Capstone on Hand Hygiene in the Operating Room: Chapter 2: Review of the Literature

Capstone on Hand Hygiene in the Operating Room: Chapter 2: Review of the Literature
Infection control is based on making sure people follow national standards and scientific research on hand hygiene. Even though the practice is important, low compliance rates make it hard to keep up with and better. To solve the problem, there are many pieces of proof that can help guide the implementation of practices that can improve the number of people who wash their hands properly. In Appendix A of my research paper, I list 30 reliable sources that talk about how healthcare centers clean their hands. These sources tell you about the reasons why people don’t wash their hands as often as they should, how to improve the practice, how important it is to improve it, and the problems that come with it. The data in the chosen articles was collected in different ways, so the strength of the proof is also different. Also, the peer-reviewed works were found in databases like CINAHL, Cochrane, PubMed, MEDLINE, and EMBASE, except for the WHO national guidelines on hand hygiene in healthcare, which were found in the WHO database.

Best Practices

Teaching and Learning

It has been shown that people in both developing and developed countries don’t wash their hands well enough. Educating and training healthcare workers are among the things that are suggested to improve hand cleanliness. (WHO, 2009). Education is important for better hand hygiene because it teaches nurses, doctors, and other health care workers how to do it properly. A study done in Vietnam found that 70% of hand cleanliness practices are done wrong, which makes the number of HAIs rise. (Phan et al., 2018). There is also proof that about 65% of healthcare workers don’t know much about the WHO’s hand hygiene guidelines and that most of them have never been to a hand hygiene education program. (Ahmed et al., 2020). Education and training can help people do a better job of self-monitoring when they wash their hands, and it can help healthcare providers learn more about diseases that can be avoided by doing so.

Multimodal Interventions

You can use a single management method or a combination of methods to improve the quality of healthcare. Single interventions use one evidence-based practice to change a behavior or process, while multimodal approaches use two or more evidence-based practices. Evidence shows that multimodal treatments are the best way to get people to wash their hands. (Rodriguez et al., 2015). Methods that are often used include leadership commitment, monitoring hand hygiene supplies, using reminders, educating people, and giving comments on how well people clean their hands. Sands and Aunger (2020) say that multimodal methods improve communication, openness, and interaction between healthcare teams, which leads to high compliance rates. Also, multimodal treatments are better than single interventions because they can measure more than one thing at once about how well people clean their hands.

Modeling for a living

When healthcare workers practice hand cleanliness, it’s important to know what makes them act the way they do. Leaders in a company should set a good example for the rest of the staff so that they can follow suit. It is thought that if supervisors are strict about hand cleanliness, junior staff will also be more careful with their hands. (Qasmi et al., 2018). Role models help employees change how they feel about hand hygiene, and it keeps bosses busy so they can watch other healthcare workers do it. Students took part in a comprehensive study that showed that role modeling interventions led to high rates of hand hygiene compliance. (Gould et al., 2017). Professional modeling is an important job skill that keeps workers busy and helps them learn more about themselves. Professional modeling takes advantage of the fact that people are more likely to do what their bosses or peers do.

Summary of the Proof

How important it is to follow hand hygiene rules

Hand hygiene obedience is clearly the most important thing to do to stop the spread of infections caused by medical care. (HAIs). These infections make it hard for the patient to get better and lengthen the time they have to stay in the hospital. On any given day, HAIs harm one out of every 31 hospital patients. (Hillier, 2020). Hand cleanliness has been shown to be an effective way to reduce infections and stop the spread of disease. A systematic study of how important it is to wash your hands showed that it is very important for preventing HAIs. The review said that keeping up with hand hygiene can help cut down on infections that affect the digestive system and the lungs. (Andriani & Nadjib, 2018). Other studies have looked at how the practice can save money and make patients happy. Tan et al. (2015) found that making sure people wash their hands can cut costs related to HAIs and make patients happier in the long run.

Strategies for making sure people wash their hands

Several ways have been suggested to get nurses to wash their hands more often, such as multimodal-directed methods and individual interventions. Education and training are two of the best ways to get people to wash their hands more often. (Dorinina et al., 2017). This method works because it helps healthcare workers learn more and become more aware of themselves. Even though the practice has potential, it takes a long time to get people to follow hand cleanliness rules. (Price et al., 2018). Infection prevention and control experts all over the world learn and teach different things about hand hygiene. One reason why people don’t wash their hands enough could be that healthcare workers don’t have enough experience and training in this area. (Tartari et al., 2019). Guidelines for practice that are based on evidence help with teaching and training to improve the practice. Even though training is suggested, compliance with hand hygiene is much better when simulations are used in a practical bedside and hands-on way.

