PICOT Study on Hand Hygiene


Hand hygiene is often taken for granted yet, it is a major cause for health-associated infections. Consistently, there was particular concern over the people who work in the tertiary university hospitals and their failure to comply with basic hand-washing protocols. The My Five Moments was a baseline study conducted to evaluate how compliant people were to the basic hand washing protocols in different hospitals. The results were varying due to the levels of knowledge, facilitators, barriers, and compliance levels. This study was concerned about the training practice, compliance, and protocol of information for the healthcare professionals and managers. The study’s objective was to determine whether introducing a new patient hand hygiene protocol was going to elicit compliance from the nurses, especially those assigned to work in the intensive care units.

The research questions are all centered around the effects of hospital-acquired infections that increase the mortality and morbidity of a critically ill patient, the health caregivers responsible for hygiene in a hospital and the process of training and information on improving hand hygiene by the hospital management. Generally, hospital-acquired infections are not uncommon. They expose patients and the hospital to expensive treatment regimens due to the increased resistance to antimicrobial drugs. The compliance of health care workers to hand-hygiene protocols remains at an alarming rate of 40%, which means many patients are exposed to risks of infections acquired in the hospital (Hor, et al., 2017). The studies have a common goal of finding out how enhancing hand hygiene in the hospitals’ settings, the infection rates caused by failure to observe proper hand hygiene, and the rate of compliance to hand hygiene by health care workers can be improved and how much effect they already have. The ethical considerations that need to be applied in this study have to be high because it is the health of people at stake.

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How do these two articles support the nurse practice issue you chose?

These two articles respond to the PICOT question of how much risk the patients are exposed to due to lack of compliance with the hand hygiene protocol. There are statistics that the articles document where only 40% of the primary health caregivers are compliant to the basic hand hygiene protocols that have been studied through the baseline study dubbed, My Five Moments (Hor, et al., 2017). The studies also included evaluation procedures for how well health care workers were compliant to the hand hygiene protocols and thus, protecting patients from hospital-acquired infections. In nursing, the fact that a patient can acquire an infection while in the hospital is cause for alarm. The study had 117 consenting participants who made it possible for the study to be conclusive. It was found that in nursing, the movement of people and items in healthcare needed to be done cautiously. Infection control and prevention within the hospital setting is important for securing the health of patients and healthcare workers. A different research by the World Health Organization documents the rising cost to the healthcare system caused by hospital-acquired infections. The cost is as high as several billion dollars annually, which makes perfect sense given that only 40% of the healthcare givers are compliant (Chatfield, Crawford, & Hallam, 2016). The nurses are aware of the risks involved when proper hand hygiene is not observed. They also have their views on how hand hygiene should be done and the majority from the second study do not like the increased use of hand sanitizers within the hospital setting. Most nurses prefer to wash their hands and run the germs off their hands with water. The interventions suggested by the nurses are likely to inspire better hand hygiene compliance because they are the people on the ground, hence, they understand what they need to do to reduce the rates of infections within the hospital. The nurses need to be involved in the process of designing hand hygiene protocols.

Method of Study

The methods of study differ in the articles. One is focused on collecting data in the form of videos while the other is focused on collecting data in the form of responses from the participants. It was also mostly considered a form of self-reporting and could be inaccurate because the participants were aware of what was going on. The collection of data in the form of personal responses is where the views of the individual interviewee are collected and analyzed. The two methods differ in the quality of data they collect. The video data is broad and good for use in a first study, after which a subsequent and more specific study will be conducted based on the results of the analysis. The study where the responses of the nurses are collected used fewer participants because it is rigorous and time-consuming. However, it gives reasons for the results collected in the numerical data. The benefit of the methods used in the article by the World Health Organization is that it gives reasons as to why the compliance rates are low. It also gives recommendations on what needs to change in the hand hygiene protocols to encourage better compliance rates. However, the intensity of the study is obviously costly and unsustainable, therefore, the sample size may not be representing the view of the whole nursing community adequately. The study conducted on videos is important because it presents the data as it is and the analyst can get different kinds of data from it. However, the video data can be biased because the respondents can act the part and unconsciously find that they comply more in the video as opposed to when the study is conducted using other methods.

