Hand Washing Among Health Care professional to Prevent Hospital Acquired Infections
Hand Washing Among Health Care professional to Prevent Hospital Acquired Infections
Constructing the Written Evidence-Based Proposal: Final
Combine all elements completed in previous weeks (Topics 1-4) into one cohesive evidence-based proposal and share the proposal with a leader in your organization. (Appropriate individuals include unit managers, department directors, clinical supervisors, charge nurses, and clinical educators.)
Obtain feedback from the leader you have selected and request verification using the Capstone Review Form. Submit the signed Capstone Review Form to
For information on how to complete the assignment, refer to "Writing Guidelines" and "Exemplar of Evidence-Based Practice."
Include a title page, abstract, problem statement, conclusion, reference section, and appendices (if tables, graphs, surveys, diagrams, etc. are created from tools required in Topic 4).
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.
NRS-441V: Capstone Project
Use the headings listed below and ensure that your papers contain the needed information for each section.
a) Length is between 250-450 words.
b) Presents a complete, concise overview of all phases of the proposed project
c) Addresses a problem or issue related to patient care quality
d) References appropriate evidence-based literature; identifies at least one evidence-based solution that may resolve the problem or issue.
2) Problem Description
3) Solution Description
4) Implementation Plan
5) Evaluation Plan
6) Dissemination Plan
7) Review of Literature
9) APA Style/Mechanics
10) APA format is used consistently in the proposal for the cover page, page header, margins, in-text citations, double-spacing, font size, and reference page.
a) Style is consistent with that expected of a formal project proposal.
b) The highest levels of evidence are used. (Note: Information from Web sites is not considered a professional reference source.)
c) At least 15 professional references (e.g., books, journal articles) are used to develop the proposal.
d) At least eight references are peer-reviewed and from quantitative or qualitative research study reports.
e) Text is free of grammatical, punctuation, typographical, and word-usage errors.
f) Project proposal is within word length requirements.
1. NRS-441V: Capstone Project Developing a Question
Recall the components of PICOT from your research course:
(P) Population of Focus: – All Hospitalized patients developing Hospital Acquired Infections
(I) Intervention- Proper Hand washing Technique
(C) Comparison- No performing Hand wash and using only other PPE Glove and mask
(O) Outcome-Reduce infection and Decrease Mortality and Morbidity.
(T) Time- During the course of Hospital stay.
Identify each of the components in relation to your topic.
P – Hospital Acquired Infections
I – Hand Washing
C – No hand wash or using glove and mask
O – Reduce infection
All patients experiencing hospital acquired infections (P), does the proper technique of hand washing among health care professionals (I) or using gloves and mask without hand wash equally effective (C) to reduce their chance of developing infection (O) during their hospital stay (T)?
Aziz, A. (2013). How better availability of materials improved hand-hygiene compliance. British Journal Of Nursing, 22(8), 458-463.
Pacheco, M., & Spyropoulos, V. (2010). The experience of source isolation for Clostridium difficile in adult patients and their families. Canadian Journal Of Infection Control, 25(3), 166-174.
Alemagno, S., Guten, S., Warthman, S., Young, E., & Mackay, D. (2010). Online Learning to Improve Hand Hygiene Knowledge and Compliance Among HealthCare Workers. Journal OfContinuing Education In Nursing, 41(10), 463-471. doi:10.3928/00220124-20100610-06
2. IDENTIFYING A PROBLEM
The purpose of this paper is to identify the problem of hand washing practice among health care professionals in hospital environment which play a major role in reduction hospital acquired infections and the effectiveness of hand hygiene in infection prevention as compare the glove and mask used techniques without hand washing in most inpatient patient care areas.
Hand hygiene is the simplest method and most effective to prevent infections in health care environments that needs the health care workers to adhere with the right hand washing techniques. There are several factors that contribute to follow and perform hand hygiene by most of health care providers and finding the problems may help to build and applied better solution. The Healthcare associated infections (HAIs) are a big health problem that increase the rate of morbidity and mortality, length of hospital stay and leads to financial burden due to high spend of money for diagnostic tests and treatments to manage the Hospital acquired infections and its complications.
The nosocomial infection is hospital acquired infection developed by the patients within two days of admission, three days after discharge and several days after surgery and nosocomial infection (NI) rate need to reduce or control with combination of necessary interventions including knowledge about the use of standard precautions, rational use of antimicrobials, hand washing, health care professionals compliance with hand hygiene and education and evidence based practices on infection prevention and control methods (Patrícia, Nogueira, P., de Godoy & Amélia., 2013).
The hands of the health care provider is the most single common way of transferring disease causing organisms and hospital acquired infections from patient to patient and from room to room during providing all types of patient care and working in the patient environment. Effective hand hygiene practice among health care providers is the simplest, best and cost effective method to reduce infections and monitoring hand hygiene practice is vital to decrease hospital morbidity and mortality, improve the quality of patient care and a part of patient safety. Most factors that contributed to this problem of low hand hygiene complain and lack of adherence to effective hand wash technique by the health care providers are lack of knowledge, work overload, lack of qualification and training, lack of orientation and practice time for health care workers to use standard precautions to prevent infections. Health care workers who touch the skin of the patient while providing care can harbor and spread infectious organisms on their hands. Annually, 90,000 patients die of health care associated infections. It is estimated about 15% to 30% of these related to poor hand hygiene (Alemagno, S., Guten, S., Warthman, S., Young, E., & Mackay, D. (2010).
Appropriate hand washing technique has impact in prevention health care associated infections in the health care environment. At this movement you put big increasable questions to yourself why this single and simplest hand washing practice is the most effective way of prevention infections and reduce the spread of germs that cause certain diseases? The key answer can be the hands of health providers which are the common means of transmitting diseases from patient to patient. Microorganisms remain on the hands of nurses for different durations. For instance, vancomycin- resistant enterococci can remain for at least 60 minutes on the finger tips, either with without gloves, whereas p. aeruginosa can remain for up to 180 min after the hands have been contaminated. In addition to the removal of visible dirt, hand washing is the best means to remove temporary flora and to reduce the number of permanent flora. A 1.5 to 2.0 fold increase in compliance with hand washing results in a reduction of 25- 50% incidents of nosocomial infections (Erkan, T., Findik, U., & Tokuc, B., 2011).
