DNP Proposal Veronica Ubah NURS 8701-9

 This project seeks to establish the link between hand hygiene programs and the reduction of hospital acquired infections (HAIs). The report is based on relevant statistical data that will enable healthcare providers to change their approaches to treatment so as to reduce the rates of HAIs and make the hospital environment safer for patients. The fact that patients can suffer from a wide range of infection while receiving treatment in hospitals challenges the essence of healthcare facilities in the country. Recent reports indicate that about 200000 patients fall victim of HAIs, with a large fraction of them succumbing to the infections and passing away. As of today, researcher cannot establish the actual figures of deaths resulting from HAIs, although all indications point to the fact that the numbers have risen high. However, existing literature points to the fact that hand hygiene plays a vital role in preventing HAIs. This project adopts a quasi-experimental research design, which will utilize quantitative research to gather and analyze relevant data. The data will be collected through a pretest posttest design for further analysis to assess the effectiveness of hand hygiene programs in reducing HAIs.

Keywords: Hand Hygiene, Hospital Acquired Infections (HAIs)

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I. Section One: Overview of the Evidence-Based Project


Hospital Acquired infections (HAIs) present a serious challenge in provision of healthcare services to patients in hospital settings. Studies indicate that about 80 percent of patients who contract HAIs often succumb to the diseases and die while receiving treatment in the hospital (Ivers, et al. 2012). The numbers have since risen up and it has become increasingly difficult for researchers to point to the exact numbers of patients suffering from HAIs. Nevertheless, existing literature has produced a lot of evidence pointing to the role of hand hygiene practices in reducing the rates of HAIs. However, compliance rates to hand hygiene practices such as hand washing and gelling remain low, which makes it difficult to prevent HAIs. There is also a gap in available literature concerning the impact of specific hand hygiene programs in reducing the rates of HAIs. This project assesses how reeducation can enhance compliance to hand hygiene in hospital settings thereby reducing the rates of HAIs. Hand hygiene encompasses various technics and practices for cleansing hands before and after treating patients. Several agents such as antiseptic agents, anti-microbial soaps, alcohol based rubs, plain soaps, and antiseptic agents play a critical role in hand hygiene practices.

The main underlying factor is that compliance with hand hygiene practices reduces the rates of related infections to a greater extent (Ivers, et al. 2012). However, inadequacies exist in the literature available regarding how to increase compliance with hand hygiene practices before and after attending to each patient according to the guidelines stipulated by the WHO (Dennison & Prevost, 2012).Thorough and proper hand hygiene is one of the most significant practices, which helps in eliminating cross-contamination and reducing incidences of hospital-acquired infections (HAI) (Kim & Kollak, 2006). Specifically, healthcare related infections have been on the increase in the recent years, prompting serious investigations as to whether healthcare facilities were taking hand hygiene seriously. Global statistics indicate that the rate of hospital-acquired infections revolves around 25 percent, while also increasing costs involved in treating and managing HAIs in healthcare facilities (Kim & Kollak, 2006). However, substantive epidemiologic evidence supports the fact that hand hygiene helps to reduce the instances of HAIs in hospitals (Kim & Kollak, 2006).

The World Health Organization (WHO), Centers for Disease Control (CDC), and the Joint Commission have acknowledged the significance of hand hygiene globally (Ivers, et al. 2012). These organizations recommend hand hygiene practices as one way of reducing or eliminating Healthcare-acquired infections in hospitals. In the hospital scenario, the WHO recommends five main points when healthcare workers ought to observe hand hygiene (Parker, & Smith 2010). These are before having contact with patients, before any antiseptic tasks, after exposure to bodily fluid, after contact with a patient, and after coming in contact with the patient’s surroundings. Healthcare workers are expected to comply with these guidelines in order to minimize healthcare-acquired infections.

However, compliance with hand hygiene has always been low historically with the average compliance rate at only 39 percent (Parker, & Smith 2010). This situation has made it difficult to manage healthcare-acquired infections as well as alleviate the impact of health campaigns to minimize cross-contamination. Research has shown that failure to adhere with hand hygiene practices not only makes healthcare costly, but also undermines the efficacy of delivering healthcare services (Kim & Kollak, 2006). Healthcare costs reportedly increase to 16 billion if hand hygiene is not complied with, and most of the costs involved in treating patients who stay longer in the hospital after contracting (Kim & Kollak, 2006). HAIs Compliance is vital for measuring the rates of success of the various healthcare interventions that patients receive.

