Benchmark – Capstone Project Change Proposal

In this assignment, students will pull together the change proposal   project components they have been working on throughout the course to   create a proposal inclusive of sections for each content focus area in   the course. At the conclusion of this project, the student will be   able to apply evidence-based research steps and processes required as   the foundation to address a clinically oriented problem or issue in   future practice.

Students will develop a 1,250-1,500 word paper that includes the   following information as it applies to the problem, issue, suggestion,   initiative, or educational need profiled in the capstone change proposal:

  1. Background
  2. Problem statement
  3. Purpose of the     change proposal
  4. PICOT
  5. Literature search strategy   employed
  6. Evaluation of the literature
  7. Applicable     change or nursing theory utilized
  8. Proposed implementation     plan with outcome measures
  9. Identification of potential     barriers to plan implementation, and a discussion of how these could     be overcome
  10. Appendix section, if tables, graphs, surveys,     educational materials, etc. are created

Review the feedback from your instructor on the Topic 3 assignment,   PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use   the feedback to make appropriate revisions to the portfolio components   before submitting.

Prepare this assignment according to the guidelines found in the APA   Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to   beginning the assignment to become familiar with the expectations for   successful completion.

You are required to submit this assignment to LopesWrite. Please refer   to the directions in the Student Success Center.



PICOT Statement Paper

Grand Canyon University


-this is not correct. See the notes & feedback I gave you.

The First Line Is Your Title, Centered, Non-Bolded, Not Underlined

Hand hygiene (HH) is an essential tool in reducing the spread of infections among patients and the healthcare professionals in the clinical setting. Multiple studies have however showed that healthcare professionals do not comply with the HH guidelines provided by the World Health Organization. This has led to increased healthcare related infections resulting in increased mortality rates. There are various factors that lead to non-compliance of the World Health Organization guidelines such as work environment and behavioral motivational factors. This shows that more needs to do in creating awareness among healthcare professionals about the importance of hand hygiene and patient safety (Anna, & Sobala, 2013).

PICOT Statement

For patients and healthcare workers in the hospital (p) does hand washing using soap and water (I) compared to an alcohol hand-based rub (C) reduce hospital acquired infection (O) within a period of stay in the hospital (T)? You got it!

Evidence Based Solution

Multiple studies show that hand washing protocol in the healthcare setting is very effectual in reducing healthcare related infections. The practice of cleaning hand before and after attending patients can help to reduce the spread of germs in hospitals. Healthcare professionals wash their hands more than half times they should on average (Deochand & Deochand, 2016). This increases the chances of spreading healthcare acquired infection (Deochand & Deochand, 2016). While hand washing protocol is useful, alcohol-based solution is more effective as it kills most of the germs that can be transmitted in the healthcare setting (Deochand & Deochand, 2016). Since alcohol-based solution is a bit expensive, patients and healthcare workers should reduce the spread of germs by complying with the hand washing protocol (Deochand & Deochand, 2016).

Nursing Intervention

Nurses interact with patients more often than other healthcare professionals and this exposes them to hospital acquired infections. For this reason, nurses should ensure all their practices are based on patient education, nursing research and are evidence based. Nurses should apply universal precautions to ensure they work in a safe environment (Sung-Ching et al., 2013). Under the universal precaution guidelines, nurse practitioners must wear protective gear before coming into contact with any patient (Sung-Ching et al., 2013). Nurses must also wash their hands before and after interacting with patients. Alcohol based solution can be used as a substitute (Sung-Ching et al., 2013).

Patient Care

Patients are very vulnerable to hospital acquired infections. Healthcare providers should create awareness among patients about the importance of hand hygiene. Patients must clean their hands regularly in the healthcare setting. They should also ask those people visiting them to ensure that they clean their hand before visiting and after living patient wards. This ensures that visitors to not spread diseases to the patients and also the patients do not infect those visiting them. Healthcare workers must put the necessary measures to facilitate the hand washing protocol (Chatfield et al., 2016).