The other important part of hand washing that put great impact on infection preventions is proper hand washing techniques. The mechanical actions of washing and drying that help to remove most transient microbial flora from the hands are use of adequate amount of soap create enough friction by rubbing the hands together and rinsing under running water which are effective and components of good hand hygiene techniques. In addition hand washing wearing gloves when providing patient care play an important role in reducing the risks of disease transmission and important to prevent bacteria and germs entering the body through the microscopic pores on the skin. Gloves use provides protective barrier from contamination of blood and body fluids but wearing gloves can’t replace hand washing because there is chance of cross contamination after glove use. Increase the rate of effective hand washing among health care professionals and appropriate use of gloves highly reduce the incidence of the transmissions of hospital acquired infections.
The health care providers’ low hand-washing compliance and poor quality of hand wash practice due to lack of knowledge and training, insufficient trained staff, work overload and shortage of necessary hand washing materials. Health care professionals’ need to involve in extensive training programs on infection prevention, the important of hand hygiene and hand washing practice and the methods of maintaining and improving hand hygiene. These needs strategies of teaching the health care providers through online program, by providing research base literatures and seminars. Also flow up and evidence practices are help increase hand washing knowledge of health professionals which leads increase hand washing compliance rate and promote quality of care.
Other than the health providers the hospital leaders and manager’s direct involvement is very important to bring solutions to avoid lack of train manpower and to provide materials and equipment necessary to perform good hand hygiene.
In general proper hand hygiene practice by health care providers has a major impact on prevention of health care associate infections. Promoting the quality of patient care, reducing the rate of mortality and morbidity caused by hospital acquired infections that help to deceased the number of days in hospital stay and reduced unnecessary medical cost is the responsibility of each health care professionals, managers and organization leaders. Use evidence based training and practice is better to manage the problem and help professionals to gain more knowledge.
Patrícia, Nogueira, P., de Godoy, ,., & Amélia. (2013). Measures of knowledge about standard precautions: A literature review in nursing. Nurse Education In Practice, 13(4), 244-249. doi:10.1016/j.nepr.2013.02.011 Retrieved from http://eds.b.ebscohost.com.library.gcu. edu:2048/ehost/pdfviewer/pdfviewer?sid=52b4372c-b7e7-4c95-ab3f-25778691fb58%40 sessionmgr111&vid=10&hid=110
Alemagno, S., Guten, S., Warthman, S., Young, E., & Mackay, D. (2010). Online Learning to Improve Hand Hygiene Knowledge and Compliance Among HealthCare Workers. Journal Of Continuing Education In Nursing, 41(10), 463-471. doi: 10.3928/00220124-20100610-06 Retrieved from http://eds.a.ebscohost.com.library.gcu.edu:2048/ehost/ pdfviewer/pdfviewer?sid=2102d5ad-48cb-427f-aeac-e6aa2531277%40sessionmgr4003 &vid=77&hid=4102 e6aad2531277%40sessionmgr4003&vid=77&hid=4102.
Erkan, T., Findik, U., & Tokuc, B. (2011). Hand-washing behaviour and nurses’ knowledge after a training programme. International Journal Of Nursing Practice, 17(5), 464-469. doi: 10. 1111/j.1440-172X.2011.01957.x Retrieved from http://eds.b.ebscohost.com.library.gcu.
3. Selected sources of Literatures
Alemagno, S., Guten, S., Warthman, S., Young, E., & Mackay, D. (2010). Online Learning to Improve Hand Hygiene Knowledge and Compliance Among HealthCare Workers. Journal Of Continuing Education In Nursing, 41(10), 463-471. doi:10.3928/00220124-20100610-06 This article indirectly tackles the issue of hand washing among healthcare workers after learning about through an online education program. Thus the aim of this article is to deal with effectiveness of online education with regards to washing of hands. Since this article does not directly tackle the issue of HAI, there is no mention of statistics because the concept of online education is new. In the end, the findings of the study affirm the importance of hand hygiene among health care workers.
Aziz, A. (2013). How better availability of materials improved hand-hygiene compliance. British Journal Of Nursing, 22(8), 458-463. This article is interested in finding out the factors that contribute to compliance with hand washing practice within health care settings. In particular, the article is intended on finding out how the availability of materials aids in hand washing among health care workers which a central matter in HAI. In trying to describe the permeation of the issue it does not use statistics and neither is there morbidity rates mentioned in the general population. In the end, the article supports my proposal and assertion that hand hygiene is important in control of HAI.
Biddle, C. (2009). Semmelwe is revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation. AANA Journal, 77(3), 229-237. The aim of this article was to check the role played by hand hygiene on prevention or transmission of disease within a healthcare setting. There is no mention of statistics because the concept transmission of diseases on workbenches does not lead to infection outside within the general population. In the end, the findings of the study affirm the importance hand hygiene among healthcare workers to stem out HAI.
DiDiodato, G. (2013). Has Improved Hand Hygiene Compliance Reduced the Risk of Hospital- Acquired Infections among Hospitalized Patients in Ontario? Analysis of Publicly Reported Patient Safety Data from 2008 to 2011. Infection Control & Hospital Epidemiology,34(6), 605-610. doi:10.1086/670637 The primary aim of this article to check on the association between hand hygiene compliance (HHC) rates and the incidence of hospital-acquired infections. This was a longitudinal study that took three years after education on importance of hand hygiene. It touches on the central idea of reducing HAI although it does not use any statistics or morbidity rates in its description of the general population. It fully supports the idea of hand hygiene as a technique for the elimination of HAI.
Edmonds, S., Zapka, C., Kasper, D., Gerber, R., McCormack, R., Macinga, D., & … Gerding, D. (2013). Effectiveness of Hand Hygiene for Removal of Clostridium difficile Spores from Hands. Infection Control & Hospital Epidemiology, 34(3), 302-305. doi:10.1086/669521 The aim of this article revolved around checking the effectiveness of spore removal form hands in an effort to maintain hand hygiene. Since this study does not involve actual study of diseases it does not have statistics and morbidity rates among the general population. It affirms the effectiveness of controlling spread of HAI by removing Clostridium difficile Spores from Hands.