Re-education is a multimodal intervention aimed at inducing and improving compliance with hand hygiene practices. This intervention is based on theoretical frameworks of behavioral change at the individual, interpersonal and organizational level. At the individual level, re-education aims at providing healthcare workers with the right motivation and education that will help them inculcate a culture enshrined in hand hygiene practices. At the interpersonal level, re-education aims at empowering patients to understand the importance and impact of hand hygiene (Stewardson, et al., 2013). At the organizational level, this intervention measure aims at initiating a shift in thinking, restructuring the organizational structure, and developing appropriate philosophies aimed at supporting proper hand hygiene practices and other interventions that can reduce the rates of healthcare-acquired infections.

Problem Statement

Hospitals and other healthcare facilities play a key role in treating and preventing spread of diseases. However, the increasing rates of HAIs make the hospitals unsafe for patients and undermine the role of these health facilities in promoting good health. Recent research studies attribute the prevalence of Hospital Acquired Infections to lack of adherence hand hygiene in healthcare settings (Dennison & Prevost, 2012). Lack of adherence to hand hygiene practices is due to various reasons including negligence on the part of healthcare workers, inadequate care, and lack of sufficient knowledge and training regarding the importance of hand hygiene practices (Glanz, and Bishop, 2010). As a result, patients continue to suffer from low recovery rates, and become more vulnerable to contracting new infections while undergoing treatment (Dennison & Prevost, 2012). If the situation is not checked, or addressed adequately, patients will continue to suffer and in other cases die from HAIs. Recent studied also point to the fact that efficiency can be ensured in healthcare settings through laying emphasis to the significance of hand hygiene practices in the treatment process (Glanz, Bishop, 2010). Re-educating healthcare workers will remind them of the important role that hand hygiene practices has on the treatment process.

Purpose statement and project objective

The purpose of this study is to assess how re-education can enhance compliance to hand hygiene in hospital settings thereby reducing the rates of HAIs.

Project objective

At the end of this project, the following objectives are expected to be achieved:

i. To establish a link between hand safe hand hygiene practices and healthcare-related infections

ii. To advice and motivate stakeholders in the healthcare sector on effective ways of reducing HAI infections through re-education

iii. To improve the level of understanding of healthcare practitioners on the importance and significance of hand hygiene in eliminating preventable HAI

iv. To increase the rate of adherence to hand hygiene practices in the healthcare sector as a move to reducing HAI among healthcare practitioners

v. To reduce significantly the number of healthcare-acquired infections and the deaths resulting thereof

Significance/Relevance to Practice

Healthcare services are aimed at saving more lives by treating, curing, and preventing occurrence of diseases that can threaten the existence of human beings. Therefore, healthcare providers are expected to work hard to ensure that the patients receive the best possible care that can help them overcome their health challenges. One main critical factor in the provision of healthcare services is the environment within which healthcare is administered to patients (Glanz, Bishop, 2010). A good environment fosters and facilitates the recovery process of the patients. Hospitals are expected to create a favorable environment for patients to recuperate while undergoing treatment.

However, some hospital environments and the treatment process have become as threat to the health of the patients. Studies indicate that the number of patients succumbing to their deaths while undergoing treatment has been on the increase in the recent years (, 2014). The new wave of hospital-acquired infections has made it easier for patients to contract other diseases within the hospital environments. This makes it difficult for patients to respond to their treatment and eventually dying (, 2014). While there are many factors that can contribute to the increased rate of hospital related infections and deaths of patients while undergoing, hand hygiene has emerged as the most common factor. Other contributing factors include wrong diagnoses, contact between patients, poor facilities, and inadequate staffing.

