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Role of Hand Hygiene in Clostridium Difficile Control

In the previously submitted work, the clinical importance of Clostridium difficile (C. diff) infections was evidently identified by referencing statistical data and reputable sources on the topic (Boyce & Zingg, 2017). The prevalence of the disease in clinical environments and the need for the elimination of negative consequences of C. diff spreading determine the primary scope of this evidence-based practice (EBP) proposal, which is to develop evidence-based guidelines for the prevention of the disease. This section of the EBP proposal focuses on the identification of a theoretical framework as well as a literature review of current sources on the research topic.

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Theoretical Framework for the EBP proposal

Identification of the Theoretical Framework

As it is mentioned by Fuller et al. (2014), the implementation of theory-based approaches can significantly facilitate the efficiency of hand hygiene interventions in clinical settings. For the purposes of this section, the article by White et al. (2015) was chosen as the primary source of information about the theoretical framework that would benefit the EBP proposal. White et al. (2015) identify the planned behavior (TPB) theory, “a well-validated decision-making model that has been applied to hand hygiene in hospital and other contexts,” as the basis for the improvement of hand hygiene among health workers (p. 60). Therefore, the usefulness and effectiveness of this theory are proved in practice.

Description of the Theoretical Framework

The core assumption of the theory under discussion is the following: the individual’s behavior is largely determined by his or her intention, which is influenced by three primary factors: “attitude, subjective norm, and perceived behavioral control” (White et al., 2015, p. 60). Attitude refers to personal evaluations of certain behavior as positive or negative, subjective norm defines the perceived social pressure, and perceived behavioral control refers to the ease or difficulty of performing the behavior of interest (White et al., 2015). These three domains represent the most critical areas of concern in terms of their impact on the behavioral patterns of an individual. Another highly important concept of the TPB theory is the belief base, which largely determines the individual’s behavior in three identified domains.

The importance of the belief base is primarily determined by the vast impact of individual’s assumptions about themselves and the people around them. The primary scope of the TPB approach is to identify the person’s beliefs and then to facilitate his or her behavior by exposing the individual to new beliefs or altering the existing ones. Since the problem under discussion is evidently connected with healthcare workers’ behavioral patterns, the identified theoretical Framework is highly useful for employment in the EBP proposal.

Literature Review on the Research Topic

First of all, it is essential to overview the articles which were used in the previous section of the EBP proposal. The report by Dubberke et al. (2014) represents a well-elaborated and comprehensive set of guidelines, which aims to highlight practical recommendations for the prevention of C. diff in acute care hospitals. The article is divided into several sections, in which general and C. diff-specific hand hygiene recommendations are provided. The contributions from reputable healthcare professionals, representing various organizations, largely define the quality of the report (Dubberke et al., 2014). The second article that was used in the introduction section of the EBP proposal is written by Barker et al. (2017). This article is of high importance since it investigates the correlation between the number of C. diff spores on patients’ hands and the use of various hand hygiene methods that are available in clinical environments. It is argued in the study that the possibility of C. diff contamination from patients’ hands is highly probable. The authors also compare the effects of alcohol-based sanitizers with soap and water, and they conclude that soap and water are more efficient; however, it is essential to use both methods to minimize the possibility of new contamination.

The following two articles that were chosen in the process of literature research could be discussed jointly, as they are both focused on the impact of sink location on hand hygiene compliance. The first article, written by Zellmer, Blakney, Van Hoof, and Safdar (2015), represents a quantitative study in which the method of direct observations was used. In the second article by Deyneko et al. (2016), a quantitative cross-sectional study, which is also based on the observation of healthcare workers and patients, is conducted. It is possible to state that the sample size differs significantly: the total number of 69 observations was made by Zellmer et al. (2015), which Deyneko et al. (2016) made 247 observations.