Results of Study

The findings from the study are that the compliance rates to hand hygiene are low. However, one study introduces a different perspective to routine infection and prevention control, whereby, the conclusion was that hand hygiene was not solely to blame for the hospital-acquired infections. The movement of items within the hospital setting is also a big culprit of these infections because hygiene is only emphasized for the people working in these areas. The working environment of the nurses is considered risky due to the different kinds of germs they are exposed to. For these reasons, nurses are provided with sanitizers, which they feel are not the most appropriate for the hospital setting because it is not washed off. Additionally, nurses also pointed out that in some instances, the knowledge and willingness to apply the hand hygiene protocol was overcome by the inability to do so, exposing the patient to hospitals acquired infections. In the My Five Moments protocol in nursing practice, the cleaning and sanitizing of objects and items should be included (Fox, et al., 2015). This means that hand hygiene protocol compliance levels cannot fully prevent hospital-acquired infections. It also goes to show that the nursing practice cannot work alone to prevent hospital-acquired infections; instead, support from all the members of staff at the hospital is important. The implications of the studies to nursing are that better ways of applying the hand hygiene protocols will be applied. Nurses are more likely to be involved in formulating these processes given the sentiments they aired during the study (Hoffmann, et al., 2019). In general, hand hygiene compliance will improve throughout the hospital setting and not only for the nurses. The hospital staff should all be sensitized on the need to maintain hand and object hygiene within the hospital to prevent infections that are caused by spreading germs to the patients.

Ethical Considerations

Ethically, the participants are supposed to be consenting. This will mean that if they give personal information, they will be aware of who is using it and why. The institution where the study is to be conducted also has to give consent. The study was also not biased because the individual point of view does not show in the study. These are good ethical practices for any qualified researcher to apply. The researchers obtained written consent of all the involved parties. They also ensured that the participation was at the convenience of the nurses so as not to interfere with their working schedules. At the end of the process, they checked back with the participants to ensure that no boundary or agreement was breached. There was no point where the researchers breached the privacy of the participants. Additionally, the researchers only used the information that the participants were comfortable sharing freely. The ethical conduct of the researchers is remarkable and enhances the applicability of the recommendations that come up as a result of the study.

Outcomes Comparison

The anticipated outcomes for the PICOT question that was derived from the studies was expected to cover the issue of hand hygiene and its link to the hospital-acquired infections. However, new causes of the hospital-acquired infections came to light such as the movement of objects in the hospital also contribute to these infections. The movement of items in the hospitals should be checked and regulated to ensure that the transfer of germs through the items used in the hospital was not causing infections. The risks of transmission of germs needed to be found out and sealed to encourage hand hygiene. The hospital acquired infections are hard to completely prevent because even the nurses cannot identify the transmission channels or incidences that stand out. All the studies had one outcome in common, the need for better compliance in hand hygiene levels by the nurses. However, it was also evident that the nurses’ low compliance on hand hygiene was not fully to blame for hospital-acquired infections. At the end of the study, it is expected that the nurses together with other policymakers will have developed a suitable method of hand hygiene compliance. The compliance rates are set to increase once the health care workers are made aware that the nurses do not fully bear the blame for the hospital-acquired infections but instead, all the workers have to adhere to the hygiene protocols.


Chatfield, S. L., Crawford, H., & Hallam, J. S. (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. A SAGE open medicine.

Fox, W., 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, 212-224.

Hoffmann, M., Sendlhofer, G., Pregartner, G., Gombotz, V., Tax, C., Zieler, R., & Brunner, G. (2019). Interventions to increase hand hygiene compliance in a tertiary university hospital over a period of 5 years: An iterative process of information, training, and feedback. Journal of Clinical Nursing, 912-919.

Hor, S. Y., Iedema, R., Wyer, M., Gilbert, G., Jorm, C., & O’Sullivan, M. (2017). Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ Qual Sal, 552-558.

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