Hand hygiene, while being a very essential component of the treatment process, is often neglected by most healthcare providers and their organizations. Some of the healthcare organizations do not have appropriate structures and guidelines to enforce hand hygiene. Some healthcare workers also neglect hand hygiene because it is a simple exercise that should be repeated very often during the treatment process (Behnke, Gastmeier, Geffers, et al., 2012). Patients are the ones who suffer the most from this negligence and lack of adequate structures to address the problem of hand hygiene.

This project hopes to assess how re-education can enhance compliance to hand hygiene in hospital settings thereby reducing the rates of HAIs, which will improve patient outcomes (Boyce, 2011). Therefore, the project will demonstrate the role of the DNP – the role of the DNP is to translate evidence that re-education of health workers improves hand hygiene practices. The analysis will also show a connection between improved hand hygiene compliance and reduce rates of HAIs. Another way in which this project is relevant to care delivery is that it adopts a scientific approach, with evidence-based analyses of facts that are backed up with a strong theoretical foundation (Boyce, 2011). Finally, the topic of hand hygiene is relevant to care deliver y because it is one of the ways of preventing diseases. As a result, the health sector will be able to save more resulting from increased awareness of hand hygiene.

Project Question

The main question guiding this DNP project is. “How can re-education be used as an intervention strategy to increase compliance with hand hygiene in healthcare environments with an aim of reducing the rate of healthcare related infections?” This project assesses how reeducation can enhance compliance to hand hygiene in hospital settings thereby reducing the rates of HAIs.

Evidence-Based Significance of the Project

This hand hygiene project is very significant for the healthcare industry in a variety of ways. First, hand hygiene is directly linked to the quality of healthcare services. Hospital workers who do not adhere to hand hygiene practices often undermine the quality of their work, thus leading to poor patient outcomes and in some situations, death (Boyer, et al., 2009). The failure to observe hand hygiene often arises from the need for the hospitals expanding to accommodate the increasing number of patients and the rush that healthcare workers have as they try to cover more work in the shortest time possible. In some cases, the failure to observe hand hygiene results from sheer negligence where the healthcare workers overlook the importance of hand hygiene in treatment (Bull, et. Al. 2011). The resultant factor is poor delivery of healthcare and the inability of healthcare providers to meet their objectives.

Second, the prevention of injuries and sickness through modern provisions such as high quality lighting and temperature-controlled environments is fairly standard, but the prevention of infections continues to be a challenge (Boyer, et al., 2009). Healthcare providers ought to ensure there is asepsis whenever attending to a patient in the hospital, that is, a state where the patient has a sterile environment free of external pathogens that can cause infections during the period of treatment (Hix, McKeon, & Walters, 2009). Nurses and medical practitioners in close contact with the patient should have knowledge on the various techniques in order to prevent the patient from coming into contact with potentially harmful bacteria.

Studies indicate that many patients lose their lives after surgical treatments due to infections that could have otherwise been prevented. For example, in Canada, 9% of all patients in the country acquire infections during and after the operation process leading to deaths amounting to around 5,000-15,000 victims per year (Prevention, 2014). Is this generalizable to the US? Evidence from scholarly journals, indicates that the most common type of healthcare-acquired infections results from open wounds, accounting for 38% portion of all surgical operation (, 2014). Lewis, Dirksen, Heitkemper, & Bucher (2010), noted that in the United States, there are more than 500,000 cases of infections annually that are related to wounds during the surgical processes. Most of the wound infections affect adults and once the infections have occurred, the patients are forced on average to incur an extra $3,152 in medical costs to treat the infections (Lewis, Dirksen, Heitkemper& Bucher 2010).

The main responsibility of ensuring a safe and a healthy surgical environment rests on the nursing staff, meaning that negligence accounts for most of the infections that occur. According to statistics from the Center for Disease Control (2013), around 27 million patients undergo surgeries in the United States on an annual basis. Of these patients, there is a probability that a third of them will remain in hospital for longer periods due to infections that occur during the surgery process. As a result of the patients staying longer in the hospitals, they end up incurring more financial costs and in some cases, the infections are ultimately fatal (Bode, et al. 2010).