Educating people about hand cleanliness in ICUs and operating rooms is mostly about how often people should wash their hands, how long they should wash their hands, why they should wash their hands, and how well alcohol-based hand rubs work. A study done in Vietnam used short videos, small group talks, and role-playing as ways to teach people how to clean their hands better. During the intervention, it was seen that people knew more about hand hygiene after a few lessons. (Phan et al., 2018). In conclusion, the experts say that teaching about hand hygiene can make a big difference in clinics with a lot of new patients. Another study found a link between hand hygiene and professional role and standing, social affiliation, changes to the work environment, and social norms. These results back up that link. (Sands & Aunger, 2020). Educational methods are important because they touch on the mental health of healthcare workers and are more likely to change their behavior.

Patients are staying in the hospital longer and costing the healthcare system more money because there are more diseases linked to medical care. There is a lot of proof that poor hand hygiene is to blame for the rising number of HAIs. (Musu et al., 2017). In the United States, over two million infections happen every year, and the only way to stop these illnesses is to wash your hands. The WHO recommends that healthcare workers wash their hands at least 91% of the time. On the other hand, the average number of healthcare workers who do this is only 40%. (Quilab et al., 2019). Observational studies done all over the world show that the best way to get people to clean their hands is through training and teaching programs. Mageus et al. (2015) say that other tactics, like using feedback, reminders, and storyboard projects, can be used in addition to the education and training interventions.

There are both short-term and long-term ways to improve hand cleanliness in health care. A search of papers in the CINAHL, Cochrane, and EMBASE databases shows that educational interventions, reminder systems, and the availability of ABHR are short-term ways to get people to follow hand hygiene rules. (Gould et al., 2017). But multimodal interventions, which use two or more methods together, help many groups in the long run. The results of this study agree with those of a study by Rodriguez et al. (2015), which found that multimodal methods are the best way to get people in ICUs to wash their hands more often. Another approach is the use of professional modeling, in which leaders or managers show how to keep hands clean by doing it themselves. (Qasmi et al., 2018). This method makes workers more positive and self-aware, which makes them more likely to take part in hand hygiene practices.


Hand hygiene is the most important thing you can do to stop HAIs and the spread of germs that are resistant to drugs. It is important for both healthcare workers and patients to follow the rules for hand hygiene. In my company, the problem with hand hygiene in the operating room is that people don’t use soap to wash their hands and don’t follow the hand hygiene instructions. From what I’ve seen, the staff doesn’t have enough basic training on hand cleanliness, and the practice isn’t pushed much in the unit. To solve this problem, I suggest using an education and training intervention program, which has been shown to make people more likely to wash their hands. (Quilab et al., 2019). Special attention will be paid to how microorganisms are spread, when to wash your hands, how to wash your hands, and how long to wash your hands, as guided by the WHO (2009) guidelines.

Ahmed, J., Malik, F., Memon, Z. A., Bin Arif, T., Ali, A., Nasim, S., Ahmad, J., & Khan, M. A. (2020). Compliance and knowledge of healthcare workers regarding hand hygiene and use of disinfectants: A study based in Karachi. Cureus Journal of Medical Sciences12(2), e7036.

Alshehari, A. A., Park, S., & Rashid, H. (2018). Strategies to improve hand hygiene compliance among healthcare workers in adult intensive care units: A mini systematic review. The Journal of Hospital Infection100(2), 152–158.

Andriani, Y., & Nadjib, M. (2018). The importance of implementation of hand hygiene practice in reducing healthcare-associated infections: A systematic review. KnE Life Sciences, 135-145. DOI: 10.18502/kls.v4i9.3565

Ataiyero, Y., Dyson, J., & Graham, M. (2019). Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. American Journal of Infection Control47(5), 565–573.

Butenko, S., Lockwood, C., & McArthur, A. (2017). Patient experiences of partnering with healthcare professionals for hand hygiene compliance: A systematic review. JBI Database of Systematic Reviews and Implementation Reports15(6), 1645–1670.

Chavali, S., Menon, V., & Shukla, U. (2015). Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian Journal of Critical Care Medicine, 18(10), 689–693.

Chhapola, V., & Brar, R. (2015). Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit. International Journal of Nursing Practice21(5), 486–492.

Doronina, O., Jones, D., Martello, M., Biron, A., & Lavoie-Tremblay, M. (2017). A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. Journal of Nursing Scholarship49(2), 143–152.

Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. The Cochrane Database of Systematic Reviews9(9), CD005186.

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 Enfermagem, 71(3), 1189-1193.

Hillier, M. D. (2020). Using effective hand hygiene practice to prevent and control infection. Nurs Stand35(5), 45-50. DOI: 10.7748/ns.2020.e11552

Megeus, V., Nilsson, K., Karlsson, J., Eriksson, B. I., & Andersson, A. E. (2015). Hand hygiene and aseptic techniques during routine anesthetic care – observations in the operating room. Antimicrobial Resistance and Infection Control4(1), 5.

