hand hygiene among nurses and healthcare workers

Research Critique

Hand washing is considered a hygienic practice that is crucial in the prevention and spread of disease-causing germs. This aspect of cleanliness is a sensitive issue when it comes to the hospital settings. Patients are the most vulnerable individuals to infections. Infections in the healthcare settings contribute to increased care costs, morbidity, and mortality. The CDC and the WHO both emphasize the importance of observing handwashing practices in hospital settings. This critique analyzes two studies that answer the PICOT question.


Chavaliet al. (2014) examine the effectiveness of hand washing hygiene program in a tertiary care hospital. The study acknowledges the adverse effects of not observing proper hand washing practices, which may lead to healthcare-associated infections, especially among patients in the ICU. The study contributes to the nursing field by advocating for verbal reminders and continuous training to adhere to hand hygiene. The purpose of the article is to evaluate compliance of the nursing and clinical professionals in the ICUs to hand hygiene practices. It also aims to assess the adherence to hand hygiene among healthcare workers after their training. This study’s research question was, “Do the physicians in ICU and other nurses comply with the hand hygiene guidelines?” On the other hand, the second study in this critique is by Ashraf et al. (2010) also addresses the PICOT question by examining the progress of hand hygiene practices in the long-term care facilities. The study’s findings can assist in offering guidance for related programs in long-term care facilities. The study’s purpose involved expediting of timely creation of programs that foster hand hygiene practices in the long-term care settings. It also aims to provide more information about hand hygiene practices specific to the LTCFs. The research question was, “What are the inconsistencies in knowledge concerning attitudes to hand washing among nurses and other practitioners? What are the existing hurdles to compliance with handwashing guidelines?”

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Relevance to PICOT

The two articles are crucial in answering the PICOT question.More information will be provided that are relevant to the PICOT question. For instance, Ashraf et al. (2010) specifically cover information about hand hygiene practices in the LTCFs. It studies the obstacles to compliance as well as the knowledge differences about hand hygiene practices among healthcare workers in LTFCs. This information is crucial in providing the answer to the PICOT that mentioned the impact of complying with the hand washing procedures on patients in the long-term care facilities. Likewise, the second article offers insights on hand hygiene practices in acute care facilities. The article’s setting is in the Intensive Care Unit of a healthcare facility.

The PICOT question identified the comparison group as health practitioners in both the LTCFs and acute care facilities. From Chavali et al. (2014), the comparison group comprised nursing staff and allied staff who got observed in the acute care facility. Broadly, they comprised nurses and healthcare workers like physiotherapists and technicians. The other article also comprised a different set of a comparison group that was also related to the PICOT question. Its comparison group comprised healthcare professionals in the LTCFs. They included nurses, certified nursing assistants, social workers, nutritionists, among other healthcare professionals. Ashraf et al. (2010) asserted that quality improvement programs should be created to target other healthcare workers apart from the nurses. Additionally, the findings recommended that this group should get encouraged to take part in training and education programsabout the topic. Barriers to practicing hand hygiene in the LTCFsidentified in the article would help in reducing hospital-acquired infections just as the PICOT questions asked. Chavali et al. (2014) also answered the question by identifying reasons for nonadherence to hand hygiene that could help in training and improving compliance with hand hygiene to reduce infections among patients.

Method of Study

Chavali et al. (2014) adopted two methods: one was prior to the study, while the other one was during the study. The two methods include the use of surveys and observations. The survey involved filling a close-ended questionnaire. Direct observation comprised a daily observance of 150 opportunities. The other article adopted the use of a survey. It involved a 52-question survey that was anonymous. The two studies used different methods but shared the use of surveys to collect data. However, both surveys had close-ended questions. Ashraf et al. (2010) used a survey based on the CDC guidelines as the other article used to validate the questionnaire.

Direct observation allows for an event to get studied in its natural setting, thus, offering rich comprehension of the subject. However, this method has its drawbacks. This method does not allow continuous monitoring. For instance, this limitation can impact the coverage of healthcare workers. Surveys are preferred since one can collect data in a short period thanks to its ability to reach wide masses. Its limitation is that it does not offer a good way to follow trends over a short time.

Results of Study

The first article that examined the compliance among nurses and other healthcare workers on hand hygiene involved 38 staff. Nurses comprised 28, while the rest were other healthcare workers. Ashraf et al. (2014) found that the compliance to hand hygiene was 78 % according to the WHO guidelines. This rate was below the required level set at 90% in the critical care settings. Nurses reported an adherence rate of 63%, while the allied staff reported a rate of 87%.  After contact with patients, the compliance rate was 93%, which is higher than the rate before contact of 63%. Also, the compliance rate before the aseptic procedure (40%) was low. The majority of the staff were aware of the health hygiene facts. On the other hand, the second article examined the need to create programs that focus on fostering hand hygiene practices in the LTCFs. This study involved 1,143 subjects in seventeen nursing facilities across the US.The study revealed that most of the healthcare workers were familiar with the CDC guidelines and maintained positive attitudesabout them. Despite the fact that the majority of the healthcare workers were familiar with the guidelines, only one-third performed better on questions regarding knowledge on the guidelines. This number scored more than 85% of the questions. The study also found that the barriers to hand hygiene, especially in the home settings were the absence of paper towels, a nearby sink, and alcohol-based hand rubs.

Outcome Comparison

The anticipated outcomes for the PICOT involved reduced infections among patients in the LTCFs and the acute care facilities due to enhanced hand washing practices and compliance among the health practitioners. Additionally, it was anticipated that healthcare practitioners significantly impact patient outcomes in healthcare settings. The outcomes of the articles revealed that knowledge, barriers to hand hygiene practice, and the role of healthcare workers play crucial roles in enhancing the handwashing compliance and practices among the healthcare workers. Furthermore, compliance rates were vital in reducing rates of infection among patients in both care settings.Enhancing handwashing practices also impacts the level of infection rates among patients in care settings. For instance, continuous trainingand providing reminders play vital roles in sustaining adherence to hand hygiene.

Hand hygiene requires a multi-faceted approach to report reduced infection rates. Human resources, knowledge, and tools all have a part to play. Fostering hand hygiene compliance among healthcare practitioners will go along way in ensuring that there is no hospital-acquired infection. The articles offer interventions such as an educational program for nursing home workers, continuous verbal reminders, and continuous training to ensure compliance with hand hygiene. Following these practices will significantly improve patients’ health, reduce costs, and lead to improved life outcomes.


Ashraf, M. S., Hussain, S. W., Agarwal, N., Ashraf, S., Gabriel, E. K., Hussain, R., … &Walia, R. (2010). Hand Hygiene in Long-Term Care Facilities A Multicenter Study of Knowledge, Attitudes, Practices, and Barriers. Infection Control & Hospital Epidemiology, 31(7), 758-762.

Chavali, S., Menon, V., & Shukla, U. (2014). Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 18(10), 689.


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