Quantitative Research: Hand Hygiene

Background of the Study

The study was guided by the need to comprehend health-associated infections caused by failure to maintain hand hygiene. Hand hygiene has been viewed as a trivial issue. Many people do not have sufficient information to understand the risk of not washing one’s hand. There is a need to handle this issue both at the micro and macro level. The study conducted by Fox, et al. (2019) and Hoffmann et al. (2019) sought to understand the correlation between hand hygiene protocol and compliance in tertiary university hospitals. The researchers already knew that individuals operating in tertiary university level had a problem in complying with the hand-hygiene protocol. A baseline study had been carried out to confirm the existence of the problem. Hoffmann et al. use the term ‘My five moments’ (MFM) as a base to identify the level of knowledge, facilitators, and barriers. The study claims that MFM varies extensively from one institution or the organization to another. 

For a substantial period, there have been insufficient HH as far as the upper management of the University Hospital Graz is concerned. Such insufficiency has possessed a significant risk to the public health and nursing practice as a whole. The significance of the study was therefore to revisit the process of training, compliance, and information control, as well as, a provision of a feedback system for healthcare professionals and managers.  The objective was to investigate the impact of introducing a new patient hand hygiene protocol to improve compliance with hand washing compliance of nurses, especially in an intensive care unit.

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The research questions for these studies include

  1. Do the hospital-acquired infections increase the mortality and morbidity of a critically ill patient?
  2. Who are the primary health caregivers responsible for hygiene in a hospital? 
  3. What is the iterative process of training and information concerning the improvement of hand hygiene (HH) by the management?

Hand Hygiene (HH)

The study conducted by Fox et al. (2019) illustrates the importance of hand hygiene, especially for patients in hospitals. Hand washing protocol would ascertain that the occurrence of hospital-acquired infections is reduced significantly while nurses as well other health practitioners are compelled to follow the hand-washing compliance requirement strictly. Generally, infections are supposed to be monitored continuously to ensure quality improvement and hence eradicate such infections. The adoption of daily washing of hands with CHG had not been adopted yet in the Mission Hospital. The reason is that the skin care products had been withdrawn and patients were advised to avoid them since they have a high probability of causing pressure ulcers. It shows why intensive care units were sharing water baths and soaps. Such an intervention was duped Patient Hand Hygiene Protocol (PHHP). It was believed that CHG could destroy microbial by disrupting bacteria cells and hence causing the death of the cells and cytoplasmic leak. A baseline survey that had been carried out by Hoffmann et al. (2018) indicates that compliance with the M5M has not been achieved in many organizations. Ideally, healthcare-associated infections continue to put the lives of patients at risk. The baseline survey illustrated that there is a need for more training, information, and compliance measures, as well as, feedback, especially to all healthcare professionals. The organization of such information would assist in answering the PICOT question. The PICOT framework provides a guideline towards the understanding of the patient/problem, intervention measures, conduct a comparison, and give the outcome. The interventions, as well as, the comparison groups as per the articles rhyme with the PICOT questions inherent in this paper. 

Method of Study

The article authored by Fox et al. (2019) used a pre-experimental study design. A comparison of two primary hospital-acquired infections was conducted. The comparison involved catheter-associated urinary tract infection and central catheter-associated bloodstream infection with nurses’ hand-washing compliance. On the other hand, the article authored by Hoffmann, et al. (2018) used a scientific observational technique. Healthcare professionals, especially in surgical and nonsurgical wards, were observed. 

An observational study involves the collection of data based on what is observed or seen. There is no interference with the variables or the subjects. Meanwhile, experiments involve manipulating one variable and measuring another variable. It follows the randomization protocol where two groups of study; experimental group and control group are chosen.

Experiments are essential in establishing cause-effect relations. They use correlational research or descriptive research to unravel the underlying causes. Such a benefit makes experimentation the conventional method of study applied by many researchers. Meanwhile, the observational study method is simple to use and ascertains the accuracy of data collected. The observational method does not require technical knowledge. 


A comparison between groups and hand-washing time was conducted to understand the nurse’s hand-washing compliance. The results of Fox’s et al. (2019) shows that the rates of hand-washing compliance increased from 0% to 85% before and after the 12 months respectively when entering the patient’s room. The mean rate reported was 35%. Meanwhile, the mean was 66% and the rate of hand hygiene compliance prior to PHHP implementation increased from 41% to 87% when getting out of the patient’s room. The results show that there was no statistical reduction of infection rates for the 12 months; however, there was a reduction in infection rates for both types of infections. 

The study by Hoffmann et al. (2018), used 19,295 moments for HH with a total of 84 compliance measurements in 49 wards. The mean for HH compliance improved from 81.9 ± 5.2% (2013) to 94.0 ± 3.6% (2017). The rate by physicians as far as compliance is concerned increased from 69.0 ± 16.6% to 89.3 ± 6.6%. Generally, M5M for HH had improved fold wise at the end of the period of study. 

The two studies are vital for the nurse because they assist in advancing their knowledge as far as their area of professionalism is concerned. They present a better perspective towards understanding and offering better patient care. Besides, nurses and health practitioners can use this information to develop their conclusions. 

Outcome Comparison

A PICOT question model was developed to assist structuring comprehensive clinical questions that will capacitate an intensive literature search. The PICOT model is essential for conceptualizing a model for hand-washing compliance research. The anticipated outcome is that the PICOT question will cover the objective of both studies. The outcomes of these two articles align with my anticipated outcomes that there will be a significant positive change after the study period expires. The results of these articles show an increase in HH compliance rates for healthcare professionals. 


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 Care24(3), 216-224.

Hoffmann, M., Sendlhofer, G., Pregartner, G., Gombotz, V., Tax, C., Zierler, 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 Nursing28(5-6), 912-919.

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