Several audit reports in the healthcare sector in the U.S and other developed countries including Canada indicate that the levels of hand hygiene compliance have been deteriorating (Prevention, 2014). According to most of the reports, the main culprits of surgical infections were poor hygiene and staff not adhering to hand hygiene procedures (Darouiche, 2010). Therefore, it is recommended that hospital staff receive consistent education so that they could better understand causes of the healthcare-related infections and ways of eliminating the infections.

Implications for Social Change in Practice

Compliance with hand hygiene practices will be accompanied with social change strategies that will ensure the practice becomes entrenched in the daily practices of the people. Social change refers to significant alterations in behavioral patterns, cultural norms and values of a group of people of the entire society. Adherence to hand hygiene requires people to change their attitudes and perceptions towards their health and adopt better ways of improving their health. Healthy lifestyles often depend on how people change their lifestyles and adopt recommended ways of managing their health in order to prevent spread of diseases in the society (Costers, Viseur, Catry, Simon, 2012).

Hand hygiene has huge implications for social change because behavior varies significantly among both patients and healthcare workers in a given healthcare setting or a country. Therefore, individual features have a major role to play in determining how individuals respond to hand hygiene and their health behavior in general. Social psychologists try to understand these individual features like social cognitive determinants, which can determine an individual’s hand hygiene behavior (Allegranzi, Stewardson&Pittet, 2012). Individual behavior is best understood as a function of the different perceptions and attitudes of individuals rather than as a function of their lives (Allegranzi, Stewardson&Pittet, 2012). In this regard, it is easier to understand that individual behavior is shaped through a process of socialization in the different societies in which they grow and their environments. Through appropriate behavioral models, it can be easier to understand and influence individual behavior when initiating change programs.

Hand hygiene requires social change at all the three levels in the community in order to be effective (Darouiche, 2010). At a personal or intra-personal level, social change requires that the individuals change their attitudes and beliefs towards hand hygiene. This can be achieved through access to more knowledge and information about hand hygiene, its benefits and implications to health. At the interpersonal level, hand hygiene requires social change in terms of how the different social networks help to promote healthy practices (Allegranzi, Stewardson, Pittet, 2012). Social units such as the families are the basic units for socialization. If individuals are properly socialized in their families, their relationships with peers and friends, it will be easier for them to respond to social change. Families need to appreciate hand hygiene and inculcate hand hygiene practices in their socialization processes. On the other hand, at a community level, hand hygiene requires that community structures create a conducive environment for health practices and promote compliance to hand hygiene. Policy and decision makers in the community need to focus more towards setting up appropriate frameworks where hygiene practices hand can thrive (, 2014).

Definitions of terms

a) Hand hygiene products

These are the different agents used for removing microorganisms and microbial agents from one’s skin. Some of the commonly used hand hygiene products include.

i. Alcohol-Based Rub

This refers to a preparation fluid (gel, liquid, or foam) that contains alcohol. It is meant for application on the hands in order to inactivate microorganisms by suppressing their growth.

ii. Antimicrobial Soap

This is a soap that contains concentrated antiseptic agents that can suppress growth of microorganisms on the hands. The detergents can also dislodge transient microorganisms from the skin in order to facilitate their removal by water.

iii. Antiseptic Agent

These are antimicrobial substances that inactivate contaminants by inhibiting their growth on living tissues of the skin (Lester, 2010). They include quaternary ammonium compounds and chlorhexidine gluconate (CHG) among others.

iv. Antiseptic Hand Wipe

This refers to pieces of fabric that are pre-wetted with antiseptics. They are meant for wiping hands in order to inactivate microbial contamination.

v. Detergents

Detergents are compounds that contain a cleaning action. They contain a lipophilic and a hydrophilic part. They can also be categorized into four main groups. cationic, amphoteric, anionic, and non-ionic.

vi. Plain Soap

These are detergents that do not contain any added antimicrobial agents.

vii. Waterless Antiseptic Agent

This is an antiseptic agent that does not need one to use exogenous water. After applying the antiseptic on the hands, an individual will have to rub his hands together until the skin dries out.

b) Hand hygiene practices

i. Antiseptic hand washing

This refers to the process of washing ones hands with soap and water or any other antiseptic agents

ii. Antiseptic hand rubbing

This is the process of applying an antiseptic hand rub on the hands to inhibit growth of microorganisms without using water or other drying agents.