Healthcare Agency

The healthcare agency must ensure their facilities have enough hand washing points to facilitate hand washing protocol. Patients and healthcare professionals will not be able to clean their hands as required if there are not enough areas designated for hand washing. Healthcare providers should also provide alcohol-based solutions in case there is any issue to do with the designated hand washing points. The agency should also ensure that all patients understand the importance of HH while in the healthcare setting. This plays a significant role in reducing the spreading of healthcare related infections (Dyson et al., 2013). Healthcare agencies should also train their healthcare professionals to increase compliance to the hand washing protocol (Dyson et al., 2013).

Nursing Practice

Combining hand washing protocol and alcohol-based solutions can help prevent most of the hospital acquired infections increasing patient safety and better overall patient outcomes (Sendall, McCosker & Halton, 2019). When patient maintain hand hygiene it will be difficult for them to spread hospital acquired infection. The same applies to healthcare professionals. A safe healthcare environment depends on the ability of both the patients and healthcare professionals to comply with the hand washing protocol. Increasing awareness of the importance of HH in the hospitals may increase compliance to the WHO guidelines reducing the spread of infections (Sendall, McCosker & Halton, 2019).

A conclusion statement is a comprehensive assessment of the paper. It does not include references or any new ideas. It is the author’s conclusion.

References you must cite a doi if you have one

Anna, G. P & Sobala, W. (2013). Observance of hand washing procedures performed by the medical personnel before patient contact part 1 Retrieved from international journal of occupational medicine and environmental health 2013

Chatfield, S. L., Nolan, R., Crawford, H., & Hallam, J. S. (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE open medicine4, 2050312116675098.

Deochand, N., & Deochand, M. E. (2016). Brief Report on Hand-Hygiene Monitoring Systems: A Pilot Study of a Computer-Assisted Image Analysis Technique. Journal of environmental health78(10). Doi?

Dyson, J., Lawton, R., Jackson, C., & Cheater, F. (2013). Development of a theory-based instrument to identify barriers and levers to best hand hygiene practice among healthcare practitioners. Implementation Science, 8(1), 111. Doi?

Sendall, M. C., McCosker, L. K., & Halton, K. (2019). Cleaning Staff’s Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study. International journal of environmental research and public health16(6), 1067. Doi?

Sung-Ching, P., Tien, K. L., Hung, I., Yu-Jiun, L., Wang-Huei, S., Wang, M. J., & Yee-Chun, C. (2013). Compliance of Health Care Workers with Hand Hygiene Practices: Independent Advantages of Overt and Covert Observers. PLoS One, 8(1), e53746. Doi?


Literature Review

Professor’s Name

Student’s Name

Course Title



Hand hygiene (HH) is a good way of preventing hospital acquired infections (HAI) among healthcare professionals, patients and those visiting them. However, studies show that patient and healthcare professionals are non-compliant to the HH standards set by the World Health Organization. This has increased the spread of HAI among patients in the healthcare system increasing their hospital stay. This paper analyzes the existing research on the topic to determine how it supports the PICOT statement for this study. The paper will also compare the sample population, research question and limitations of the existing research.

Picot Statement

For patients and healthcare workers in the hospital (p) does hand washing using soap and water (I) compared to an alcohol hand-based rub (C) reduce hospital acquired infection (O) within a period of stay in the hospital (T)?

Comparison of Research Questions

One of the studies on the topic aimed to determine the effectiveness on providing educational programs among nurses to increase compliance with HH guidelines (Daisy & Sreedevi, 2015). Another study on the topic focused on determining how the observation of HH can reduce the rate of infections in hospitals (Fox et al., 2015). A study conducted in 2017 aimed to determine the hand washing procedures used by healthcare professionals before making any contact with their patients in hospitals (Knighton, 2017). Another study conducted in 2018, aimed to determine how providing training programs for nurse could improve adherence to HH (Graveto et al., 2018). These research questions all focus on how compliance to HH guidelines in healthcare systems can improve patient outcomes.

A study conducted in 2015 aimed to aim to determine the effectiveness of HH in large healthcare organizations in Vietnam (Thoa et al., 2015). Another study aimed to explore the procedures and practices of HH among healthcare professionals in hospitals (Lawal et al., 2018). A research done in 2018 aimed determine the availability of necessary hand washing tools , compliance among nurses and access to essential hand washing tools on surgical general wards, intensive care unit and medical education (Niyonzima, Brennaman & Beinempaka, 2018). Another similar study conducted in 2018 aimed to review the experiences of HH among nurses working in the acute care department (Phan et al., 2018). These research questions in one way or the other provide significant insights that support the current PICOT statement.

