Literature Review Assignment: Hand Hygiene and Hospital Acquired Infections

Sammille Pointer

Nipissing University

NSGD 2216 – Critical Inquiry and Evidence Informed Practice

Dr. Rick Vanderlee

April 11, 2023

 Literature Review Assignment: Hand Hygiene and Hospital Acquired Infections

Both hand hygiene and hospital acquired infections remain very relevant topics in

healthcare today. Each year several patients develop infections while they are receiving care in

hospitals. Hand hygiene has suggested as an effective way of reducing the spread of infection.

After reviewing many peer- reviewed primary sources of literature within the last 10 years it is

understandable that researchers continue to explore the connection between the two. This review

will explore some of the common themes seen in the literature that was reviewed, as well as

some of the limitations of the studies. After reading all the articles there is a common correlation

between the incidences of hospital acquired infections and hand hygiene. The studies analyzed

the effects of hand hygiene on the occurrence of hospital acquired infections. The results of all

the studies showed that there was to some extent a downward trend in one or more hospital

acquired infections when hand hygiene compliance was increased. Many of the articles also

explored hand hygiene education as it relates to compliance and included this intervention in

their studies. Providing both patient and staff teaching on hand hygiene contributed to increased

compliance with personal hand hygiene practices. Analyzing the interventions and results of both

in the studies there appears to be an emphasis of importance on the relationship between hand

hygiene and infections. Although there appears to be a correlation between hand hygiene and

hospital acquired infections, all the studies expressed the common limitation of their research

being the single center study. While all the centers had seen a positive trend between hand

hygiene and hospital acquired infections the samples were small and potentially not

generalizable. Examining the key findings and limitations on the relationship between hand

hygiene and hospital acquired infections further research may be needed on a broader scope that
observe the overall effects of hand hygiene and infections across many institutions and

healthcare in general.
 References

Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017). Patients’

hand washing and reducing hospital-acquired infection. Critical Care Nurse, 37(3).

https://doi.org/10.4037/ccn2017694

Kong, A., Botero Suarez, C. S., Rahamatalli, B., Shankweiler, J., & Karasik, O. (2021). Hand

hygiene and hospital-acquired infections during COVID-19 increased vigilance: One

hospital’s experience. HCA Healthcare Journal of Medicine, 2(5).

https://doi.org/10.36518/2689-0216.1296

Monistrol, O., Calbo, E., Riera, M., Nicolás, C., Font, R., Freixas, N., & Garau, J. (2012). Impact

of a hand hygiene educational programme on hospital-acquired infections in medical

wards. Clinical Microbiology and Infection, 18(12), 1212–1218.

https://doi.org/10.1111/j.1469-0691.2011.03735.x

Pokrywka, M., Buraczewski, M., Frank, D., Dixon, H., Ferrelli, J., Shutt, K., & Yassin, M.

(2017). Can improving patient hand hygiene impact clostridium difficile infection events at

an academic medical center? American Journal of Infection Control, 45(9), 959–963.

https://doi.org/10.1016/j.ajic.2017.06.019
 Citation Method/ Design; Context/ Setting/
Purpose/ Focus Key Findings Gaps/ Limitations
Level of Evidence Sample
(Haverstick ” This study was Patients provided with Hospital setting on Unit-specific infection The study was
et al., done to determine individual bottles of units where majority of control data showed that conducted on 1 unit
2017) if increased access hand sanitizer. patients were unable to VRE infections in 1 medical center.
to hand hygiene Nurses and nursing get to the sink to wash decreased by 70%. Limits the
products and technicians provided their hands. MRSA infections generalizability to
patient education hand hygiene Nurses observed and decreased by 63%. other settings
could improve education to patients. provided patients A Wilcoxon rank sum Results were
patients’ hand Patients completed a access to alcohol-based test revealed no compared with
hygiene and 6-question survey hand sanitizer, hand significant difference in results for a group of
reduce the before the wipes, or soap and the rates of C difficile patients from before
transmission of intervention, at water at the bedside. infection before and the intervention
HAIs.” hospital discharge and after the intervention. instead of with
1, 2, and 3 months results from a
after the intervention. randomized control
Infection data was group.
tracked monthly by The demographics
infection prevention of the 2 groups were
staff. not evaluated.

