1. Importance of Hand Hygiene
Catherine Copperthwaite
Alex Sher
Scarleth Diaz

2. PICOT Question
In hospitalized patients (P), does incorrect hand washing on the nurses' part (I), increase the risk of illness or disease (O), during their stay at the hospital (T)?

3. Facts
Hand washing is the single, most effective, and simplest method to preventing and decreasing the effects of disease, illness, and sickness.
Hospital acquired infections (HAI), is estimated to be as high as $45 billion each year.
Most literature on hand washing and conformity by staff members shows that multimodal strategies are effective in improving hand washing compliance.
The World Health Organization (WHO), Centers for Disease Control (CDC), and Joint Commission agree that there are at least, “5 moments for hand hygiene”.
Improper hand washing includes using incorrect methods and missing the crucial time to wash your hands.
The World Health Organization (WHO), Centers for Disease Control (CDC), and Joint Commission agree that there are “5 moments for hand hygiene.

4. Multimodal strategies would include:
Continuous education and training
Monitoring and feedback
Organizational support
Readily accessible hand hygiene resources
Reminders throughout the workstation
Multidisciplinary Teams
Multimodal strategies would include:
Multimodal strategies would include:
Continuous education and training
Monitoring and feedback
Organizational support
Readily accessible hand hygiene resources
Reminders throughout the workstation
Multidisciplinary Teams

5. 5 Moments for hand hygiene
The five moments for hand hygiene have been accepted globally.
Before touching a patient.
2. Before clean or aseptic procedures.
3. After any body fluid exposure.
4. After touching a patient.
5. After touching a patients surroundings.
The 5 Moments for hand hygiene

6. AANA Guide Summary
Proper hand hygiene is the most important preventive measure a nurse can do for infection control. Based on the article “AANA Introduces an Evidence-Based Infection Control Guide, hand hygiene for 15 seconds with alcohol-based hand rubs can kill 99.99% of bacteria,[and] most viruses”.(Griffis, 2013).
The American Association of Nurse Anesthetists recognizes the importance of infection control and stresses the necessity of proper hand hygiene to protect patient’s health and life.

7. AANA Guide Strength and Weakness
One of the strengths of the research is the credentials of the author. Charles A. Griffis has a PhD and is a Certified Registered Nurse Anesthetists. He has also published other works regarding the immune system and its functions. Additional strength comes from the credibility of the author sources which included information from the Occupational Safety and Health Administration, the CDC, and Healthcare Infection Control Practices Advisory Committee.
The research weakness come from the small number of articles the authors pulls the information from. Even though the origins of the articles are credible, there are too few articles. Also the author does not describe the basis for choosing the articles he did.

8. Point of Care Hand Hygiene
The patient zone refers to the areas that the patient comes in contact with. This includes immediate surroundings, surfaces and other areas the patient is transported to.
It is important to wash your hands at the recommended moments, times when transmission is most likely to occur.
This literature review accepts the “ 5 moments for hand hygiene”.
The article listed 15 studies that demonstrated improvement in hand washing after implementing “point of care” (POC) solutions at hospitals worldwide.
The researchers evaluated “hand sanitizers” in depth, to find the best product and the best places to display them.
Implementing POC solutions throughout your hospital, requires continuing education, regulations, and ongoing research to decrease illness and disease from improper hand washing.

9. Strengths and Weaknesses
The research article was well written and easy to understand. The abstract covered the main points of the article. There were multiple studies evaluated to reinforce the importance of POC solutions and endorse their findings. The conclusion summarized the discoveries, the outcomes and added that their needs to be continued research, feedback, and adaptation to improving hand hygiene.
WEAKNESSES:
The only weakness I found in the article was they did not give directions on how to properly use hand sanitizers. They researched and explained almost everything else, but did not account for one of the most important details-HOW !
The limitations in this article are minimal, and I believe they have no impact on the message and importance of this assessment and conclusion.