Comparisons of sample population

The existing studies have been conducted in different environment with different sample sizes. The first study conducted in 2015 has a sample size of 60 nurses working in various private healthcare facilities (Daisy & Sreedevi, 2015). The second research was conducted within two hospitals. The third study has a sample size of 120 medical personnel among them being physicians and nurses. This represented more than twice the population of the previous studies combined. Another study done in 2018 was conducted among various healthcare personnel working at an intensive care unit. This study had a significant lower population as compared to the previous three studies (Graveto et al., 2018).

The fifth study was conducted in fifteen critical care unit and two intensive care units (Thoa et al., 2015). This allowed the researchers to explore different aspects associated with HH comprehensively. Another study conducted in 2018 involved 113 nurse practitioners and was done in 12 weeks (Lawal et al., 2018). Another research was done in five units that handle critically ill patients in surgical wards, ICU and medical emergency units (Niyonzima, Brennaman & Beinempaka, 2018). The final study was conducted among eight nurses in various departments in United States healthcare facilities (Phan et al., 2018). The sample populations included in each of these studies were enough to present the desired findings. However, the studies that had bigger population provided more reliable findings.

Comparison of limitations

Each of the studies that were reviewed had their own limitations. The first time used a labor intensive approach that led to a lot of time wastage (Daisy & Sreedevi, 2015). The sample population of the second study was very small and the results found may not represent the general population (Fox et al., 2015). The third study had an improper representation of the target population and this led to inability of researchers to control the environment (Knighton, 2017). The fourth study was a review and therefore had a lot of biasness issue to deal with. This approach also made it difficult for researchers to identify all data connected to their research question (Graveto et al., 2018). This has significant impacts on the findings of the study.

The fifth study had limited ability to compare as groups used where not alike (Thoa et al., 2015). This presented significant threats to the internal validity of the study. The sixth study had an improper representation of the target population and there was difficulty in the process of analyzing data (Lawal et al., 2018). The seventh research was limited by the fact that behaviors could not be analyzed over a given period of time (Niyonzima, Brennaman & Beinempaka, 2018). It also did not help in determining cause or effect and allowed for conflict of interest that could have affected the findings. The eighth study used a labor intensive approach which made it difficult to investigate various aspects among the groups selected (Phan et al., 2018). It also was time consuming and interpretations were widely limited.


In conclusion, the studies that have been reviewed in this paper support the PICOT statement. Most of the studies had a good sample size which allowed their findings to be reliable. It is recommended that healthcare organizations implement HH programs to create awareness among burses on the importance of hand hygiene. Healthcare organizations should also develop educational programs to increase adherence to HH guidelines among nurses. This study will help to advance knowledge on the importance of using hand washing protocol in HH and lay grounds for future studies.


Daisy, V. T., & Sreedevi, T. R. (2015). Effectiveness of a Multi-Component Educational Intervention on Knowledge and Compliance with Hand Hygiene among Nurses in Neonatal Intensive Care Units. International Journal of Nursing Education7(4), 98-103.

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.

Knighton, S. (2017). The Use of Instructional Technology to Increase Independent Patient Hand Hygiene Practice of Hospitalized Adults in an Acute Care Setting. In Open forum infectious diseases (Vol. 4, No. suppl_1, pp. S411-S412). US: Oxford University Press.

Graveto, J. M. G. D. N., Rebola, R. I. F., Fernandes, E. A., & Costa, P. J. D. S. (2018). Hand hygiene: nurses’ adherence after training. Revista brasileira de enfermagem71(3), 1189-1193.

Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo, H. T., Theorell-Haglow, J., & Gordon, C. J. (2018). An educational intervention to improve hand hygiene compliance in Vietnam. BMC infectious diseases18(1), 116.

Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T., Wertheim, H. F., & Son, N. T. (2015). Cost-effectiveness of a hand hygiene program on health care–associated infections in intensive care patients at a tertiary care hospital in Vietnam. American journal of infection control43(12), e93-e99.