Erkan, T., Findik, U., & Tokuc, B. (2011). Hand-washing behaviour and nurses’ knowledge after a training programme. International Journal Of Nursing Practice, 17(5), 464-469. doi:10.1111/j.1440-172X.2011.01957.x The article articulates and describes vividly the nature of HAI especially with regards to how health care workers can prevent HAI. Since it deals with reactions of nurses before and after training on the importance of hand hygiene, the statistics that are availed are a comparison of the washing hands trends before and after the training. After training it is evident that the nurses have changed their perception about washing hands and the practice has gone up which in turn helps in controlling HAI.
Gantt, L., & Webb-Corbett, R. (2010). Using simulation to teach patient safety behaviors in undergraduate nursing education. Journal Of Nursing Education, 49(1), 48-51. doi:10.3928/01484834-20090918-10 The article deals with simulation as means of imparting patient safety among nurse students. One of the patients’ safety is hand washing or hygiene which is the central theme of eradicating HAI. In this regards, it becomes important to teach nursing students about patient’s safety. There are no morbidities and statistic description of the issue at hand, because hand washing in health care is only found among nurses and other health care workers. There is affirmation of hand hygiene importance in the control of HAI.
Helder, O., Agnes, de Boer, ,., van Goudoever, ,., Verboon-Maciolek, M., & Kornelisse, R. (2013). Effectiveness of non-pharmacological interventions for the prevention of bloodstream infections in infants admitted to a neonatal intensive care unit: A systematic review. International Journal Of Nursing Studies, 50(6), 819-831. doi:10.1016/j.ijnurstu.2012.02.009 This article does not have anything to do with HAI directly and is a systemic literature review about the prevention of infections among infants admitted in a hospital.
Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., & Achterberg, T. (2013). Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: A cluster randomised trial. International Journal Of Nursing Studies,50(4), 464-474. doi:10.1016/j.ijnurstu.2012.08.004 The aim of this article is test different theories which revolve the leadership styles of nurses in entrenching a culture of washing hands and encouraging increased hand hygiene among nurses. Since this study does not deal with HAI directly, it does use statistics to show the permeation of hand washing practice among nurses does it neither involve morbidity rates or incidences in the general population. With the central idea revolving about the influence of leadership on hand washing practice among nurses, the article affirms the importance of hand washing in clinical care settings.
Huis, A., Hulscher, M., Adang, E., Grol, R., van Achterberg, ,., & Schoonhoven, L. (2013). Cost- effectiveness of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: A cluster randomised trial. International Journal Of Nursing Studies, 50(4), 518-526. doi:10.1016/j.ijnurstu.2012.11.016 – This article clearly identifies the underlying issues with regards to hospital acquired infections whereby emphasis is stressed on improvement of hygiene among. In matters pertaining to statistical information, the article does not explicitly mention any prior statistics except those that were obtained after the study. There is also no mention of the morbidity or rates of incidence in the general population but the article supports the proposed change of washing hands.
Kelckova, S., Skodova, Z., & Straka, S. (2012). Effectiveness of Hand Hygiene Education in a Basic Nursing School Curricula. Public Health Nursing, 29(2), 152-159. doi:10.1111/j.1525-1446.2011.00985.x The aim of this the interventional proposal of washing hands as one of the ways of reducing HAI. However, it only describes the gravity of the situation without providing statistics. In terms of examples, the article recognizes the importance of including hand hygiene within the curriculum of nursing students. There is total support for the adoption of washing hands as a tactic of reducing HAI.
Kowitt, B., Jefferson, J., & Mermel, L. A. (2013). Factors Associated with Hand Hygiene Compliance at a Tertiary Care Teaching Hospital. Infection Control & Hospital Epidemiology,34(11), 1146-1152. doi:10.1086/673465 The aim of this article was to check out the factors that are important in informing about maintaining hand hygiene within tertiary institutions. The general idea is to maintain hand hygiene with an aim of controlling HAI. Since this study does not involve actual study of diseases it does not have statistics and morbidity rates among the general population. The findings of the study show that maintaining and upholding many factors that encourage hand hygiene is important for eradication of HAI.
Pacheco, M., & Spyropoulos, V. (2010). The experience of source isolation for Clostridium difficile in adult patients and their families. Canadian Journal Of Infection Control, 25(3), 166-174. This article is descriptive studies that records the experiences of families with regards to their knowledge of isolation for C. difficile and hospital-acquired infections (HAI) and explore the psychological impact of isolation and HAI on patients and families. Thus the article being a descriptive does not incorporate any statistics with much of the description being about how C. difficile isolation impacts on the lives of individuals. The final conclusion of this paper does not touch on the issue of hand hygiene which is my proposal for eradication of HAI.
Patrcia, Nogueira, P., de Godoy, & Amlia. (2013). Measures of knowledge about standard precautions: A literature review in nursing. Nurse Education In Practice, 13(4), 244-249. doi:10.1016/j.nepr.2013.02.011 This article does not have anything to do with HAI directly and is a literature review about the general safety of patients in hospitals.
Randle, J., & Clarke, M. (2011). Infection control nurses’ perceptions of the code of hygiene. Journal Of Nursing Management, 19(2), 218-225. doi:10.1111/j.1365-2834.2010.01147.x The primary aim of the article was to check the perceptions of nurses with regards to how they handle hygiene challenges in health care setting. Once again this study is within a clinical setting and therefore there is no statistics about the issue and there is no morbidity within the general population. All nurses in the study perceive hygiene as important for control oh HAI.
Salaripour, M. M., & M. Perl, ,. T. (2013). The effectiveness and the retention level of the competency-based training for infection prevention and control practices. Canadian Journal Of Infection Control, 28(1), 13-17. This article tackled the issue of training on procedures of control protocol for infectious diseases within hospitals. As such, the article has very little to do with hand hygiene and control of HAI.
Smith, S. (2009). A review of hand-washing techniques in primary care and community settings. Journal Of Clinical Nursing, 18(6), 786-790. doi:10.1111/j.1365-2702.2008.02546.x This article is about a descriptive study about the different techniques that are used in hand hygiene within hospital settings. It touches on the central idea of reducing HAI although it does not use any statistics or morbidity rates in its description of the general population. It fully supports different hand washing techniques for the elimination of HAI.