10. Clean Your Hands Campaign
Hospital acquired infections (HAI) are believed to be contracted mainly through cross infection, via the hands.
“Hand washing is considered to be the most effective way of reducing cross-infection” (p. 95).
In 2005, England and Wales developed the “Clean Your Hands Campaign” to encourage health care professionals to promote hand washing
Alcohol hand rub placed at every bedside
Posters to promote proper hand washing
Patients encouraged to ask healthcare workers of their hand washing
(Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, & Weinberg, 2007)

11. Clean Your Hands Campaign contd.
Gould, et al, 2007 proposed that the evidence of the effectiveness of the Clean Your Hands Campaign was incomplete and supposedly ineffective.
The research stated that there needs to be more done to effectively control HAI. Suggested methods included:
Education of healthcare workers on the appropriate frequency, technique, and timing of hand-washing
Use of moisturized soap/alcohol to increase hand-decontamination episodes
Further patient empowerment on encouraging health care workers to utilize hand washing through promotional pins and patient surveys
(Gould, Hewitt-Taylor, Drey, Gammon, Chudleigh, & Weinberg, 2007)

12. Strengths and Weaknesses of Gould, et al, 2007
The article promoted an extensive and thorough literature review concerning the effectiveness of hand washing on HAI control.
The article promoted future research on appropriate hand washing and application to clinical nursing experiences.
Weaknesses
The article did not include any comparison groups. For instance, infection control with and without the Clean Your Hands Campaign.
The article did not include appropriate statistical analysis of the subjects being studied.
Limitations
The study was limited to hospitals in England, Wales, and Geneva. The study did not include American Hospitals.

13. It is not all your fault
According to the CDC as much as 40% of women do not wash their hands after using the restroom, and approximately 60% of men do not wash up either. Around one person will wash their hands for every five who don’t. (CDC, 2011)
For every person who washes their hands at the correct time, there are five people who do not. (CDC, 2011)
Close to 95% of all people who do wash their hands, are not washing correctly. (WHO, 2009)

14. Thoughts to Ponder
The CDC recommends 12 moments to wash your hands. (CDC, 2011)
Hand sanitizers should only be used for approximately 4-5 times before washing your hands with soap and water.
Don’t forget to moisturize your skin to keep the epidermis free from cracks and dry skin. An added protection, from the outside in.
You are the best prevention, Spread the word, Not the disease. When is the last time you washed your hands?

15. Conclusion
In hospital patients, does incorrect hand washing on the nurses part, increase the risk of illness or disease, during their stay in the hospital?
With the literature reviews and experiments that we have focused on, the answer is yes. There are several reasons that this question might have different results. For instance, not all people wash their hands and that was the source; the other caregiver did not wash their hands and that was the source; the disease was already there and that was the source. There could be many excuses, or questions why?, but there is only one answer. Hand washing, if done incorrectly, with methods and timing, could increase patient suffering and stays within the hospital.
Hand-washing is only effective when using the appropriate method, frequency, and timing.
Utilizing appropriate moments to wash hands
Washing for at least 15 seconds each time
Utilizing moisturized soaps/alcohols
Alternating use of alcohol and soap/water
Education and training is necessary to teach these methods to health care workers.

16. References
Allegranzi, B. & Pittet, D. (2009). Role of hand hygiene in healthcare-associated
infection prevention. Journal of Hospital Infection 73,
Centers for Disease Control and Prevention. (2002) CDC guideline for hand
hygiene in the healthcare settings. Atlanta, Ga: Center for Disease Control and Prevention
Gould, D.J., Hewitt-Taylor, J., Drey, N.S., Gammon, J., Chudleigh, J., & Weinberg, J.R. (2007). The CleanYourHandsCampaign: Critiquing policy and evidence-base. Journal of Hospital Infection, 65,
Griffis, C.A. (2013). AANA introduces an evidence based infection control guide. AANA Journal.81(3)
Kendall, A., Landers, T., Kirk, J., Young, E. (2012). Point-of-care hand hygiene: Preventing infection behind the curtain. American Journal of Infection Control, 40, S3-S10
World Health Organization. (2009). WHO guidelines on hand hygiene in health care. Geneva [Switzerland]: World Health Organization
World Health Organization. WHO guidelines on hand hygiene in health care.
Geneva [Switzerland]: World Health Organization; 2009.
2. Centers for Disease Control and Prevention. CDC guideline for hand hygiene in
healthcare settings. Atlanta [GA]: Centers for Disease Control and Prevention;