Lawal, T. O., Monsudi, K. F., Zubayr, B. M., Michael, G. C., Duru, C., Ibrahim, Z. F., & Aliyu, I. (2018). Hand hygiene practices among nurses in health facility in a semi-urban setting. International Journal of Health & Allied Sciences7(3), 191.

Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018). Practice and compliance of essential handwashing among healthcare workers at a regional referral hospital in Uganda: A quality improvement and evidence-based practice. Canadian Journal of Infection Control33(1), 33-38.

Topic 9 DQ 2

Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers.

Re: Topic 9 DQ 2

The great challenge of today’s world is providing efficient and high-quality healthcare treatments to patients. EBP is the problem-solving perspective for taking decisions on the basis of current best evidence. It is not the part of a research; however, it belongs to quality and standard improvement. (Wong, 2015). There are many barriers that may prevent EBP change proposal from continuing. One of them is ability to approach and evaluate evidences. (Harding, 2014) The well-designed projects will always base on evidences to check what works and what doesn’t? To overcome this issue, it is better to get feedback through surveys or if it is already implemented then record your own results to evaluate. Good evidence is the one which includes all details like what we want to know, what the objective is and in what context does these evidences needed? The other is cultural or personal values. Patients might refuse to get recommended treatments due to socials, cultural or religious factors. A nurse practitioner described the culture barrier as actuality that is the cause of worst nursing practice. (Yates, 2015).

There must be the culture that allow practice with evidences that keep us up to date. This issue doesn’t only regard patient but also the values of organization matters a lot. Somehow professional advancement among nurses is undermined because of cultural attitudes of hospital system and that needs to work on.


Harding, K. E.‐T. (2014). Not enough time or a low priority? Barriers to evidence‐based practice for allied health clinicians. Journal of Continuing Education in the Health Professions , 224-231.

Wong, C. S. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders.

Yates, M. J. (2015). From a Provider’s Perspective: Integrating Evidence-Based Practice into the Culture of a Social Service Organization. Child Welfare, 87.


Title of Your Paper

Your Name

Submitted to Your Professor Here

Name of Your Class

Grand Canyon University

June 20, 2015

Title of Your Paper

The issue of nursing incivility and its effect on a healthy workplace are disturbing. The nursing profession and the safety of the patients nurses care for, are at risk when nursing incivility is allowed. The purpose of this paper is to define nursing incivility, explore the effects on the workplace and patient care, and identify resolutions.

Defining Nursing Incivility

Nursing incivility is not easily defined and it can be vague and passive. One definition of workplace incivility is “low intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect” (Laschinger, Wong, Cummings, & Grau, 2014, p. 6). Some examples of this deviant behavior include “dismissing an employee’s ideas or opinions, making derogatory or demeaning remarks about individuals at work, and excluding people from unit-based social activities” (Laschinger et al, 2014, p. 6).


The nursing profession has a history of incivility. “Nurses eat their young has been a well known but dark secret within the nursing profession” (Hippeli, 2009).

Pros and Cons of Nursing Incivility

It is difficult to identify any positives from nursing incivility. Disrespectful and uncivil behavior should never be allowed. The question then becomes “why is this still a problem?” The answer lies in what would be considered “pros”.


Addressing the behavior of incivility has risks.


The costs of nurse training, turnover, and lost productivity as a result of nursing incivility has been well documented.


The two main stake holders identified for the issue of nursing incivility is the nursing profession and governing bodies.

Nursing Profession

The nursing profession as a whole, has a duty to maintain its credibility and continue the integrity.

Governing Bodies

In 2008, the Joint Commission released a sentinel event alert regarding behaviors that undermine a culture of safety (Joint Commission, 2008).

Plan of Action

Hippelli wrote this about nursing incivility: “professional nurses recognize the problem but are convinced that they are not part of the problem or the problem needs to be solved by somebody else” (Hippelli, 2009, p. 187).


Obtaining outcomes can be done through education.

Proposed Funding

Considering that staff turnover due to a hostile workplace is costly, the benefits of establishing a healthy workplace environment is easy to calculate.