Takahashi, I., & Turale, S. (2010). Evaluation of individual and facility factors that promote hand washing in aged-care facilities in Japan. Nursing & Health Sciences, 12(1), 127- 134. doi:10.1111/j.1442-2018.2009.00509.x This article is in cognition of the central idea of the interventional proposal of washing hands as one of the ways of reducing HAI. However, it only describes the gravity of the situation without providing statistics. In terms of examples, the article recognizes the rising number of healthcare facilities for the aged in Japan which have become fertile grounds for HAI. There is total support for the adoption of washing hands as a tactic of reducing HAI.
Wu, T., Salvadori, M. I., Seabrook, J., & Coleman, B. (2011). The efficacy of mandatory online modules in training residents in the proper use of personal protective equipment. Canadian Journal Of Infection Control, 26(4), 253-256. This article indirectly tackles the issue of equipment use among healthcare workers using online learning education program. Thus the aim of this article is to deal with effectiveness of online education with regards to washing of hands. Since this article does not directly tackle the issue of HAI, there is no mention of statistics because the concept of online education is new. In the end, the findings of the study affirm the importance of equipments among healthcare workers to stem out HAI.
Wyeth, J. (2013). Hand hygiene and the use of personal protective equipment. British Journal of Nursing, 22(16), 920-925. The central thematic issue of this article hygiene in hospitals which the article proposes can only maintained through the use of protective equipment. The magnitude of the problem is only clearly described without the provision of supporting statistics. In addition, there is not mention of the extend of permeation of the problem within the general population since the article deals with Infection prevention and control nurses (IPCNs). There is tackling and support of hand hygiene which is the way forward for the elimination of HAI.
4. Incorporating Theory of Hand Washing
PICOT is used in evidence based nursing practices through formulation of questions that will serve several purposes, among the purpose of the PICOT question is for prognosis, prevention, etiology, or diagnosis. PICOT are initials for (P) Population of Focus: (I) Intervention: (C) Comparison O) Outcome T) Time. In this case, the intervention is hand washing which was meant to prevent hospital based infections. This paper evaluates whether proper hand washing reduce hospital acquired infection and factors that can result to hospital infections.
According to Biddle, (2009), hospital acquired infections many health institutions across the globe yet they can simply be managed by effective hand washing is the solution to this menace. Statistics show that nosocomial disease transmission, and other diseases in the healthcare setting is attributed to poor hand hygiene. This is because pathogens keep on changing, and demographic changes within the society influence the individuals’ level of resistance. Hand hygiene is an important hygiene procedure that can prevent infections within hospitals especially in regard to infants infections whose immune is not fully developed (Helder, et, al, 2013). DiDiodato, (2013) research reveals that hand hygiene is the major cause of hospital acquired infections
In the hospitals, infections occur when the health care professional do not adhere to the required standards of hand washing procedures. This can be as a result being overworked, or inability of the charge nurse or health care manager to support the efforts that can result to behavioral change in respect to hand washing hygiene. To overcome this limitation, Gantt & Webb-Corbett (2010) argues that the undergraduate students should be trained on the importance of patient safety through hand washing that can prevent the HAI. They should support the health the health care professionals through training and education on hands hygiene, more so, nurses should be trained on different hand washing techniques (Smith, 2009)
The healthcare professionals should increase their level of hands hygiene in efforts to address the problem of hospital infection by following the present hand washing procedures and using the right disinfectants. They should be trained on either to wash their hand correctly at the right time or use gloves, which are also a solution to hand hygiene. Wyeth (2013) argues that gloves also protect nurses from infections too. Besides focusing on the hands hygiene, they should be educated on the overall importance of hygiene in the hospital and in the community at large. Through that, hospital acquired infections will be a history.
5. REVIEW OF THE LITERATURE
Article One: Cost-effectiveness of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines
This article discusses the different strategies and efforts towards addressing compliance with hygiene standards especially among nurses. However, in the face of properly formulated economic evaluations concerning hand sanitation, it is difficult to make headway in improving related strategies. An application of the trait theories can be useful in solving the training and modeling programs (Huis, Hulscher, Adang, Grol & Schoonhoven, 2013). Nurses that have picked up necessary skills to lead such as patience, tact, and foresight can be used to instill the behavior of complying with high levels of hand hygiene within the institution.
Article Two: Evaluation of individual and facility factors that promote hand washing in aged-care facilities in Japan
The article elucidated the importance of timely and regular practice of hand washing in lowering infection rates. However, this practice has not been largely embraced by hospitals within Japan. The article was concise and precise in addressing the current condition of hand washing and general sanitation among citizens globally and in Japan. The article made appropriate and exhaustive use of statistical data from medical institutions and past researches. This served to increase the validity of the article as well as the main argument (Takahashi, & Turale, 2010).
Article Three: Hand hygiene and the use of personal protective equipment
In his article, Wyeth discusses the role played by infection prevention and control nurses (IPCN) in determining sanitation levels within the hospital environment. IPCNs perform the important role of auditing the practice and looking into different incidents with a view of addressing them quickly. The article provided a precise analysis of the status of hand hygiene as well as how hospitals handle personal protective equipment. Wyeth presented his argument from the nurses’ point of view that reinforced their role in handling emergency infection incidents (Wyeth, 2013). Using a structured approach, the article managed to cover a wide area of the research topic effectively and brought out the thesis in a clear manner.
Article Four: Hand-washing behavior and nurses’ knowledge after a training program
The study purposed to assess the hand washing behavior and knowledge among nurses using a comparative tool that sought to evaluate the progress of the same staff population before and after the training program. Using a set of statistics for the case study, the article was able to prove that the introduction of hand sanitation was influential in increasing hygiene awareness among nurses (Erkan, Findik, & Tokuc, 2011). The cognitive learning theory seeks to address the method of learning that can be embraced by the nurses. This theory involves internalization of facts during the learning process.
Article Five: How better availability of materials improved hand-hygiene compliance
In summary, the article discusses the role played by hand washing materials in ensuring high levels of sanitation among nurses. The article reported that high availability of these materials was responsible for the high sanitation levels in England. The paper used statistical data from government and private studies to validate the facts on hand sanitation (Aziz, 2013).
Article Six: Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines
This article utilized innovative approaches to tackle the compliance with hand hygiene regulations within hospitals. The article used an experiment and a control test that included sensitization, feedback, and constant nurse education to receive outcomes on hand hygiene (Huis, Schoonhoven, Grol, Donders, Hulscher, 2013). The trait theory of leadership can be used to impart the teachings given at the team and leadership level since nurses can easily learn new traits that pertain to hand washing and hospital sanitation. The article used a methodology that ensured that the control experiment provided adequate information on the factors that affected hand sanitation.