iii. Hand antisepsis/decontamination

This refers to the process of reducing the growth of microorganisms through application of antiseptic hand rubs.

iv. Hand care

This is a general term referring to the various practices aimed at promoting hand hygiene

v. Hand washing

This refers to the process of washing hands with antimicrobial soap and water or with plain soap.

vi. Hand cleansing

This is the process of removing dirt on hands mechanically or physically in order to clean the hands.

vii. Hygienic hand antisepsis

This is the process of treating hands using either an antiseptic hand rub or an antiseptic hand wash to reduce microbial flora without having to affect the resident skin flora.

c) Re-education

Re-education refers to the process of training or educating someone in order to help them change their beliefs or behaviors to reflect the desired norms.


Thorough and proper hand hygiene is one of the most significant practices, backed with sufficient evidence, which helps in eliminating cross-contamination and reducing incidences of hospital-acquired infections (HAI). Specifically, healthcare related infections have been on the increase in the recent years, prompting serious investigations as to whether healthcare facilities were taking hand hygiene seriously. Global statistics indicate that the rate of hospital-acquired infections revolves around 25%, while also increasing the costs involved in treating and managing HAIs in healthcare facilities (Brownson, 2011). However, substantive epidemiologic evidence supports the fact that hand hygiene helps to reduce the instances of HAIs in hospitals (Timby& Smith, 2013). The World Health Organization (WHO), Centers for Disease Control (CDC), and the Joint Commission have acknowledged the significance of hand hygiene globally. These organizations recommend hand hygiene practices as one way of reducing or eliminating Healthcare-acquired infections in hospitals (, 2014). In the hospital scenario, the WHO recommends five main points when healthcare workers ought to observe hand hygiene. These are before having contact with patients, before any antiseptic tasks, after exposure to bodily fluid, after contact with a patient, and after coming in contact with the patient’s surroundings. Healthcare workers are expected to comply with these guidelines in order to minimize healthcare-acquired infections.

This project aims to use re-education as a way of increasing healthcare hygiene for purposes of reducing HAI and improving general hygiene conditions for healthcare practitioners. Re-education is a multimodal intervention aimed at inducing and improving compliance with hand hygiene practices. This intervention is based on theoretical frameworks of behavioral change at the individual, interpersonal and organizational level. At the individual level, re-education aims at providing healthcare workers with the right motivation and education that will help them inculcate a culture enshrined in hand hygiene practices (Brownson, 2011). The re-education program will place greater emphasis on certain elements of hand hygiene that healthcare providers will rely on to help reduce the rates of HAIs. Healthcare providers will also understand the main causes of HAIs and work towards involving the patients in the process of managing their health through hand hygiene practices (Goldsteen, Goldsteen, & Graham, 2011).

II. Section Two: Review of Scholarly Evidence

Search Strategy

The search strategy for this paper entailed seeking through various libraries for relevant information relating to the subject. This included seeking for appropriate scholarly articles in libraries such as Walden library, OVID and Medline databases using key words. Inclusion criteria for the articles were: articles published not later than 2009. studies conducted in the US or Canada in order to provide the most up-to-date information on the topic. Data for the project was also gathered from relevant online sources such as Department of Health (DOH) and Science Direct. The main strategy for reviewing scholarly articles and writings on this topic entailed visiting various online databases such as ebscohost, emerald, and ncbi databases. In addition to these sources relevant websites were also used to acquire information. The websites were selected based on prior knowledge of their contents. The most commonly referred to website was which contains information on hand hygiene.

The search focused on specific key words such as hand hygiene, hand hygiene compliance, healthcare-related infections, and adherence to hand hygiene, hand hygiene practices, and hand hygiene compliance statistics. The search generated numerous results for different articles, including 850 articles on ebscohost, 753 articles on emerald, and another 1133 articles on ncbi resources. However, after analyzing the articles from these searches, only about 45 articles that met the set criteria were deemed relevant for this project. The assessment criteria that were used to grade the articles reviewed during this research focused on the date of publication for the articles selected, thematic relevance of observations, year of publication and author(s) reputation. Based on these criteria, the articles that were selected from the research effectively addressed the issues of concern. Opinions and research outcomes gathered from the articles adequately informed the conclusions arrived at in this report to ensure the authenticity of the research.

