Healthcare-Associated Infections: Literature Review


Healthcare-associated infections (HCAIs) may be caused by direct medical interventions or result from interaction with the healthcare environment. To reduce the risk of infection, preventive measures should be taken, such as encouraging patients and nurses to adhere to hand hygiene. This paper is intended to evaluate the previously written literature concerning the following PICOT question: “In patients receiving multiple types of care (P), will adherence to hand hygiene guidelines (I) as compared to the lack thereof (C) lead to lower HCAIs rates (O) at two months post-implementation?” This work will compare research questions, sample populations, and the limitations of the study, as well as provide a conclusion with recommendations for further research.

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Comparing Research Questions

Research questions embrace a wide range of issues relating to the rate of HCAIs in healthcare organizations. Some research questions were focused on how various surveillance systems, such as automated hand hygiene monitoring system (Boyce et al., 2019), hospital-wide infection control programs (Hagel et al., 2019), and multifaceted infection control including antibiotic stewardship (Murni, Duke, Kinney, Daley, & Soenarto, 2015) influenced HCAIs rates. Other questions were concerned with the nursing staff’s awareness of hospital infection (Sarani, Balouchi, Masinaeinezhad, & Ebrahimitabs, 2016) and compliance to hand-washing (Fox et al., 2015). Patel, Engelbrecht, McDonald, Morris, and Smythe (2016) focused on hospital-wide intervention for increasing hand hygiene. Likewise, Sickbert-Bennett et al. (2016) studied improving hand hygiene but put the emphasis on its influence on HCAIs rates. Stiller, Salm, Bischoff, and Gastmeier (2016) investigated how the hospital ward design, namely access to a hand rub dispenser and hospital room size, related to HCAIs rates. Thus, the research questions are diverse, and each of them considers a different aspect of improving hand hygiene and reducing HCAIs rates.

Comparing Sample Populations

Selecting a specific group of the population is crucial for conducting medical research. The studies under consideration were conducted in hospital settings; however, Stiller et al. (2016) based their research on other studies carried out in hospitals. Boyce et al. (2019) chose a 93-bed nonprofit hospital for their study to ascertain if hand hygiene compliance was as high as it was reported. Fox et al. (2015) conducted the research in intensive care units (ICUs) since their patients had problems adhering to hand hygiene themselves and, therefore, depended on nurses’ compliance to hand-washing. Hagel et al. (2019) performed the study in 27 general wards and 5 ICUs to assess the efficiency of a hospital-wide infection control program and define if it has a different impact on these groups of patients. The sample population of Murni et al. (2015) was made up of children in the pediatric intensive care unit in an Indonesian hospital. This segment was chosen because the purpose of the research was to explore the influence of hand hygiene and antibiotic control on hospitalized children in developing countries.

Three studies used the nursing staff as their sample population. Patel et al. (2016) selected 11 wards and studied all personnel working there, regardless of their rank. Sarani et al. (2016) chose the sample population through random sampling, thus selecting 170 nurses working in surgical and pediatric wards, as well as dialysis units. The study of Sickbert-Bennett et al. (2016) involved all the personnel of North Carolina Hospitals to observe whether the improvement of the staff’s compliance to hand hygiene would decrease HCAIs rates. Thus, although there were some differences in the selected population, all the researchers proved that increasing personnel and patients’ adherence to hand hygiene reduced the risk of developing hospital infection.

Comparing the Limitations of the Study

Researchers define limitations in their studies to reveal the challenges they faced during their observations and provide the basis for further research. Boyce et al. (2019) stated that their study did not have a control group to compare the performance with and without the installation of an automated monitoring system. Furthermore, the small size of the studied hospital makes it complicated to generalize the research findings. Fox et al. (2015) compared the outcomes of their study to the parameters before the study instead of creating a control group, which made the impact of the hand hygiene protocol doubtful. Other limitations include studying a particular segment of the population (Murni et al., 2015), a small number of the sample population (Sarani et al., 2016), and a short period of observation (Hagel et al., 2019). Thus, comparing the results of the study with the results before the intervention is the most complicated part of the research. The absence of the second control group, which would perform under ordinary conditions, challenges the credibility of the research outcome.


In conclusion, the recognition of HCAIs has led to an increased effort to prevent patients from developing infections while undergoing medical treatment. Since such a cost-effective way of addressing this problem as adherence to hand hygiene proves to be efficient, further studies are necessary to find methods of improving this parameter. The systems of monitoring the nursing personnel’s compliance to hygiene should be examined. Moreover, the nurses’ awareness of the significance of hand-washing should be evaluated and improved.


Boyce, J. M., Laughman, J. A., Ader, M. H., Wagner, P. T., Parker, A. E., & Arbogast, J. W. (2019). Impact of an automated hand hygiene monitoring system and additional promotional activities on hand hygiene performance rates and healthcare-associated infections. Infection Control & Hospital Epidemiology, 40, 741-747.

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Fox, C., Wavra, T., Drake, D. A., Mulligan. D., Bennett, Y. P., Nelson, C., Kirkwood, P.,… 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 Care, 24(3), 216-224.

Hagel, S., Ludewig, K., Pletz, M. W., Frosinski, J., Moeser, A., Wolkewitz, M., … Scherag, A. (2019). Effectiveness of a hospital-wide infection control programme on the incidence of healthcare-associated infections and associated severe sepsis and septic shock: A prospective interventional study. Clinical Microbiology and Infection, 25(4), 462-468.

Murni, I. K., Duke, T., Kinney, C., Daley. A. J., & Soenarto, Y. (2015). Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: An effectiveness study. Archives of Disease in Childhood, 100, 454-459.

Patel, B., Engelbrecht, H., McDonald, H., Morris, V., & Smythe, W. (2016). A multifaceted hospital-wide intervention increases hand hygiene compliance. South African Medical Journal, 106(4), 335-341.

Sarani, H., Balouchi, A., Masinaeinezhad, N., & Ebrahimitabs, E. (2016). Knowledge, attitude and practice of nurses about standard precautions for hospital-acquired infection in teaching hospitals affiliated to Zabol University of Medical Sciences (2014). Global Journal of Health Sciences, 8(3), 193-198.

Sickbert-Bennett, E. E., DiBiase, L. M., Schade Willis, T. M., Wolak, E. S., Weber, D. J., & Rutala, W. A. (2016). Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerging Infectious Diseases, 22(9), 1628-1630.

Stiller, A., Salm, F., Bischoff, P., & Gastmeier, P. (2016). C., & Riley, T. V. (2016). Relationship between hospital ward design and healthcare-associated infection rates: A systematic review and meta-analysis. Antimicrobial Resistance and Infection Control, 5(51), 1-10.

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