Hand Hygiene in the Operating Room to prevent healthcare-associated infections (HAIs)

Hand Hygiene in the Operating Room to prevent healthcare-associated infections (HAIs)
The number of healthcare-associated infections (HAIs) has been going up, and people who don’t take precautions are getting sicker and dying more often. Hand hygiene is known to be the most basic thing that can be done to prevent HAIs, but many healthcare workers don’t do it. To stop the spread of microbes, nurses and doctors, particularly those who work in places like operating rooms and critical care units, should take good care of their hands. Even though hand hygiene is very simple and easy to do, healthcare workers don’t always do it. This is a problem. Both developed and developing countries have trouble making sure people wash their hands. Statistics show that less than 40% of people do wash their hands. (Musu et al., 2017). As the healthcare industry moves toward providing better care, there is a need to use evidence-based methods to solve common problems, like getting healthcare professionals to wash their hands.

Clinical/Organizational Problem

There is strong proof that many healthcare facilities don’t follow the rules about how to clean your hands. In hospitals, hand hygiene is important in every area, but the ICU and operating rooms are always given the most attention when it comes to hand hygiene protocols. Patients who are at high risk of getting sick are taken care of in these areas. These infections are one of the biggest problems in the world today because they cause unnecessary pain, raise the cost of providing services, and have a huge effect on morbidity and mortality. The biggest problem at my hospital is getting nurses and surgical techs to follow the rules about how to clean their hands in the operating room. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) both say that people should wash their hands to lower the chance of HAIs. The best way to clean your hands is with water and soap, but you can also use other things like alcohol-based hand care.

Hand hygiene rules are hard to follow in the operating room because people don’t always use soap to wash their hands and don’t always do what’s suggested. For example, most health care workers don’t wash their hands before meeting a patient, after taking off their gloves, or before using invasive tools to care for a patient. Also, the WHO says that people should wash their hands for 20 to 30 seconds, but this is rarely done. (WHO, 2009). When looking at the tools and equipment available for washing hands, the operating room is well-equipped with sinks that are easy to see and close by. Each station has directions on how to clean your hands with alcohol-based products and with soap and water. 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.

Explain the problem

One of the best ways to prevent infections is to wash your hands, but most people don’t do it. The WHO says that germs are most often spread through the hands, and that the best way to stop this is to wash your hands. (WHO, 2009). Because it’s hard to get people to do this, the WHO gives signs for hand hygiene in all healthcare situations. First, it’s best to wash your hands with soap and water when they look dirty or after you use the bathroom. Other times when you should wash your hands are after touching a patient or being exposed to spore-forming bacteria. (WHO, 2009). Every person who works in the operating room cleans their hands, even when going from a contaminated part of a patient’s body to another part of the same patient’s body. These signs make sure that people who work in health care know where and when to wash their hands.

It is important for both healthcare workers and patients to follow the rules for hand hygiene. When nurses and surgical workers wash their hands, they protect their health. When body fluids, wound dressings, and invasive medical devices get on a health care worker, they could get an infection. Hand hygiene keeps the provider healthy, which is good for both the patients and the company in the long run. Studies show that health care workers don’t wash their hands as often as they should. (Musu et al., 2017). These doctors are likely to infect their patients and their families, which could lead to more bad things happening and close calls. Compliance with hand hygiene has an effect on the level of care given by the organization because not doing the practice hurts the patient. A higher number of HAIs can make patients unhappy, which can hurt Medicare and Medicaid payments.

Most bad things that happen during care delivery are infections caused by medical care. Infection prevention and control is the best way to stop HAIs. The most basic way to do this is to wash your hands. When illness prevention isn’t done well, patients and their families suffer a lot because they have to stay in the hospital longer and pay more for their care. About 2 million Americans get HAIs every year, and the infections cost hospitals an average of $45 per case. (Mageus et al., 2015). There are more and more microorganisms that can’t be killed by antibiotics. This makes people sicker and kills more of them. Hand hygiene helps stop the spread of these harmful germs that can kill people and make life hard for them and their families. Changes need to be made to how hand hygiene is done in operating areas to make sure patients are safe, stop infections from spreading, and lower the costs of HAIs.

Causes Broken Down

There have been reports from all over the world of people not washing their hands enough or not washing their hands at all. WHO (2009) says that the usual rate of hand hygiene compliance at the start ranges from 5% to 89%, with 38.7% being the average. Observational studies show that the 20 to 30 second time range for washing hands is not always followed. Some healthcare workers have been seen to wash their hands in as little as 6 seconds. The WHO gives a full list of things that get in the way of good hand cleanliness so that providers can solve the problem. According to the study, poor hand hygiene compliance was linked to being male, being a doctor, working during the week, being in the same room as a patient before contact, not having enough staff, and having patient care interrupted. (WHO, 2009). Also, most health care workers are only seen to wash their hands after being with a patient for a long time.