Article Seven: Online Learning to Improve Hand Hygiene Knowledge and Compliance among HealthCare Workers
The article addressed the emergence of Internet learning approaches in providing new avenues to continue education concerning hand sanitation. The internet has emerged as a resourceful tool that was captured in the article and confirmed in a study that involved over 200 workers who took part in a survey on online education programs (Alemagno, Guten, Warthman, Young & Mackay, 2010). The article was written in an excellent way that covered the survey and the results concisely. The selected topic was appropriate and covered a new area of healthcare that incorporates information technology and medicine.
Article Eight: The experience of source isolation for Clostridium difficile in adult patients and their families
Clostridium difficile is a problem that affects family members and exhibits symptoms such as loneliness, dejection, and seclusion. Clostridium as the causative bacteria was effectively covered in the article using scientific methods. The article also made use of an interview consisting of ten participants to come up with detailed results on the reactions of family members as well as nurses. The article effectively addressed a rare topic within nursing and sought to do so using descriptive techniques to deliver a standard paper (Pacheco & Spyropoulos, 2010).
Article Nine: Using simulation to teach patient safety behaviors in undergraduate nursing education
The article discussed the integration of patient safety instruction in simulation experiences for students studying nursing. The article made use of assessment and grading systems to collect data from students on the effectiveness of instruction on hand washing. The cognitivism paradigm argues that students can be perceived as an information processor that handles activities such as problem solving, memory and thinking (Gantt & Webb-Corbett, 2010). The paradigm also suggests that instead of programming individuals to act in a certain way, human beings should be allowed to participate actively in the learning process and have the opportunity to think for themselves.
Article Ten: Effectiveness of Hand Hygiene for Removal of Clostridium difficile Spores from Hands
Handling clostridium difficile infections using hand-washing practices formed the thesis of this article. The article used an experiment to compare the effect of tap water and laboratory prepared hand sanitizers and in the results, revealed that lab sanitizers were four times more effective in controlling clostridium outbreaks (Edmonds, Zapka, Kasper, Gerber, McCormack, Macinga, Johnson, Gerding, 2013). Edmonds and other authors however failed to include substantial data on the participants and their selection criteria as well as the methodology used in the article. This presented an article that failed to present its case on hand sanitization effectively.
Article Eleven: Factors Associated with Hand Hygiene Compliance at a Tertiary Care Teaching Hospital
The article was concerned with analyzing several factors that influence compliance with hand hygiene in one particular teaching hospital. The results of the study revealed that a multi-pronged approach was useful in ensuring that compliance among workers in all the levels in the hospital. The article reported the use of an observational study to obtain empirical data on the compliance levels. The behaviorism paradigm can be used to explain the behavior of the physician, support staff and nurses in response to the changes introduced by hand sanitation programs (Kowitt, Jefferson, & Mermel, 2013). The theory assumes that people are passive and respond to environmental motivations. Their behavior is influenced by negative or positive reinforcement that in this context refers to the changes introduced in the teaching hospital.
Article Twelve: The effectiveness and the retention level of the competency-based training for infection prevention and control practices
This article discusses the larger topic of controlling the spread of infections within healthcare institutions through training processes. The article outlined the difficulties involved in complying with IPAC procedures and the consequent training efforts by stakeholders in the industry. The social development theory can be used to explain the phenomenon in most healthcare organizations by arguing that social interaction is a major factor in most organizations. It proposes that in order to realize greater cognitive responses to the IPAC regulations, it was imperative that the individuals focus on the more knowledgeable other (MKO) who would be in charge of the training procedure (Salaripour & Perl, 2013). This MKO will ensure that the actors in the nursing field gain the right type of information and reinforce it using authority or influence.
Article Thirteen: Efficacy of mandatory online modules in training residents in the proper use of personal protective equipment
This article was based on the evaluation of the efficacy of training nurses on the appropriate ways of using personal protective equipment. Using an online medium to deliver the training modules to nurses has been proved effective in lowering cases of infection transmission and subsequently increasing the proper usage of hospital protective equipment. The cognitive theory of multimedia learning forwarded by Mayer proposed that the learning process should be refined by multimedia elements that improve the retention, recalling and understanding levels due to utilization of the five senses (Wu, Marina, Seabrook, & Coleman, 2011). Consequently, the training program for nurses should include other elements of multimedia such as video, audio and graphics to impart the significance of using personal protective equipment.
Article Fourteen: Measures of knowledge about standard precautions
The literature review discussed the implementation of standard precautions within hospitals in as far as infection control is concerned. The evaluation of knowledge, compliance, and attitudes towards standard precautions has always been a challenge. The study revealed that structured questionnaires acted as the most commonly used tool in collecting information concerning the standard precautions. The classical conditioning theory can effectively explain the differences in comprehending safety regulations using associative learning where a nurse learns by making new associations in the hospital settings. These associations need to be with positive influences that promote hand hygiene (De, Nogueira & Mendes, 2013).
Article Fifteen: A review of hand-washing techniques in primary care and community settings
This article discusses the hand washing behaviors among nurses that work in primary care settings with the intention of picking the best practice that is cost effective and functional. The topic was quite significant as infections within healthcare were responsible for approximately 5000 deaths in England alone. The social learning theory forwarded by Bandura can be used to explain the drop in infection-related deaths/ as it proposes that people learn new behaviors and habits from other people through observation and simulation. Consequently, the management of hospitals should set a standard of maintaining high levels of hand washing so that the rest of the staff can follow (Smith, 2009).
6. Developing an Implementation Plan on Hand Washing
Method of obtaining Necessary Approval
Getting the necessary and appropriate support for the approval plan is very important especially for the procurement of grants. After the final summary of the plan has been made, it is important for the plan to be presented to the main stakeholders that will be affected by the plan. The proposed implementation should have some qualities such as protecting the rights and confidentialities of the respondents among others. The first team to be notified is Institutional Review Board (IRB) which is supposed to investigate the viability of the plan and whether it adheres to the set down regulations. After this stage, the plan is send to the Evidence Based Practice (EBP) board that is supposed to review the implementation plan and come up with recommendation or revisions to be made. This board (EBP) is at the center of all procedures that take place within the hospital and it is the one that authorizes the use of new clinical or other procedures. The EBP board is largely a professional body that looks at the reasons for implementing changes and whether the proposed changes are beneficial to the institution.