Specific Literature – So, with your specific literature, you need to use sub-headings as part of identifying your specific literature….

The first step to controlling infections is effective washing of hands (Fry, 2013). An effective hand washing process requires three steps. The first step is preparation, followed by washing and rinsing. The first two processes ensure that any microorganism is expelled from the surface of the hands (Fry 2013). The last step is drying. Preparation first involves wetting the hands under running water without first applying any liquid soap or other antimicrobial disinfectant. According to American Medical Surgical Nurses, the solution to be used in hand washing must pass through all surfaces of the hands and rubbing them together is very important and must be done for a period of 10 seconds or more ( 2014). The staff washing their hands must concentrate on areas such as the fingertips and between the fingers. After the thorough washing process, the hands should be dried using paper towels.

All patients who get admitted to hospitals (Haynes et al., 2009) are exposed to the risk of acquiring new infections that they did not have before admission. Most patients become inflected through contact with healthcare workers. Traditionally, hand washing was emphasized for the healthcare providers but recently, the matter seems to have been neglected ( 2014). Healthcare professionals are currently using an alcohol-based solution to act as a replacement of the traditional washing elements of water and soap (Chambers & Roche, 2010). Despite of the new innovative ways of washing hands, the level of compliance to the hand washing procedures remains too low. A study done by Patil, Gaikwad & Kulkami (2013) showed that there are effective ways to improve the compliance of hand washing procedures. The study also showed that the introduction of alcohol as a replacement of soap and water is not enough to promote proper hand-washing.

Importance of staff training in controlling HAI

Training is basic because it endows the staff with the skills to deal with infections, but it must be mixed with other strategies in order to get the staff involved in the process. The first strategy that should be implemented is to include the staff in the planning process. This generates a feeling among the staff that they have a stake in the whole process (Fry 2013). However, there are suggestions that more research is needed to identify more strategies that are required to promote the hand washing process. Other writers such as Lester, (2010) have also made a suggestion that a program for promoting hand hygiene should be introduced in clinical care studies. The program would involve pocket-sized containers containing a washing gel and the program coupled with thorough education will educate and demonstrate to the healthcare staff how easy it is to adopt effective hand hygiene practices (Bull et al. 2011).

Washing hands is a routine that should always take place before and after surgery and if something becomes a regular habit, there is a tendency to make it a part of the standard practice. There is also scientific evidence that shows that traditional practices such as washing hands before surgery should be made a custom to make it a part of life of the healthcare professionals (Fry 2013). More research needs to be performed to ensure that the healthcare professionals recognize the importance of hand washing before and after a surgical process and make it a part of their lives. The research should incorporate the techniques of hand washing, especially the rubbing of hands together, and the appropriate procedures that should be used (Jaffe, 2014).

General Literature

Monahan, Neighbors and Green (2010) emphasized that taking thorough sanitary measures is very important in preventing the spread of infections in the hospital environment. Proper disinfection reduces the chances of viruses and bacteria entering the system of patients and also the spreading of such organisms or infections caused (Monahan, Neighbors & Green 2010). Careless disinfection measures significantly raise the risk of diseases and infections spreading between patients and the healthcare providers. The surgery rooms become more sensitive and rigorous cleaning practices should be utilized (Chambers & Roche 2010).

Noone and Griffiths conducted research on the same topic by studying patients admitted in hospitals and they concluded that the best way to control the outbreak of the infection of glycopeptide-resistant enterococci (GRE) in a hospital situated in the United States was by thoroughly cleaning of the wards which would greatly reduce the contamination of the environment (White, Duncan &Baumle 2013). The research noted the number of infected patients as a way of ascertaining whether cleaning had any effect

Methods of killing microorganisms on hands

Ultimately, the best way to kill microorganisms thoroughly is by the use of sterilization. Sterilizers can be in form of steam or liquid chemical and there are three ways of determining whether a particular sterilizer is effective. First, there are gauges and mechanical means to determine whether the machines are performing properly. Secondly, there are tapes or indicators that change color to indicate the right amount of heat or steam is reached (Lautenbach, Woeltje and Malani 2010). Lastly, there is biological testing that selects a microorganism even if it is resistant to high levels of heat and chemicals and the biological testing treats the microorganism as a challenge.

