Suggestions for Improving Hand Hygiene Compliance

The practice-based nursing theory was used for this report. It has provided the necessary framework for the process of planning a nursing intervention. It was favored over more abstract theories because it had a more direct effect on nursing practice. For instance, Jean Watson, a nursing theorist, has identified hand-washing as “a time to center, reflect, empty, and consciously remind oneself of the importance of quieting and slowing down, allowing authentic presence to emerge” (as cited in Mick, 2016, p. 1759). Although practice-based theories are connected to the concepts from middle-range and grand theories, they remain narrow in scope.

The paper proposes an implementation plan to improve hand hygiene compliance in hospital settings, particularly in neonatal care units. Based on the research examined earlier, there is a need to develop a self-assessment form for nurses. Firstly, successful implementation requires management support, which is why the senior nursing staff has to be informed about the changes using multiple communication channels (World Health Organization, n.d.). Then, a chief nursing officer (or another nursing supervisor) should appoint a coordinator or a multi-disciplinary team that would be in charge of hand hygiene improvement (World Health Organization, n.d.). Lastly, hospitals will need to identify existing hand hygiene policies and guidelines and align them with the new plan. To ensure systematic change, there is a need for the baseline assessment of resources by each hospital (World Health Organization, n.d.). Then, hospital executives need to ensure the procurement of hand hygiene products, including towels, water, soaps, hand-rubs, and sinks. Senior nursing staff and program coordinators have to obtain financial resources from superiors to facilitate the effective implementation of the hand hygiene improvement initiative.

After the first steps, there is training and education. They involve numerous activities, but most of all, planning. The staff needs to identify skilled trainers and allocate the appropriate portion of the hospital’s budget for their employment. These professionals would partake in the process of designing a basic hand hygiene education program. Apart from teaching classes, they would also develop a plan for continuous education based on the feedback. The next step in the implementation would be ensuring there are enough reminders for nurses. This can be done through various online and offline distribution materials. The implementation would follow a multimodal approach by having a system of periodic self-assessment. The program would be constantly evolving based on its evaluations and nurses’ feedback. The last step would include community and patient engagement through a series of events, discussions, and entertainments. The outcome measures in this implementation model include rates of HAIs. Therefore, the use of these rates over time will indicate the success of the program. HAI rates will also help to assess the impact of the program on the quality of care and patient satisfaction rates. The program will be identified as ‘successful’ if there is an increase in hand hygiene compliance, in the utilization of hand hygiene products, and in the improvement of hand hygiene.

The implementation of the proposed hand hygiene program is by the evidence-based practice (EBP) guidelines. EBP is essential to providing quality care to patients because it is an integral part of enhancing the nursing practice. Adopting EBP improves patient outcomes and increases healthcare provider satisfaction rates (Mathieson et al., 2019). The report features a PICOT, which is s a four-part method of developing a question that would assess the problem, intervention, comparison, outcome, and timing. The question is “Can hospital-acquired infections (P) be effectively minimized by proper hand hygiene compliance (I) practiced by care providers compared to non-compliance with hand hygiene practices (C) in as far as improvement of patient outcome and care quality is concerned (O) within five months (T)?” Additionally, a detailed literature review is included in the report. It consists of various critiques of the latest academic research regarding hand hygiene and HAIs. Therefore, it is evident that the report has used a series of data-guided investigations to generate the most definitive conclusions. As a result, an implementation plan was developed.

Evaluation is another important part of the hand hygiene program implementation. The process will include regular evaluation and feedback. Regular evaluation refers to setting up hand hygiene compliance observations over time. Hospital staff and program coordinators would identify the sources of expertise for the evaluation process, including data managers and epidemiologists. The feedback portion will imply the creation of a specific system that will allow coordinators to record and report results to senior staff in the most time- and cost-efficient way. Feedback will also facilitate open communication and further development of the program. Prioritizing evaluation is important to make appropriate changes to the program and optimize the training process. There are several potential barriers to the implementation of the program. Firstly, there is “currently a lack of agreement on what optimal hand hygiene compliance should be for a specific clinical setting or situation” (Gould et al., 2017). Secondly, there is very little accessible data regarding the cost-effectiveness of hygiene initiatives, which is a major challenge for the program’s implementation in a bureaucratic hospital setting.


Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews. Web.

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20(6). Web.

Mick, J. (2016). An alternative to singing “Happy Birthday”: Healthcare provider’s rhyme for handwashing time. American Journal of Infection Control, 44(12), 1759-1760. Web.

World Health Organization (n.d.). Template action plan for WHO framework. Web.

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NursingBird. "Suggestions for Improving Hand Hygiene Compliance." February 16, 2022.