In conclusion, a toxic workplace costs the patient and the profession of nursing.


American Nurses Association. (2010). Nursing: Scope and standards of practice. (2nd ed.). Silver Spring, MD:

Centers for Disease Control. (2014). Workplace safety & health topics: Workplace violence. Retrieved from

Hippeli, F. (2009). Nursing: does it still eat its young, or have we progressed beyond this?. Nursing Forum44(3), 186-188. doi:10.1111/j.1744-6198.2009.00141.

Joint Commission. (2008). Behaviors that undermine a culture of safety. [Data file]. Retrieved from

Khadjehturian, R. E. (2012). Stopping the Culture of Workplace Incivility in Nursing. Clinical Journal Of Oncology Nursing, 16(6), 638-639. doi:10.1188/12.CJON.638-639.

Lachman, V.D. (2014). Ethical Issues in the Disruptive Behaviors Of Incivility, Bullying, and Horizontal/Lateral Violence. MEDSURG Nursing, 23(1), 56-60.

Laschinger, H.S., Wong, C. A., Cummings, G. G., & Grau, A. L. (2014). Resonant Leadership and Workplace Empowerment: The Value of Positive Organizational Cultures in Reducing Workplace Incivility. Nursing Economic$, 32(1), 5-44.

Occupational Safety and Health Administration. (2015). Guidelines for preventing workplace violence for healthcare and social service workers [Data file]. Retrieved from

Riffkin, R. (2014). Americans rate nurses highest on honesty, ethical standards. Gallup. Retrieved from

Running head: hand hygiene compliance 1

hand hygiene compliance 8

Hand Hygiene Education Implementation and Nurses Compliance in Reducing Nosocomial Infections

Grand Canyon University NRS-490

March 31, 2019


Hygiene is a very crucial factor in prevention of infection in any health care facility. Also, compliance of handwashing ensures patients safety, aids in the treatment and recovery of hospitalized patients. Hand hygiene is important action performed by healthcare works to prevent transmission of healthcare associated infection (Smiddy, O’Connell & Creedon, 2015). Health care professionals such as doctors, nurses, physical therapist and laboratory technicians, take the responsibility of providing efficient, effective and quality care that will improve the health of their patients.

The purpose of this paper is to discuss the change proposal project components the author has been working on throughout the course. The goal of health care works rendering a quality, effective and efficient care to their patient in the health care setting will be difficult to achieve if the rate handwashing adherence is below expectation. Unclean healthcare environments harbor germs that can cause disease, thereby placing the patient at risk of developing infection instead of recovering from their present health condition. Healthcare providers inability to comply with hand hygiene is one the main reason patient develop hospital acquired infections (HAIs). Healthcare employees have the lives of patient in their hands therefore, hand hygiene should not by any means be neglected or dominated out in any healthcare facility.

Approximately 250 health care specialists in a Metro Detroit facility happened to be watched and assessed directly; prior to the start of the exercise, participants were selected based on their hand washing comprehension and compliance. Partakers expresses that they observed improvement on handwashing practices and that most nurses complied to hand washing guidelines evidenced by some significant reductions in the rate of transmission of HAIs within the healthcare facility. HAIs are the infections a patient acquire during the period of hospitalization. The result of the research showed a huge decrease in the spread of nosocomial infections due to progress of hand hygiene training and nurses’ compliance to handwashing protocols. These infections mostly manifest during or after 48 hours of admission or thirty days after discharge from the hospital or health-care facility. The author of this research study sees HAIs as a dangerous disease with many complications. Because inadequate handwashing practices by healthcare workers are the main cause of spread of hospital acquire infections, it is important to educate staff members on proper hand hygiene, implement plan to encourage hand hygiene compliance in the healthcare settings. Blood-stream, ulcers / surgical wounds, CAUTI and respiratory infections are the most common types of HAIs

Problem Statement

Good hand hygiene practice is one of the essential factors in planting an end to cross infections and HAIs. However inadequate handwashing among healthcare providers leads to transmission of infection from one patient to another and they end up contacting the infection and it keeps spreading. (Hinz, McGee, Huitema, Dickinson, & Van Enk, 2014). The necessity of handwashing and adherence in the hospital setting is to facilitate the reduction of HAIs. Some healthcare corporations that are known to be very compliant with handwashing guidelines maintains the high hygiene level and generally have a good treatment that guarantees powerful healthcare system that assist with the standard health and wellbeing of patients. In order to secure patient safety, all health care environment should be kept clean at any given time. When health care facilities are clean, micro organism have no place to grow which will prevent or reduce the extent at which nosocomial infections spreads.