Hand hygiene is hard to keep up with in many places because healthcare workers don’t know enough about how important it is. Junior staff are likely to copy best practices from their bosses, like washing their hands. If the boss isn’t a good role model, the practice is less likely to be done. Some institutions may not follow the rules because they don’t have simple tools like soap and a variety of sinks where people can wash their hands. Research has shown that promoting hand hygiene at the official level can be harder if people don’t take part in it. Nurse managers and other leaders in the company should set up campaigns to make people aware of the practice. Observational studies on hand hygiene compliance also show that the problem is caused by sinks that are hard to get to, a low chance of getting an infection from a patient, and not knowing or not agreeing with the rules for hand hygiene. One thing that all studies agree on is that lack of information about hand hygiene is a big reason why people don’t want to change. (Sands & Aunger, 2020). A strong hand hygiene education program could help a lot with getting the word out in the operating room and other hospital units about how important it is to wash your hands.

Stakeholders Needed to Be Found

Healthcare-associated infections can’t be stopped by one person alone. Instead, it takes everyone on the healthcare team working together. The hospital management, nurses, surgeons, and surgical technicians are the most important people for this project. These people have a direct say in how the department’s quality improvement plans are carried out, and they also help other staff members keep up with infection control practices. The team is also involved in making policies and making changes when they are needed. The suggested quality improvement project will depend on the four stakeholder teams to make sure it works.

Administrators of health care are in charge of making sure quality is kept up and that any changes needed to improve care are made. Administrators are in charge of keeping an eye on how well an organization is doing and putting together healthcare teams to help them work together. The main jobs of the hospital management will be to approve the project, let other interested parties know about the change, and make sure the quality improvement project goes well. The second team player is the nurses who work in the operating room. This includes both the nurses who move around the room and the scrub nurses. These people work nonstop, moving up and down to bring important materials to the operating room. The nursing team will help put the new change into practice and give comments.

The doctors and surgical technicians are also part of preventing infections in the operating room. The doctors are there for every surgery in the unit, so they are part of the team that needs to follow the rules for hand hygiene. The surgical technicians are there to make sure that all the tools for a procedure are ready, as well as to hand out the tools that are needed during the process. Since these two teams work together in the operating room, it will be important for them to take part in the project to make sure that hand hygiene is kept up in the department.

Talk about Stakeholders

Management of a hospital

The job of the hospital administration is to improve the quality of healthcare groups. The suggested change is a quality improvement plan to get people in the operating room to wash their hands more often. The project is important to the administrators because it will help improve the level of services given to patients and make patients happier. Also, if the project is carried out well, the number of HAIs in the unit will go down, which will save money on costs linked to longer hospital stays. The administration has the power to accept or reject the project, and how the new change will be used in the long run will rest on the rules they set. The project is affected by the administration because their decision and support will affect how other stakeholders react to the suggested change.


During surgery, there are moving nurses, scrub nurses, and other people who work together in the operating room. Nurses know that it’s important to wash their hands before and after surgery to reduce the risk of illness. The nursing team has the power to accept or reject the suggested change because it has a direct effect on their culture. As the biggest group of health care workers in the operating room, nurses have the power to change how people wash their hands by showing others how to do it. The nurses are interested in the idea because they think it will make their patients happier. This is likely to happen if they practice good hand hygiene. The nursing staff will want to know how the new change will help cut down on HAIs, which could make patients safer. As the biggest team in the unit, if they agree to the project, other parties, like the surgeons, will be more likely to agree to the change.


In the operating room, everyone on the medical team, including the surgeons, must keep their hands clean. The doctors talk to other people in the department, like the patient, which makes it possible for an infection to spread. Surgeons also need to keep their hands clean because they work to protect their patients’ health. The surgeons can choose to take on the new job or not. This group is interested in the project because the new change will help cut down on HAIs and make patients happier. The team also wants to know how they can stop infections from spreading in the operating room to reduce the number of bad things that happen. The surgeons can persuade the managers, nurses, and other health care workers to accept the new change. They can also suggest policies that will keep the change going.

Surgery Assistants

The surgical techs help set up a clean operating room and put together the tools that are needed for surgery. As part of the surgical team, they can choose whether or not to accept the new change. Their main concern about the project is how the change will make patients and health care workers safer. By taking part in safe hand hygiene practices, surgical techs can affect how other members of the health care team think about the new change.

Describe the Project

In a world where technology is changing the most, the healthcare field is making a lot of progress. But most organizations have focused on how to use technology to help care for patients and have forgotten important things like patient safety and how well the organization is doing. Improving quality is meant to make things safer, more effective, and more efficient. The current project to get more people to wash their hands in the operating room is meant to measure and improve the level of care by making patients safer. It aims to get everyone on the healthcare team in the operating room to clean their hands better, which will improve the level of care in the facility as a whole.