Description of Current Problem
There has been a laxity among healthcare professionals with regards to hand hygiene which exacerbates chances of one getting hospital acquired infection (HAI). Research has shown that in US one out of every ten patients admitted in hospitals often suffer from or get HAI. This high level of contamination is unacceptable especially in hospital environments where there is supposed to be total eradication of germs and pathogens.
According to Takahashi & Turale (2010), the most common pathogen that causes HAI is Staphylococcus aureus. However, due to poor antibiotics prescription practice, there has been an increase of resistance to the antibiotics by the bacteria which have acquired new genetic material. This material confers them with resistance that is easily transmitted through different strains such as Methicillin-resistant S.aureus (MRSA) which accounts of over 60% of the HAI cases.
In the past the most preferred way of combating HAI has been the use of antibiotics which has resulted in the development of strains that are resistant to drugs. The rise of antibiotic resistant bacteria has resulted in the use of regimens which combine their efficacy to wipe out bacteria. The problem with this approach is that it is not sustainable for a long period because it may result in the creation of more resistant strains that will compound the problem. The use of antibiotics has been used in close proximity with surveillance of the situation which involves sweeping throughout hospitals to systemically collect data that is related to health information of patients and eventually analyze the data. The primary aim of this collection of data through surveillance is for the collection of data is for comparison purposes with the outcome then used to help in clinical practice (Erkan, Findik & Tokuc, 2011).
Detailed explanation of proposed solution
The proposed solution to the problem of HAI is teaching and training health care professionals on hand washing. According to Wyeth (2013), previous studies have shown that the hands of healthcare professionals play a crucial role in the transmission of microorganisms and pathogens before they eventually find their way to patients. It has been shown that the transmission of pathogens among patients takes five steps. The skin of patients is often colonized by transient bacteria which are then subsequently shed into the surrounding environment leading to contamination. When healthcare professionals such as nurses touch on the skin of their patients during normal examinations, their hands become contaminated even in cases where they use hand gloves. In cases where hand hygiene is relaxed, the transmission of infections among patients in hospitals is bound to be more pronounced. Based on this evidence of the way pathogens maneuver their way around, it suffices to say that hand hygiene or washing is the
cornerstone of eliminating or reducing HAI (Aziz, 2013). In addition, hand washing is not only the recommended mode of isolating pathogens but it is also the most recommended way of preventing site specific infections. Over the last decade, the use and effectiveness of hand washing evidence has increased phenomenally although there are some issues that have prevented the prominence hand washing within healthcare settings. These are what are considered impediments that make washing hands to be complied with by healthcare professionals. Some of the low compliance rates are found within the developing nations which can be attributed to lack of funds to support the drive of hand washing. While this is the main problem in the developing world, the developed world has the problem been a high dependency on gloves. When healthcare professionals wear gloves, the washing of hands is not very undertaken due to the assumption that the gloves take care of dirtying hands. While this may be true, the problem here is the transmission of pathogens from one patient to another and since the gloves are not washed while on hands, transmission of pathogens occurs freely (Huis, Schoonhoven, & et al., 2013).
Rationale for Selecting Proposed Solution
The selection of this method or proposed solution of training and education of health care professionals is that hand washing is the basic way of keeping personal hygiene. In addition, it is very simple and does not require any elaborate procedure to follow other than using water and any other available cleanser that the hospital can afford. Besides these, hand washing or hygiene is one of the all time ways and policies that have been in place in most of clinical settings and its effectiveness has been proved by time and research. On the part of side effects, there are no known side effects or downside of washing hands because it is an internationally accepted practice that eliminates pathogens from hands. Another reason for selecting this solution is that one of the reasons that there is a high level of non-compliance with hand washing practices isbecause of misconceptions and lack of proper training modalities (De, Nogueira, de & Mendes, 2013). Many of these misconceptions arise when most of these professionals wear gloves and then think that since they have protected themselves, they cannot transmit infections. In addition, by teaching health care professionals about hand washing practices and their importance is a first line of defense which ensures that the taught education will be used in the prevention of the infections as opposed to treating already acquired infections which is harder. There are many ways of making sure that there is compliance with hand washing because some particular types or class of healthcare employees do not wash their hands often. It has been shown that the accessibility of stations for hand hygiene and the use of alcohol for sanitizing hands are very crucial in increasing hand hygiene compliance. Some people consider washing hands the old fashion way using soap and water very tedious and thus they would prefer the use of hand sanitizers such as alcohol which dries very fast. Some of these chemical sanitizers such as alcohol which are organic in nature dry very fast from the hands and are potent virucidal, bactericidal and fungicidal (Pacheco & Spyropoulos, 2010).
Description of Implementation Logistics
One of the logistics required in the implementation of this program the policies that are necessary and in tandem with the theme of training. The design of policies is often seen as the hardest part in training because health care institutions already have policies in place that are supposed to be followed. In this case, it is obvious that healthcare institutions have hand washing policies in place but are rarely followed. There are many reasons why policies are not complied with and the main ones & professional and organizational barriers. While organizational barriers are easy to deal with, the professional barriers remain to be a main challenge in eliminating them.
The reason attributed to this is that professional barriers are influenced by multitude thinking whereby people in a certain profession or job do things in a certain way. For instance, doctors have been known to wash their hands less frequently than nurses may be due to their minimal contact with patients compared to nurses (Edmonds, Zapka, Kasper, Gerber & et al., 2005). Another logistic worthy considering is the coordination of the training activities among the different health care professions found in hospitals. In this regards, several factors have to be considered such as the work load of the different professionals and how often they interact with patients. Among all health care professionals, doctors and nurses are the most people that interact most with patients and thus they should be the target group. The mode of delivery for the training is also a point of concern because of time constraint and levels of understanding of different people. From experience and research carried so far on the implementation of refresher courses, online learning is the proved efficient way of imparting knowledge. Learning of healthcare professions through online modules can be done at the times when the workers are off duty or have free time because all they do is to log in their online accounts and remind themselves about what they learned earlier. In addition, the number of patients served and size of a health facility is very important in determining the amount of alcohol required. For large health care institutions having a high patient turnover, the need to wash hands among the staff is quite high &therefore a high volume of alcohol is required. These logistics are enough for the kick starting of the hand washing campaign and depending on the success of the program, more logistics may be required.
