performance of hand-washing procedures and other hygiene procedures by both nurses and patients may favorably impact safety within a clinical setting. To reduce the incidence of healthcare-associated infections in hospitalized patients, personnel should consider several factors. First of all, it is essential to provide all needed hygienic supplies and train nurses to use them regularly. Additionally, the study evidence indicates that monitoring of nurses’ compliance is critical to the success of prevention strategies. Overall, it is possible to conclude that if all factors are simultaneously addressed as a part of an integrated patient safety development program, the hospital will achieve better outcomes in the reduction of patient morbidity due to infections.

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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.

McLaws, M. (2015). The relationship between hand hygiene and health care-associated infection: It’s complicated. Infection and Drug Resistance,8, 7-15. Web.

Shiva, F. (2014). Hand hygiene in healthcare settings: Clean hands save lives. Archives of Pediatric Infectious Diseases, 2(1). Web.

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