Healthcare workers in Detroit Medical Center were examined for a reduction in nosocomial infections via hand hygiene teaching and adherence monitoring. The writer noted that most healthcare workers do not adhere to handwashing because of lack of education. Some of them complained that they don’t have time to practice hand hygiene as a result of lack of handwashing equipment, high patient ratio, skin irritation and lack of hand hygiene monitoring. Nosocomial infection is defined as infection a patient contracted during their stay in the hospital (Thoa et al., 2015). This infection is very harmful and can jeopardize patient safety. Nosocomial infection is very common and occurs everyday in the hospital, while it can be avoided if the healthcare workers are compliant with hand hygiene protocols within the facility and when providing patient care. Evidence has shown that facilities where caregivers do not practice adequate hand hygiene results to distribution of nosocomial infections.

When healthcare workers neglect handwashing, they pose dangers of acquiring infection to patients and others. Nurses are the closest to patients and their hands are always on the patient when providing care therefore, inadequate hand hygiene is the leading cause of spread of nosocomial infection. This problem is the reason why the researcher wants to know if in an acute care setting healthcare providers(P) will implement hand hygiene education and compliance (I) on hand hygiene practice(C) to decrease nosocomial infections (O) within four weeks period(T).

Purpose of the Change Proposal

It is the responsibility of all healthcare providers to advocate for every patient to make sure that each person obtains safe, efficient, effective and quality healthcare services. Also, healthcare providers should endeavor to work as a team to provide solution that will improve the overall well-being of the patient. Moreover, it will be difficult to accomplish this aim if the healthcare environment increases the chance of contracting the infection as a result of noncompliance of hand hygiene practices. Handwashing practice is the cheapest and simple precaution that prevents spread of nosocomial infections in the hospital and healthcare workers must observe adequate handwashing while rendering patient care. There are so many explanations for noncompliance of handwashing among healthcare workers such as, unawareness, working overtime which may cause burnout. Additionally, laying emphasis on the change proposal which targets to encourage compliance of hand hygiene and education will inspire healthcare workers to observe hygiene at its peak, therefore reducing the rate at which nosocomial infection is being transmitted. Reducing expenses and medical cost utilized to treat complication developed from nosocomial infection is one of the objectives for the proposed change. The hand hygiene program is an effective strategy in reducing the incidence of hospital-acquired infections and is cost-effective (Thoa et al., 2015).

Nosocomial infection delays treatment in the hospital but when the rate of spread is reduced, the hospital will have brief length of stay patient are hospitalized because the process of treatment will be faster and not delayed. This will make bed available for other patient who need it for critical conditions. With few ill patients in the healthcare settings nurses, doctors, lab technicians and other healthcare providers will pay attention and take them serious thereby achieving the aim of providing safe, effective, efficient and quality healthcare services. World Health Organization published guidance on a standardized multistep technique to promote coverage of all surfaces of the hands with hand hygiene product, estimating 20–30 seconds for hand rubbing, Wash hands with warm or cold water. “There is no evidence that warm water is superior to cold water, although tepid water may be better tolerated” (Ellignson et al.2014).


Many researchers use this acronym PICOT to expand their research question(s). P- signifies problem/population/patents, I- represent intervention to fix the problem, C- denotes comparison or opposite of the intervention. O- means the outcome and finally T symbolizes the timeframe used to achieve the desired outcome(s). utilizing the project change proposal, the recognized population provided in this research comprises of healthcare workers in the acute care setting. Intervention in the study is the implementation of education on hand hygiene. Comparison is the hand hygiene practice compliance. The study’s outcome is the decrease in spread of nosocomial infection and the time to achieve this is four weeks. The PICOT used for the change proposal identified is for healthcare workers in the acute care setting(P), hand hygiene education implementation(I) and compliance to hand hygiene practices(C) decreasing nosocomial infections (O) for the period of four weeks (T).