Mu, X., Xu, Y., Yang, T., Zhang, J., Wang, C., Liu, W., Chen, J., Tang, L., & Yang, H. (2016). Improving hand hygiene compliance among healthcare workers: An intervention study in a hospital in Guizhou Province, China. The Brazilian Journal of Infectious Diseases : An official publication of the Brazilian Society of Infectious Diseases20(5), 413–418.

Musu, M., Lai, A., Mereu, N. M., Galletta, M., Campagna, M., Tidore, M., Piazza, M. F., Spada, L., Massidda, M. V., Colombo, S., Mura, P., & Coppola, R. C. (2017). Assessing hand hygiene compliance among healthcare workers in six intensive care units. Journal of Preventive Medicine and Hygiene58(3), E231–E237.

Nomides, N., Sweeney, J., Yee, M., Washer, L., Murphy, S., Valyko, A., & Sturm, L. (2017). Hand hygiene in the operating room: The final frontier. American Journal of Infection Control45(6), S102-S103.

Pedersen, L., Elgin, K., Peace, B., Masroor, N., Doll, M., Sanogo, K., … & Bearman, G. (2017). Barriers, perceptions, and adherence: Hand hygiene in the operating room and endoscopy suite. American Journal of Infection Control45(6), 695-697.

Phan, H. T., Tran, H., Tran, H., Dinh, A., 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.

Price, L., MacDonald, J., Gozdzielewska, L., Howe, T., Flowers, P., Shepherd, L., … & Reilly, J. (2018). Interventions to improve healthcare workers’ hand hygiene compliance: A systematic review of systematic reviews. Infection Control & Hospital Epidemiology39(12), 1449-1456. DOI: 10.1017/ice.2018.262

Qasmi, S. A., Shah, S. M. M., Wakil, H. Y. I., & Pirzada, S. (2018). Guiding hand hygiene interventions among future healthcare workers: Implications of knowledge, attitudes, and social influences. American Journal of Infection Control46(9), 1026-1031.:

Quilab, M. T., Johnson, S., & Schadt, C. (2019). The effect of education on improving hand hygiene compliance among healthcare workers. Hos Pal Med Int Jnl3(2), 66-71. DOI: 10.15406/hpmij.2019.03.00153

Rodriguez, V., Giuffre, C., Villa, S., Almada, G., Prasopa-Plaizier, N., Gogna, M., Gibbons, L., García Elorrio, E., & Argentinian Group Hand Hygiene Improvement (2015). A multimodal intervention to improve hand hygiene in ICUs in Buenos Aires, Argentina: A stepped wedge trial. International Journal for Quality in Health care27(5), 405–411.

Saharman, Y. R., Aoulad Fares, D., El-Atmani, S., Sedono, R., Aditianingsih, D., Karuniawati, A., van Rosmalen, J., Verbrugh, H. A., & Severin, J. A. (2019). A multifaceted hand hygiene improvement program on the intensive care units of the National Referral Hospital of Indonesia in Jakarta. Antimicrobial Resistance and Infection Control8, 93.

Sands, M., & Aunger, R. (2020). Determinants of hand hygiene compliance among nurses in US hospitals: A formative research study. Plos One15(4).

Şen, S., & Kaya, H. (2018). A new teachıng strategy for hand hygıene complıance improvement in nurses. International Journal of Progressive Sciences and Technologies10(1), 111-119.

Seo, H. J., Sohng, K. Y., Chang, S. O., Chaung, S. K., Won, J. S., & Choi, M. J. (2019). Interventions to improve hand hygiene compliance in emergency departments: A systematic review. Journal of Hospital Infection102(4), 394-406.

Sopjani, I., Jahn, P., & Behrens, J. (2017). Training as an effective tool to increase the knowledge about hand hygiene actions: An evaluation study of training effectiveness in Kosovo. Medical Archives (Sarajevo, Bosnia and Herzegovina)71(1), 16–19.

Tan Jr, A. K., & Jeffrey Olivo, B. S. (2015). Assessing healthcare associated infections and hand hygiene perceptions amongst healthcare professionals. International Journal of Caring Sciences8(1), 108.

Tartari, E., Fankhauser, C., Masson-Roy, S., Márquez-Villarreal, H., Moreno, I. F., Navas, M. L. R., … & Aelami, M. H. (2019). Train-the-Trainers in hand hygiene: A standardized approach to guide education in infection prevention and control. Antimicrobial Resistance & Infection Control8(1), 206.

Teesing, G. R., Erasmus, V., Petrignani, M., Koopmans, M. P., de Graaf, M., Vos, M. C., … & Voeten, H. A. (2020). Improving hand hygiene compliance in nursing homes: Protocol for a cluster randomized controlled trial (HANDSOME Study). JMIR Research Protocols9(5), e17419. doi: 10.2196/17419

World Health Organization. (2009). WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. World Health Organization.

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