A recent trend in the healthcare industry is the use of evidence-based practice to improve quality. This has led to growth and expansion of the industry. These practices put the focus on the patient and are thought to make service delivery safer and more focused on the patient. The project uses the latest research on how to get people in different healthcare situations to wash their hands more often. When the project is finished, it will help make patients and healthcare workers safer and cut down on the number of infections caused by healthcare in the facility. The other goal of this project is to improve and sharpen my study skills, which are important for nurses with a master’s degree. The project will show a synthesis of key professional competencies in the areas of communication and building relationships, understanding of the healthcare environment, leadership, working with others, and organizational business administration.

The Solution Suggested

Hand hygiene is the most important thing you can do to stop HAIs and the spread of germs that are resistant to drugs. Up to 15% of hospitalized patients get HAIs, which is a big problem in both developing and wealthy countries. (Sands & Aunger, 2020). Even though hand cleanliness is very important, it is always hard to keep up with and improve the practice because of problems with compliance. So, if we want to lower the number of HAIs today, we need to come up with programs that make it easier for people to follow the rules for hand care. The WHO has detailed rules about hand hygiene and suggests using evidence-based methods to improve compliance, such as training, reminders, and giving out hand hygiene supplies. (WHO, 2009). The proposed answer is to teach the staff in the operating room how to clean their hands and how important it is to do so.

The nurses, surgeons, and surgical technicians who work in the operating room will take part in the planned education program. Special attention will be paid to how microorganisms are spread, when to wash your hands, how to clean your hands, and how long to wash your hands for. The content of the theoretical classes will be based on both the WHO standards for hand hygiene and institutional guidelines. The WHO’s “Observation and Calculation Form” will be used to figure out the average rate of compliance before the new change is made.

Summary of the Proof

How to Clean Your Hands in an Operating Room

One place where cleanliness and cleanliness of hands are very important is the surgery room. In addition to the nurses and surgeons who work closely with the patient, the anesthetists also have to make sure they have clean hands. This staff member works with the patient and other things, like drug processes. Several studies show that these people’s hand cleanliness is between 2% and 18% of the time. (Mageus et al., 2015). Also, there is proof that people who work in operating rooms can spread germs from equipment, supplies, the patient, and other healthcare providers to other people. A study was done to find out how well people in operating rooms clean their hands and where they could make changes. The study’s results agree with other research that says hand cleanliness in the operating room is bad and that doctors and nurses usually only wash their hands after procedures. (Mageus et al., 2015). It is suggested that methods like education and hands-on training be used to improve how well people wash their hands when giving routine anesthetic care.

Practices for keeping hands clean are followed

Hand hygiene is the easiest and most effective way to avoid infections that are linked to medical care, but not many people do it. Nurses care for patients the most often, so they have more chances than other workers to wash their hands. Initial data shows that following hand hygiene rules has a lot more to do with things like professional job and status, social affiliation, changing the work environment, and social norms. (Sands & Aunger, 2020). So, strategies to get people to wash their hands more often should focus even more on the person and less on common methods like observation and reminder systems. Educational methods are important because they touch on the mental health of healthcare workers and are more likely to change their behavior. Sands and Aunger’s (2020) study found that educating people about hand hygiene is a powerful and effective intervention that helps improve dialogue and openness.

During regular care, healthcare workers have a duty to make sure patients are safe. The WHO advises washing your hands, which has been shown to stop HAIs, to stop the spread of infections. But it is very hard for healthcare workers to follow the rules about how to clean their hands. Studies have suggested ways to solve the problem, such as educating and training people, putting up hand hygiene prompts, and making sure people have the tools they need to clean their hands. (Phan et al., 2018). Studies have also focused on important places that need to be very clean, like surgery rooms, intensive care units for babies, and other ICUs.

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 the growing number of HAIs is due to people not washing their hands well enough. 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. An observational study with 120 people in a Florida hospital found that doctors and nurses were 20% more likely to follow the rules. (Quilab et al., 2019). Based on the data, it was decided that education is a good way to help people clean their hands.

Better hand hygiene can be taught and learned.

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). WHO (2009) says that teaching and training are the best ways to get healthcare facilities to clean their hands better. Even though training is suggested, compliance with hand hygiene is much better when simulations are used in a practical bedside and hands-on way. By giving healthcare workers hands-on training, the rate of compliance goes up and the practice stays around for a long time. Based on the WHO’s multimodal hand hygiene approach, the Train-the-Trainers (TTT) initiative has helped people in many countries learn more about how to keep their hands clean. Research into how well the model works shows that it helps participants learn more, share their experiences, and make new connections. Educating people in this way can make more people wash their hands in many places.

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.