Both articles conclude that poor access to sinks decreases handwashing compliance significantly (Deyneko et al., 2016; Zellmer et al., 2015). However, Deyneko et al. (2016) do not provide concise guidelines for the improvement of the situation, while Zellmer et al. (2015) propose an evidence-based intervention of placing two more easily visible sinks in hospital environments. The importance of the studies under discussion is that the authors provide C. diff-specific observations, relatable for the majority of clinical environments. The data that could be retrieved from the articles is highly significant for the development of evidence-based practice guidelines, which is the primary scope of this EBP proposal.

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The next article under discussion, written by Landelle et al. (2016), is a prospective study, which strives to determine the risk factors associated with contamination of healthcare workers (HCW) hands with C. diff spores. The authors employ a considerably large sample of a participant in their research. It is proven in the article that nearly one-quarter of HCWs, who care for patients infected with Clostridium difficile, have their hands contaminated with C. diff spores. These results prove the urgent necessity for the development of a C. diff contamination prevention strategy. It is also suggested by Landelle et al. (2016) that the problem under discussion has a vastly negative impact on the overall quality of caregiving in clinical environments.

A controlled quasi-experimental study by Longtin et al. (2016) is focused on a similar clinical problem as in the article mentioned in the previous paragraph, as the authors strive to understand how C. diff spores could be detected and isolated in clinical environments in order to decrease the level of healthcare-associated C. diff incidence. It is concluded by the authors the timely detection and isolation of C. diff carriers (who are primarily patients infected with the disease) significantly decreases the probability of new contaminations of C. diff by other patients and healthcare workers. The article by Longtin et al. (2016) represents current and actual information on the topic, and the results of the study are based on the information retrieved from a considerably large sample of participants.


Barker, A., Zellmer, C., Tischendorf, J., Duster, M., Valentine, S., Wright, M., & Safdar, N. (2017). On the hands of patients with Clostridium difficile: A study of spore prevalence and the effect of hand hygiene on C difficile removal. American Journal of Infection Control, 45(10), 1154-1156. Web.

Boyce, J., & Zingg, W. (2017). Role of hand hygiene in Clostridium difficile control. In D. Pittet, J. M. Boyce, & B. Allegranzi (Eds.), Hand Hygiene (pp. 373-377). New York, NY: John Wiley & Sons.

Deyneko, A., Cordeiro, F., Berlin, L., Ben-David, D., Perna, S., & Longtin, Y. (2016). Impact of sink location on hand hygiene compliance aftercare of patients with Clostridium difficile infection: a cross-sectional study. BMC Infectious Diseases, 16(1), 203-210.

Dubberke, E. R., Carling, P., Carrico, R., Donskey, C. J., Loo, V. G., McDonald, L. C.,… Gerding, D. N. (2014). Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S48-S65. Web.

Fuller, C., Besser, S., Savage, J., McAteer, J., Stone, S., & Michie, S. (2014). Application of a theoretical framework for behavior change to hospital workers’ real-time explanations for non-compliance with hand hygiene guidelines. American journal of infection control, 42(2), 106-110.

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Landelle, C., Verachten, M., Legrand, P., Girou, E., Barbut, F., & Buisson, C. B. (2014). Contamination of healthcare workers’ hands with Clostridium difficile spores after caring for patients with C. difficile infection. Infection Control & Hospital Epidemiology, 35(1), 10-15.

Longtin, Y., Paquet-Bolduc, B., Gilca, R., Garenc, C., Fortin, E., Longtin, J.,… Ben-David, D. (2016). Effect of detecting and isolating Clostridium difficile carriers at hospital admission on the incidence of C difficile infections: a quasi-experimental controlled study. JAMA Internal Medicine, 176(6), 796-804.

White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W.,… Martin, E. (2015). Using a theory of planned behavior framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses. BMC Health Services Research, 15(1), 59-68.

Zellmer, C., Blakney, R., Van Hoof, S., & Safdar, N. (2015). Impact of sink location on hand hygiene compliance for Clostridium difficile infection. American Journal of Infection Control, 43(4), 387-389.

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