Literature Search Strategy Employed

The author utilized the research plan to search for literature from various database that is linked to the project topic. Essential information related to the topic were gathered from the numerous research plan. The researcher used PICOT to create the research question, this makes it easy to select vital evidence on techniques in which healthcare providers in the acute care setting can prevent the spread of nosocomial infection and comply to hand hygiene guidelines. The authors concentration was focused on identifying some current studies in respect to education on handwashing compliance and prevention of nosocomial infections. Cochrane and MEDLINE are outstanding database online question that was used for the search plan.

Evaluation of the Literature

High quality research literature was used to conduct this study which is pertinent to the problem statement, for example, Lawal et al., (2018) article is the research study learning about hand hygiene practices in the healthcare facility in a semi-urban setting, reply to the research question on how the knowledge and practices of hand hygiene among healthcare worker decrease nosocomial infection. Nurses knowledge on the correct technique involved in hand hygiene is deficient. Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018) article is the research study on availability and suitability of essential hand washing facilities, assess essential handwashing practice compliance among healthcare workers. The choice of literature the researcher used is in line with the statement of problem hence supplying essential data to the research study.

Applicable Change or Nursing Theory Utilized

Non-compliance of adequate hand hygiene practices among acute care nurses illustrates that it is crucial to have an intervention available to help improve the knowledge of healthcare workers on the importance of hand hygiene and adherence. Since substantial number of healthcare workers response is poor, the change applied can assist in reducing the problem which requires finding out why the acknowledgment to adequate hand hygiene practice is deficient. Nurses will be well informed and educated on the benefits of hand hygiene if they are aware and implement the theories in behavioral changes which is very vital in successful program application of decreasing the rate of nosocomial infections. Knowing hand hygiene behavior assumes and predict attitude of an individual with the help of planned behavioral theory.

Proposed Implementation Plan

It is very imperative to practice the standard precautions that will help promote hand hygiene. Hand hygiene compliance is the basis of infection control programs (Phan et al., 2018). The author suggested intervention for this research includes, explaining the importance of educating healthcare providers to carry out hand hygiene protocols appropriately while providing patient care. Seminars on hand hygiene compliance should be conducted to help nurses to work together as a team and come up with the thoughts that can assist with the practice of hand washing such as wearing gloves, placing hand sanitizers at the major locations like patient’s door, hallway, breakroom, around the computer and the nurse’s station.

It is recommended to perform hand hygiene before touch a patient, before clean procedure, after touching a patient, when hands are visibly dirty and after touching the environment (Lau, Tang, Mak & Leung, 2014). These strategies will enhance hand hygiene compliance among healthcare workers. The success of this project was assessed using quiz, posters and monitors. The study is evaluated every week for consecutive four weeks to check the progress of hand hygiene training and compliance protocols likewise decrease of hospital acquired infections. Results are compared every week with initial result at the beginning of the project and summarized. There was reduction in nosocomial infection because of compliance of adequate hand hygiene.

Potential Barriers to Plan Implementation

Negligence, laziness and non-compliance to adequate hand hygiene protocol are among the behaviors that hinders the success of the proposed change to encourage the standard rules of adequate hand hygiene in the acute care setting. It might be difficult for healthcare providers to adjust to the change thereby delaying the intended plan to enhance sanitation. Leaders and managers should provide support, filter ideas, and remove barriers to implementation of best practices identified by positive deviants for improving hand hygiene compliance (Marra & Edmond, 2014). Healthcare providers are to be prompted of their duty to render safe, effective, efficient and quality patient care. To achieve this goal, it is imperative to comply to hand hygiene practices.

Evidence of Revision

Evidence based practice is an approach which involves many stages that require thorough check and finances to function well. My mentor and I will make a detailed budget of how the method will work. Everything should be planned within the budget made by the financial manager. Every step is taken keenly for the practice to function well. Since my project is on hand hygiene, the finances of the evidence-based practice will be high. Money is needed to set up a facility more hand sanitizer dispensers and portable hand sanitizers and pocket hand lotions stationed at work stations which is conducive for nurses who use the area. The finances may come from donors, well-wishers, investors and the government.