Plan of what to do

The first step in putting the project into action will be to ask the government for permission to do the study. The nurse educator will be asked to lead the process and help the school figure out why the project is needed. If the project is given the green light, a literature review will be done and the information needed to show facts about the new change will be gathered. The hospital research department will be asked for baseline data on the number of HAIs in the facility and possible reasons why the present practice is not working. The next step will be to get information from the library about methods that have been shown to improve hand hygiene compliance. The proof will be used in the next step, which is introducing the project to the staff in the operating room and other people who have an interest in it during the first meeting.

In the second step, the staff in the operating room and other important people will be told about the project. The suggested solution will be shared with the hospital staff by the hospital administration, the nurse educator, and the unit manager. At a preliminary meeting, the stakeholders will be told what to expect, what their jobs are, and how long the study will last. In the third part of the project, the staff in the operating room will be taught how to clean their hands using the WHO protocol and proof from the literature. Using the WHO Observation and Calculation Form, the suggested method will involve keeping track of how often people in the operating room wash their hands and figuring out what that rate is. After the observation time, the providers will be trained, and the WHO checklist will be used to focus on when hand hygiene is needed, how microorganisms are spread, how long it takes to wash hands, and how well they are rubbed.

In the last step, people will learn how to clean their hands in real life and be tested to make sure they understand. The nurse educator will use videos to show the staff how to clean their hands in the operating room, and simulation tasks will be set up to help the staff improve their skills. Posters about hand cleanliness and how to do it will be put up all over the operating room to remind people of these things. After the training is over, the new change will be watched for one hour, twice a week, for six weeks. Every week, the project delivery team will meet to prepare reports. Each Friday, the administration team will meet for a briefing. At the end of the six weeks, there will be a discussion where the results will be compared to the baseline data. This will help decide what to do about the suggested change.


The suggested change in the operating room can be put into place in six weeks. During the first week, we will try to get approval from the hospital administration, gather proof and educational materials, and tell the operating room staff about the project. At the end of the first week, partners will also meet for the first time. In the second week of the project, we will be observing to get some early information about how well people clean their hands in the operating room. The nurse educator will also plan training and simulation events for week three. The hospital administration will be called to make sure that the training has everything it needs.

In the third week of the project, workers will learn about how to clean their hands in a classroom setting. In week four, workers will get hands-on training about hand hygiene through online videos and simulations. Posters with information about how to wash your hands will also be put up in the surgery room. During weeks five and six, the new change will be reinforced, the tracking team will be chosen, and the project manager will meet with the team to get feedback on the first steps.

Needed Materials and People

Material for teaching and learning will be one of the most important tools for the project. The staff and teachers will need to have access to the education hall, projectors to show the information, tables for taking notes, and writing supplies. After all the processes are done, the simulation will be done in the operating room. The unit manager will help set up the spread of extra soap and alcohol-based hand rub that will be used during simulations and other training exercises. The nurse educator and the unit manager will teach in both classroom and hands-on lessons.

Proposed Theory of Change

The change management theory of Kurt Lewin will be used to guide and explain the suggested solution. Lewin’s theory of change management is made up of three easy steps: unfreezing, making the change, and refreezing. In the unfreezing stage, people in a group realize that they need to change. It means dealing with the workers’ feelings, impatience, and denial that they need to change. (Wojciechowski et al., 2016). At this time, communication should be clear, and employees should help plan how the change will be made. In the second stage, which is about the real change, Lewin stresses how important it is to move quickly to make the new change happen. Change needs to happen through education, conversation, and giving support. The third step is the refreeze time, which is all about making the new change stick. To keep the change going, there must be reviews, monitoring, and changes.

The suggested project will use the unfreezing stage to teach people how important it is to wash their hands. Meetings will be held with the people who work in the operating room to make sure that the change sticks. The moving part of Lewin’s theory will be made up of theoretical and practical training. At every step of the process, the nurse trainer and the unit manager will help keep an eye on the new change. Also, there will be weekly communication about how things are going to keep workers and managers up to date. During the refreezing, changes will be made and the process will be watched. By making rules and evaluating the change often, the practice will become part of the organization’s culture.

Problems with Getting Things Done

Barriers to change can come from problems with the institution’s processes, the environment, or people at all levels of the organization who don’t want to change. The first possible problem is not working well with the organization’s leadership. The managers may be enthusiastic about the new change because it will take a lot of time and work to make sure it works. Second, workers may not like the new change because it doesn’t change how they wash their hands or how they do it. Most people think that time will be a problem, especially when it comes to training workers in busy operating rooms. Staff who work on locum or double shifts, like doctors who are busy, might find it hard to finish training.


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. https://doi.org/10.1186/s13756-015-0042-y

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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668933/

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.


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

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


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.


Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating Lewin’s theory with lean’s system approach for change. Online Journal of Issues in Nursing21(2). DOI: 10.3912/ojin.vol21no02man04

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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