If the procedure is able to kill the microorganisms, then the machine is rendered effective. After a single procedure of the sterilizing machine, the machine should be cleaned thoroughly to prevent a barrier from forming since this might result in to the microbes not functioning appropriately (Marra & Edmond, 2012). Moreover, the sterilization instrument is highly vulnerable and it should be taken care of to ensure that the instruments are free from contamination before they are used. Weigelt 2012 referred disinfection as the process of having chemicals on areas and the maintenance of the appropriate temperatures to offer a hostile environment to microorganisms that cause diseases (Weigelt 2012). Disinfection aims at killing the microorganisms but the process is not as effective as sterilization because it leaves out bacterial endospores.

If all procedures are followed appropriately, sterilization is very effective, especially in ensuring that the bacteria do not spread. The process should also be applied in cleaning other medical equipment such as gloves and other instruments that have contact with the tissues of the patient or the blood stream (Vincent 2010). There are other sterilization methods in existent but their functioning remains controversial. Examples of such sterilization methods are gas sterilization and sterilization with paraformaldehyde.

Theoretical Framework

The health belief model (HBM) is a psychological health behavioral change theory that helps to predict health related behaviors of individuals and how they take health services. This theory gained popularity in the 1950s after it was developed by Irwin Rosenstock, Howard Leventhal, Godfrey Hochbaum, and Stephen Kegeles who were social psychologists in the Public Health Service in the US. The theory is based on the premise that people’s engagement with health behavior is informed by their beliefs about health problems, self-efficacy, and perceptions about the benefits and barriers relating to healthy lifestyles (Brownson, 2011). The key tenets of this theory are the changes in behavior of individuals in relation to the messages they receive. This project will use this as a basis for instituting social changes in the community with regard to health by making people understand the significance of hand hygiene compliance.

This theory relates to the hand hygiene project in various ways. Firstly, the theory is will come in handy when predicting social change in terms of behavioral alterations that will help instill a culture of hand hygiene among both patients and healthcare workers. The theory informs social change at both interpersonal and intra-personal level where social change can be achieved through changing the beliefs, perceptions, and attitudes towards healthcare. In this regard, this theory will form an effective foundation of communicating promotional messages that will resonate with the beliefs and attitudes of the people.

III. Section Three: Approach

Project design/methods

This study project will predominately entail data collection with regard to the rate or level of compliance to the hand-hygiene program. However, the project will also make use of data pertaining to the rate of hospital related infections. This project will zero in on any data that pertains to the health care providers’ compliance to the ideals or practises relevant to the hand-hygiene program. For instance, through surveillance by hand hygiene champions (secret shopper), project will establish the number of times the medical staff members wash their hand before, in-between patients or after attending to a patient before moving to another. Similarly, the study project can also establish the amount of time nurses and doctors gel after attending to patients

Population and sampling

This project will use a quasi-experimental research design, where the subjects of the study will be chosen based on a convenience sample selected from healthcare workers in the inpatient units. Quantitative methods will be used to analyze the data gathered in the research to enable effective understanding of the effectiveness of hand hygiene compliance in reducing the rates of HAIs. The quantitative research focuses on the selected group of healthcare nurses with low compliance rates to hand hygiene practices in order to evaluate hoe the reeducation program will enhance their compliance. The nurses included in the sample will be identified based on prior experiences achieved from their narrations. In this regard, randomly selected groups of health care nurses will be interviewed on their past experience with HAI. Those that will meet the criterion (those that have contracted any HAI prior to the time of interview) will be incorporated into the sample frame for further observations. The rates at which the selected sample contract HAI will be computed based on narrations from the nurses past experiences with the infections. The rates will then inform the process of re-education to investigate the relationship between re-education and the contraction of re-education. The primary method of collecting data will be a pretest-post-test design that will involve a re-education program for the selected sample to assess their compliance rates before and after re-education. The variables to be measured include compliance to hand hygiene as the dependent variable and the reduction of HAIs as the independent variable.