Resources required for implementation
One of the important resources that the campaign cannot survive without is financial source or funding which will be involved in the provision of the learning materials. Owing to thefact that the campaign would be for the whole health care institution, vast amounts of money are required to finance this implementation. The good thing is that there are no additional staffs required to run the program except the one time services required to put the materials in place. Other resources that required are posters and pamphlets which should be placed all over the health care facility in the strategic locations already identified. These posters should be of different types in relation to their design because people have different preferences and tastes with regards to what they associate with learning.
Alemagno, S. A., Guten, S. M., Warthman, S., Young, E., & Mackay, D. S. (2010). Online learning to improve hand hygiene knowledge and compliance among health care workers. Journal of Continuing Education in Nursing, 41, 10, 463-71.
Aziz, A. M. (2013). How better availability of materials improved hand-hygiene compliance. British Journal of Nursing (mark Allen Publishing), 22, 8, 25.
De, C. N. P., Nogueira, P. C., de, G. S., & Mendes, I. A. C. (2013). Measures of knowledge about standard precautions: A literature review in nursing. Nurse Education in Practice, 13, 4, 244-249.
Edmonds, S. L., Zapka, C., Kasper, D., Gerber, R., McCormack, R., Macinga, D., Johnson, S., Gerding, D. N. (2013). Effectiveness of Hand Hygiene for Removal of Clostridium difficile Spores from Hands. Infection Control and Hospital Epidemiology, 34, 3, 302-305.
Erkan, T., Findik, U. Y., & Tokuc, B. (2011). Hand-washing behavior and nurses’ knowledge after a training program. International Journal of Nursing Practice, 17, 5, 464-469.
Gantt, L. T., & Webb-Corbett, R. (2010). Using simulation to teach patient safety behaviors in undergraduate nursing education. The Journal of Nursing Education, 49, 1, 48-51.
Huis, A., Hulscher, M., Adang, E., Grol, R., van, A. T., & Schoonhoven, L. (2013). Cost-effectiveness of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: A cluster randomized trial. International Journal of Nursing Studies, 50, 4, 518-526.
Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., & van, A. T. (2013). Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: A cluster randomized trial. International Journal of Nursing Studies, 50, 4, 464-474.
Kowitt, B., Jefferson, J., & Mermel, L. A. (2013). Factors Associated with Hand Hygiene Compliance at a Tertiary Care Teaching Hospital. Infection Control and Hospital Epidemiology, 34, 11, 1146-1152.
Pacheco M. & Spyropoulos V. (2010). Salaripour, M. & Perl, T. M. (2013). Smith, S. M. (2009). A review of hand-washing techniques in primary care and community settings. Journal of Clinical Nursing, 18, 6, 786-90.
Takahashi, I., & Turale, S. (2010). Evaluation of individual and facility factors that promote hand washing in aged-care facilities in Japan. Nursing & Health Sciences, 12, 1, 127-34.
The effectiveness and the retention level of the competency-based training for infection prevention and control practices. Canadian Journal of Infection Control, 28, 1, 13-18.
The experience of source isolation for Clostridium difficile in adult patients and their families. Canadian Journal of Infection Control, 25, 3, 166-180.
Wu, T., S., Marina I., Seabrook, J. & Coleman, B. (2011). The efficacy of mandatory online modules in training residents in the proper use of personal protective equipment. Canadian Journal of Infection Control, 26, 4, p253.
Wyeth, J. (2013). Hand hygiene and the use of personal protective equipment. British Journal of Nursing, 22, 16, 920-925.
7. DEVELOPING AN EVALUATING PLAN
Developing an Evaluating Plan
There is need to understand the actual uptake of this practice among health professionals within the hospital as well as castors to the hospital. Providing avenues for communication between the staff and the management will also provide one of the strategies towards solving problems in undertaking this practice. A survey shall be conducted on all staff on their respective attitudes in terms of expectations and the assumed results after taking up this practice among health professionals. This will also offer a mean towards addressing possible grievances and opinions that would improve the efficacy of the proposed program (Alemagno, el al., 2010).
Surveys shall be conducted on all levels of the organization to understand the response levels towards the program. Working towards obtaining data in terms of the various turnover rates is essential for the success of this project. This involves in the evaluation of turnover rates in terms of patients. Hand hygiene uptake among the health care professionals and visitors would be determined in terms of the number of activities practices which would be recorded over a week or month for comparison purposes. Other data that is importance is the data relative to the number of nosocomial infections within the hospital between the onset of the program and after the program (Aziz, 2013).
Nosocomial infections are a burden to hospitals in terms of increased bed space because the slow progress among patients towards discharge as well as increased costs of operation among patients. In addition, evaluation these type of elements within a month would also contribute a great role to support this practice. This involves comparison of discharge patterns and numbers as a result of decline in the number of infections in the hospital environment. Surveys using instruments such as questionnaires are essential towards understanding the overall attitudes and perceptions of staff on the effectiveness of the program towards reducing spread of infections within the hospital (Biddle, 2009).
There is also the importance of engagement of patients and their families to increase their understanding that help to reach on the key initiative. This includes evaluation of the overall role of the program towards improved provision of care to the patients. In addition, the focus is also on the overall number of patients recorded as infected with nosocomial infections at a similar time during the previous year. This provides an avenue for comparison in terms of the overall numbers patients with infections at previous time and the number of individuals currently. Visitors should also be encouraged to take up this practice when contact with the patient is anticipated (Biddle, 2009).
Hand hygiene among patients should be emphasized given that they also provide points of transmission for various diseases within the hospital setting. This includes ensuring that the policies for such conduct are enforced by registered nurses in the hospital setting. The survey instruments will provide an avenue towards evaluation of the perceptions and attitudes of individuals on hand washing techniques. Integration of the various data collection methods into the evaluation plan is the first approach to increase understanding the level of efficacy of the program in the hospital (Biddle, 2009).
A variety of methods may be used towards data collection to include the collection of both quantitative and qualitative data for a highly successful evaluation program. There is a needs to use data instruments that have been used previously by other parties in similar contexts. Some of the approaches to be used include checklists, survey, questionnaires, and interview protocols.
