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Quality Improvement Paper on Hand Hygiene

Issue of Hand Hygiene

Washing hands properly is a health requirement so basic that it barely warrants discussion, yet the recent increase in the demand for high-quality care has defined stricter guidelines and standards for care. Thus, the problem of hand hygiene has risen as one of the issues that need raising awareness about and promoting clear standards for the prevention of diseases (Pronovost, 2015). Furthermore, due to the focus on practicing the “art” of nursing, the modern nursing and healthcare setting lacks rigid instructions for managing the quality of care (Pfäfflin et al., 2017). Therefore, there is a need for improved hand hygiene standards.

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Impacting the Quality of Care: Institutional Policy on Hand Hygiene

Due to the absence of rigid guidelines for hand hygiene, the propensity toward the development of infectious diseases increases in patients. Thus, there is an evident need in introducing a proper hand hygiene policy that will help to address the described issue. The expected change will enhance the quality of care by averting infectious diseases and building the efficacy of nursing strategies used within the clinical setting (Dai, Milkman, Hofmann, & Staats, 2015).

The focus on instructional policies will help nurses to avoid the occurrence of nosocomial infections when touching possibly contaminated surfaces (Deyneko et al., 2016). The described change is particularly important for the environment of the critical care unit and similar settings where patients are especially vulnerable to external threats. An improved instructional policy will also help to set the standards that nurses will memorize to the point where the process of hand hygiene will become automatic and will require a minimum of time.

The gap between the Hand Hygiene Issue and Institutional Policy

At present, there is a significant gap between the instructional policies for managing hand hygiene and the actual implementation of the existing guidelines. For instance, a recent article on the subject matter shows that a range of nurses neglects to follow the suggested standards for hand hygiene (Chassin, Mayer, & Nether, 2015). Thus, nurses subject patients to the threat of nosocomial infections and the aggravation of their condition due to the exposure to aggressive factors of a rather hostile environment.

Moreover, there is strong evidence of a range of healthcare practitioners and nurses defying the proposed instructions for maintaining hand hygiene. According to the paper by Salge, Vera, Antons, and Cimiotti (2017), physicians tend to ignore the set standards for hand hygiene, mostly due to time constraints. While being a seemingly minor change in the existing policy for managing patients’ needs, the tendency to ignore hand hygiene recommendations is in direct opposition to the current principles of care (Dai et al., 2015). Indeed, at present, guidelines for hand hygiene specify directly not only the scenarios in which the related actions should be taken but also the exact steps that one should take to maintain hand hygiene (Chassin et al., 2015).

For example, the current instructions specify what areas are missed frequently during the process of washing hands, thus encouraging nurses and healthcare practitioners to pay closer attention to these areas (Salge et al., 2017). The current instructions for hand hygiene can be regarded as appropriate, yet one needs to encourage compliance with these instructions as the ultimate necessity for preventing the cases of nosocomial diseases.

The population at Risk: Description and Rationale

Patients, in general, can be seen as a vulnerable group in the case under analysis since poor hand hygiene affects all types of clients in the healthcare system. However, when considering the people that are affected by poor hand hygiene to the greatest extent, one should focus on the needs of ICU patients. Similarly, inpatients as a more general group are exposed to the threat of infectious diseases in the hospital setting, which makes them the population at risk (Hagel et al., 2015).

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The reason for considering inpatients, in general, and people in the ICU, in particular, as a vulnerable group are quite self-explanatory. Since inpatients and especially those that are placed in the ICU settings are often immunocompromised, they are likely to develop significant complications in case of nosocomial infection (Hagel et al., 2015). Since the latter may reduce their chances for recovery to a considerable extent and even jeopardize their lives, it is critical to view them as the primary vulnerable group.