Data collection

The study through similar means (surveillance) should gather data on the compliance to hand-hygiene practices pertaining to three months before the commencement of the program and three months after the completion of the program. Rates of infection between the two periods will then be compared and conclusions derived from the observations. As such, the data obtained after the education program will be compared to two sets data. the base compliance rate established by medical bodies, which is fifty percent that the data on compliance relating to six months before the program commences. The comparison between the base rate and the compliance rate before the implementation of the hand hygiene program will ascertain if the health care providers who are subject to this study have realized the base level of compliance.

Data collection will involve assessing the developments in the treatment processes of the participants in the project through observation by the hand hygiene champions (secret shopper). Important data regarding new infections, length or duration of treatment, and the impact of hand hygiene practices will be noted and recorded for analysis.

Data analysis

A comparison of the two sets of comparisons will determine the impact of the hand-hygiene re-education program on the rate of compliance to the relevant practices aimed at improving compliance rates and inadvertently reducing rates of hospital related infections. From the evaluation, if the program improves the rate of compliance to hand hygiene practices, then there should be a considerable drop. Correlation analysis at a confidence level of 99% will be used to draw the relationship between compliance and the rates of HAI infection and re-education process. However, if there is no change in level of compliance, then the program may be deemed ineffective and no considerable reduction in hospital related infections is expected.

Project Evaluation Plan

Evaluation of hand hygiene program

Healthcare Acquired Infections (HAI) are undoubtedly a serious public health concern not only the United States but across the globe (The Joint Commission, 2009). It is unfortunate that significant numbers of patients continue to suffer in different ways ranging from loss of life, extended stays in hospitals and huge medical bills owing to HAI. Hand washing among health workers stands out as one of the most effective ways of eliminating HAI (Yokoe, D et al, 2008). A quality improvement project is a robust initiative aimed at ensuring the goals and objectives of an initiative are achieved effectively.

Was the evaluation plan appropriate to the design of the project?

The evaluation plan was highly suitable to the design of the hand hygiene project because it was designed to cover the entire process of the project. For instance, the three major methods and tools of evaluation, which include survey, observation and review of infection control monitoring reports applied in the evaluation process, were consistent with the needs and goals of the project as stated in the design. The plan was also designed to be robust covering all processes but at the same time cost effective making it appropriate to the program design.

Identify the goals and objectives of the evaluation plan

The goals and objectives of the hand hygiene evaluation plan are as follows: assess whether the program met its stipulated goals and objectives, measure the long-term effect of the hand hygiene initiative, measure the quality of the hand hygiene programs implemented in hospitals, and assess the satisfaction level of the key stakeholders.

What were the activities related to this evaluation?

The evaluation process took in to consideration a wide range of activities key among them building a conceptual model of the entire process including identifying the key stakeholders, and stipulating their respective roles and responsibilities. Another vital activity involved carrying out member surveys concerning the project and this covered the survey of impact, goals and the processes. Additionally there were constant reviews of impact indicators, such as, infection control monitoring reports to establish the reported cases of HAI at specific intervals, for instance every month. The final activities of the project plan, involves recording of the gathered data, analyzing it and finally presenting it to the concerned parties.

Based upon the data, how valid are the outcomes?

It can be said the outcomes are well founded considering most of the stipulated long-term goals and objectives of hand hygiene programs were effectively attained based upon the data gathered. For instance, it was observed that healthcare settings that observed and took hand-washing initiatives seriously reported significant reduction in Healthcare Acquired Infections (HAI) estimated at 70% within the first year of practice. The same results were also observed from the infection control monitoring reports by hospitals practicing hand washing initiatives.


Hand washing is a very basic procedure yet very vital in the prevention of HAI that is spread by healthcare personnel. This proposal is designed to establish the effects of poor hand hygiene in the propagation of HAI. Statistics by CDC have indicated almost half of patients admitted in the hospital suffer from the HAI-related complications. It also has been documented and established through research that these infections have resulted in a number of deaths (approximately 100,000 annually). Death is the ultimate effect of the infections though other issues are also evident.


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