(Monistrol “to evaluate the A before–after The hospital has three New cases of hospital No control group
et al., impact of a interventional study internal medical wards acquired MRSA went was used because
2012) multimodal conducted in four (113 beds) with 132 down from 0.92 in the the intervention was
educational phases. Baseline health workers and a PRE period to 0.25 per hospital-wide.
campaign on HH phase, an intervention constant nurse-to- 1000 hospital-days in the The multimodal
compliance, period, a post- patient ratio of 1:12. POST period (p 0.2). campaign was
encouraging the intervention and the The bed occupancy rate After a multimodal applied in the rest of
use of AHR in follow-up evaluation, in the surveyed wards campaign of hand the hospital wards
internal medicine 1 year later. at the time of the study hygiene employee with posters,
wards.” Hand hygiene ranged from 92.3% to compliance improved pictures, leaflets and
compliance during 92.8%. and alcohol-based hand reminders.
 Citation Method/ Design; Context/ Setting/
Purpose/ Focus Key Findings Gaps/ Limitations
Level of Evidence Sample
professional routine rub consumption No group session,
patient care, alcohol- increased. compliance
based hand rub No changes in observation or
consumption and incidences of hospital surveillance of
MRSA hospital acquired infection were hospital acquired
acquisition were observed after the infections was
compared before and educational campaign. carried out outside
after the intervention the studied area.
and 1 year later.
(Pokrywka “ to improve the Biphasic, quasi- Performed at a 495-bed Patient hand hygiene The selection of
et al., opportunities for experimental, single- medical. opportunities improved patients being
2017) PHH though staff center study Alert patients agreeable significantly (P < .0001) surveyed. Only
education and The study was to answering a survey after staff and patient patients who were
patient assistance, designed by infection on hand hygiene were education. awake, alert, and
and finally, to ask preventionists and included if they were C. Diff. standardized available at the time
the question if nursing leadership in coherent, agreeable to infection ratio (SIR) of the surveys were
improving PHH response to increasing answer questions about decreased significantly included as
opportunities in hospital C. diff events hand hygiene and could for 6 months (P ≤ .05) participants.
the hospital could and assessments of recall their recent hand after the patient hand Patients who were
affect the patient hand hygiene. hygiene experience in hygiene intervention. unable to participate
occurrence the hospital. may have had a
of Clostridium different hand
difficile (CD) hygiene experiences
infection” than those who were
alert and awake.
Patient’s may not
have felt
comfortable
answering the
survey questions
verbally, possibly
 Citation Method/ Design; Context/ Setting/
Purpose/ Focus Key Findings Gaps/ Limitations
Level of Evidence Sample
influencing their
answers. No direct
observation of
patient hand hygiene
was done by the
surveyors. Patient
responses to the
number of times
they had washed
their hands may also
vary by the time of
day the survey was
obtained.
(Kong et “hand hygiene Cross-sectional Osceola Regional Increase in compliance Single center was
al., 2021) compliance at our retrospective Medical Center in with hand hygiene after observed.
hospital will have observational study to Kissimmee, FL. implementation of Lack of statistical
significantly examine the effect of Implement hospital-wide infection significance likely
increased and, as a COVID-19-related comprehensive control measures. due to our small
result, (ii) the infection prevention practices to enhanced Downward trend in all sample size. Even
incidence of non- control measures on institutional and hospital-acquired though a significant
COVID-19-related hand hygiene personal hygiene infections, which was difference was not
hospital-acquired compliance and The focus was on hand not statistically observed for
infections will hospital-acquired hygiene, universal face significant. hospital acquired
have decreased. infections. coverings, expanded A strong statistically infection, a
environmental services significant negative clinically and
and restriction of non- correlation was found financially
essential personnel and between hand hygiene significant
visitors. compliance and the rate difference could still
of Clostridium difficile be present.
hospital-acquired
infection.