Improvement Strategies

Because of the vast range of complications that infectious diseases caused by poor hand hygiene entail in the hospital setting, it is critical to shape the existing policies and improve the process of managing patients’ needs. Thus, improving the existing standards for hand hygiene and especially its monitoring needs to be considered as an urgent and necessary change. Specifically, principles of multimodal hand hygiene strategy have to be implemented in the healthcare setting in accordance with the principles set by the World Health Organization (WHO) (Pfäfflin et al., 2017).

The proposed approach implies that the principles of five movements should be introduced into the hospital settings. According to the clarification provided by the WHO, the five movements’ framework encourages nurses to pay closer attention to the process of washing hands and allows them to clean the areas that are typically left ignored (Dai et al., 2015). Therefore, the focus on the proposed technique is especially important for the prevention of hospital-acquired infections (HAIs) (Pronovost, 2015).

It is believed that the changes in the policy toward had hygiene and the introduction of tools for monitoring its implementation will help to minimize the outcomes involving the development of HAI in the clinical setting (Chassin, Nether, Mayer, & Dickerson, 2015). Specifically, addressing the problem of nosocomial infections in the ICU environment will be sought as a desirable outcome. For this purpose, a change in nurses’ behaviors and attitudes toward the process of hand hygiene will be needed, which invites the opportunity for reconsidering the current leadership framework.

By shaping the leadership process toward personal improvement and focusing on the needs of patients, one will promote the values such as responsibility and patient-centered care (Salge et al., 2017). The resulting shift toward a more effective hand hygiene strategy is believed to help to minimize the instances of HAIs in the ICU setting and the clinical environment.


Due to the lack of clear instructions combined with the tendency to view nursing as art rather than science, the introduction of clear and consistent guidelines for hand hygiene among nurses and patients alike should be deemed as an absolute necessity. With the promotion of the relevant policies and the enhancement of the quality of hand hygiene, one will be able to reduce the number of cases involving infectious diseases and promote patient education about the importance of proper hand hygiene. At present, there is a significant gap between the application of the existing hand hygiene principles and the instructional policy for the specified process.

Therefore, an RPI-based approach toward promoting proper hand hygiene is strongly recommended. By establishing the principles of hand hygiene at the health policy level, one will contribute to a rapid improvement of the current situation and the management of the concern regarding the probability of HAI.

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Chassin, M. R., Mayer, C., & Nether, K. (2015). Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance. The Joint Commission Journal on Quality and Patient Safety, 41(1), 4-12.

Chassin, M. R., Nether, K., Mayer, C., & Dickerson, M. F. (2015). Beyond the collaborative: spreading effective improvement in hand hygiene compliance. The Joint Commission Journal on Quality and Patient Safety, 41(1), 13-25.

Dai, H., Milkman, K. L., Hofmann, D. A., & Staats, B. R. (2015). The impact of time at work and time off from work on rule compliance: the case of hand hygiene in health care. Journal of Applied Psychology, 100(3), 846- 862. Web.

Deyneko, A., Cordeiro, F., Berlin, L., Ben-David, D., Perna, S., & Longtin, Y. (2016). Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: a cross-sectional study. BMC infectious diseases, 16(1), 203-209. Web.

Hagel, S., Reischke, J., Kesselmeier, M., Winning, J., Gastmeier, P., Brunkhorst, F. M.,… Pletz, M. W. (2015). Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring. Infection Control & Hospital Epidemiology, 36(8), 957-962. Web.

Pfäfflin, F., Tufa, T. B., Getachew, M., Nigussie, T., Schönfeld, A., Häussinger, D.,… Schmidt, N. (2017). Implementation of the WHO multimodal hand hygiene improvement strategy in a University Hospital in Central Ethiopia. Antimicrobial Resistance & Infection Control, 6(1), 3-12. Web.

Pronovost, P. (2015). Sustaining and spreading improvement in hand hygiene compliance. The Joint Commission Journal on Quality and Patient Safety, 41(1), 3.

Salge, T. O., Vera, A., Antons, D., & Cimiotti, J. P. (2017). Fighting MRSA infections in hospital care: How organizational factors matter. Health Services Research, 52(3), 959-983. Web.

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