Some of the approaches to be used towards data collections include:
• Group techniques
• Cast studies
• Logs and diaries
• Staff satisfaction levels
• Physical examinations
• Other institutional records
• Surveys or questionnaires may be used towards evaluation of the attitudes, knowledge and characteristics of participants for evaluation to understand program efficacy.
• Interviews also provide elaborate means of getting testimonials and vital information on the levels of preference for a program and its effectiveness levels. Furthermore this is the method for obtaining information regarding engagement levels, effect of changes in procedures and protocols (Alemagno, et al., 2010).
• Various tests and measures on knowledge, skills, attitudes and changes in behavior may be conducted on an independent basis (Alemagno, et al., 2010). This may be additional to questions that are provided within the questionnaires and interview questions. They serve as supplementary sources of information for this program. Using a multifaceted approach toward collection of information is appropriate and recommended of this evaluation. This provides a means towards obtaining rich data that is informative on the efficacy levels of this project.
Conclusively, different methods may be used in data collection including the collection of both quantitative and qualitative data for a highly successful evaluation program. It is important to use data instruments that have been used previously by other sources in similar contexts. Providing a methods or ways of communication between the health care providers and the management will also provide one of the strategies towards solving problems in improving the practice of hand washing among health care professionals to prevent hospital acquired infections. Nosocomial infections are a burden to hospitals in terms of increasing bed space due to slow progress among patient discharge as well as increase the cost of care and treatment among patients.
Alemagno, S., Guten, S., Warthman, S., Young, E., & Mackay, D. (2010). Online Learning to Improve Hand Hygiene Knowledge and Compliance Among HealthCare Workers. Journal Of Continuing Education In Nursing, 41(10), 463-471. doi:10.3928/00220124-20100610-06
Aziz, A. (2013). How better availability of materials improved hand-hygiene compliance. British Journal Of Nursing, 22(8), 458-463.
Biddle, C. (2009). Semmelweis revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation. AANA Journal, 77(3), 229-237.
8. Disseminating Evidence on Hand Washing
It is essential to ensure dissemination of evidence based practices’ findings to the various stakeholders and health care professionals towards the development of innovations for practice. Dissemination of evidence is important to the achievement of better improvements in this practice. Issue of new polices using a variety of formats such as posters, emails, individual notifications, and memos. Researchers usually design effective health based practices and programs with the purpose of improvements in public health. The aim of this project has been to integrate hand washing techniques in the hospital all in the aim of reducing the spread of nosocomial infections (Biddle, 2009).
Hence to ensure the efficacy of this program, it is essential to select dissemination and implementation methods that would ensure effective delivery of the selected technique among health care professionals in the hospital environment. Education outreach visits are face to face visits by the various trained professionals to health care professionals within their respective practice settings. The strength of this strategy lies in the fact that it involves individual interaction between parties. Decision support systems and reminders are also some forms of dissemination techniques that could be adopted by the hospital.
The reminders would prompt the professionals to conduct proper hand washing techniques in their respective setting before and after contact with a patient or before and after providing any type of patient care. This could be used in an array of contexts such as such as reminders on screening patients for infections after surgical operation, other invasive procedures and before discharge from the hospital. Furthermore, before entry into surgery, posters and reminders could be placed in strategic positions to ensure that hand washing techniques are upheld by the health care professionals (Aziz, 2013).
Audits and feedbacks are also strategies that could be used to ensure continued improvements in performance within the organization. For effective audits and feedback, there is need for recognition of the essence of changes in practice in terms of adoption of hand washing techniques among health care professionals within their respective contexts. Change is essential as a means of ensuring that processes and operations and standardized for maximum benefits. In addition, audits and feedback provide the most effective means of interaction between the management of the hospital and the health care professionals. Issues related to the adoption of this practice among the health care professionals would be addressed. The complaints and suggestions towards enhancing this practice within the hospital working environment would be supported through feedbacks provided by the health care professionals (Alemagno, et al., 2010).
Educational materials should be provided by the hospital in a large number and possibly accessed to all health care providers. Materials such as clinical practice guidelines and protocols, audiovisual materials, electronic publications and journal articles should be provided to the medicalprofessionals with an aim of enhancing their understanding of the essence of hand washing techniques. Furthermore, educational materials also provide a background for improvements in other practices (Polit, & Beck, 2008).
Alemagno, S., Guten, S., Warthman, S., Young, E., & Mackay, D. (2010). Online Learning to Improve Hand Hygiene Knowledge and Compliance Among HealthCare Workers. Journal Of Continuing Education In Nursing, 41(10), 463-471. doi:10.3928/00220124-20100610-06
Aziz, A. (2013). How better availability of materials improved hand-hygiene compliance. BritishJournal Of Nursing, 22(8), 458-463.
Biddle, C. (2009). Semmelweis revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation. AANA Journal, 77(3), 229-237.
Polit, D., & Beck, C. (2008). Is there gender bias in nursing research?. Research In Nursing &Health, 31(5), 417-427. Retrieved on 3/30/14 from http://eds.a.ebscohost.com.Library. gcu.edu:2048/ehost/pdfviewer/pdfviewer?sid=8a011448-0458-4e6d-ad77-d70d2f96632d%40sessionmgr4005&vid=8&hid=4208
PLEASE CHECK THIS INSTRUCTIONS BELOW
This Evidence-Based Proposal of Capstone project of Hand Washing among health care professionals to Prevent Hospital Acquired Infection and compare with Glove use without hand washing. The problem is health care provider’s non-compliance of hand hygiene and lack of adherence of proper hand washing technique among health care workers because of lack of motivation, knowledge and time. The solutions are training, education and teaching with different methods to create awareness, to give motivation and evidence based knowledge to the health care providers and to bring behavioral change among the professional on hand washing techniques. Also use hospital leaders and manager’s involvement and support on this change.
All this paper work needs to be done based on the articles of Selected Source of Literature and Review Literatures that I send with this order.
Please check the Capstone Project Writing Guide lines in page 1 and 2.
I send each individual work I did You can put together to write the Evidence-Based proposal to make sense for my project and you can add the research based questioner, graphs and other necessary things for the project.
If have any question you send me message on the communication board and also if you need I can send you Example of another projec
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