To goal of standard health care service is to improve patient outcome, safety and wellbeing and not to expose them to nosocomial infection. Globally, nosocomial infection is a major concern in the healthcare setting and the key cause of poor handwashing, which can be prevented by adequate hand hygiene practices. Hand hygiene is the most cost effective, inexpensive and easiest measures toe reduce or prevent nosocomial infection in the healthcare settings. Hand hygiene education should be encouraged in the acute care setting to reduce the rate individual contracts and transmit nosocomial infection.


Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., … & VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through hand hygiene. Infection Control & Hospital Epidemiology35(8), 937-960.

Hinz, K. L., McGee, H.M., Huitema, B. E., Dickenson, A. M., & Van Enk, R. A., (2014).

Observer accuracy and behavior analysis: Data collection procedures on hand hygiene compliance in a neurovascular unit. American Journal of Infection Control, 42 (10),


Lau, T., Tang, G., Mak, K. L., & Leung, G. (2014). Moment‐specific compliance with hand hygiene. The clinical teacher11(3), 159-164.

Lawal, T. O., Monsudi, K. F., Zubayr, B. M., Michael, G. C., Duru, C., Ibrahim, Z. F., & Aliyu, I. (2018). Hand hygiene practices among nurses in health facility in a semi-urban setting. International Journal of Health & Allied Sciences7(3), 191.

Marra, A. R., & Edmond, M. B. (2014). New technologies to monitor healthcare worker hand hygiene. Clinical Microbiology and Infection20(1), 29-33.

Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018). Practice and compliance of essential handwashing among healthcare workers at a regional referral hospital in Uganda: A quality improvement and evidence-based practice. Canadian Journal of Infection Control33(1), 33-38.

Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo, H. T., Theorell-Haglow, J., & Gordon, C. J. (2018). An educational intervention to improve hand hygiene compliance in Vietnam. BMC infectious diseases18(1), 116.

Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T., Wertheim, H. F., & Son, N. T. (2015). Cost-effectiveness of a hand hygiene program on health care–associated infections in intensive care patients at a tertiary care hospital in Vietnam. American journal of infection control43(12), e93-e99.

Appendix A

Quiz on hand hygiene

1. Hand washing noncompliance among healthcare providers can be transmitted through inadequate hand hygiene?

A. True

B. False

2. it is recommended to wash hand with soap and water for how long?

A. 30 Seconds

B. 10 Seconds

C. 20 Seconds

D. 5 Seconds

3. When is the right time to perform hand hygiene? Select all that apply.

A. Before eating

B. After coughing, sneezing or nose blowing

C. After using the bathroom

D. Before and after each patient care

E. All of the above

4. How can transmission of germs be avoided?

A. Wearing mask

B. Avoid touching sick people

C. Practicing hand hygiene

D. Staying away from others

5. Healthcare provided are required to wash their hand before each patient contact?

A. True

B. False

6. Hand hygiene education implementation encourage hand washing practice adherence?

A. True

B. False

Appendix B

Author- Brain Grease Retrieved from Hand washing Poster

Rate of Nosocomial Infections Before Implementation of Hand Hygiene Education

Week 1 Week 2 Week 3 Week4 200 400 500 600 Week 1 Week 2 Week 3 Week4 180 300 480 500 Week 1 Week 2 Week 3 Week4 160 240 440 400 Week 1 Week 2 Week 3 Week4 120 220 420 380

Rate of Nosocomial Infections After Implementation of Hand Hygiene Education

Week 1 Week 2 Week 3 Week 4 140 80 100 80 Week 1 Week 2 Week 3 Week 4 120 60 80 60 Week 1 Week 2 Week 3 Week 4 100 40 60 40 Week 1 Week 2 Week 3 Week 4 80 20 40 20

Do you need a similar assignment done for you from scratch? We have qualified writers to help you. We assure you an A+ quality paper that is free from plagiarism. Order now for an Amazing Discount!
Use Discount Code "Newclient" for a 15% Discount!

NB: We do not resell papers. Upon ordering, we do an original paper exclusively for you.