Literature Review


Patients strive for healthcare services in order to recover their health. Therefore, it is unexpected that some of the patients get worse from the provision of services. Various ways of offering healthcare services can result to poor health while in the hospital through nosocomial infections. These are considered as infections that a patient can acquire within the 48 hours of hospital admission. These are also known as hospital acquired infections. Hand hygiene has been considered as an effective way of fighting nosocomial infection in various healthcare environments. The aim of this paper is to evaluate the various studies that offer evidence based on research to reflect on the impact of nosocomial infections on patients. The literature comparison will offer clinical evidence that will be important in offering knowledge to various stakeholders concerning the importance of hand hygiene during healthcare provision.

Comparison of Research Questions

Through evaluating various studies, it is clear that proper hand hygiene offers promising outcomes concerning reduced nosocomial infections. Most of the studies have are examining the same research question with regards to prevention of healthcare related infections. Danasekaran, R., Mani, G., & Annadurai, K.  (2017) research question was the impact of staffing level on healthcare. linked infections. This study aimed at synthesizing the recent study to examine the relationship between the staffing level and the patients’ risk of being affected by healthcare related infections. Wavra, et al 2015 does not offer research question but the aim of the study is to examine the occurrence of health-related contagions within hospitals in Australia. Huis et al., (2013) does not also offer research questions but aims at examining the nursing care practices as well as exploring infection prevention progressions.

McAlearney et al., (2017) relies on hypothesis on a number of structural practices that are evident in high functioning hospitals and that are not available in low functioning hospitals. The research aimed at developing reliable and valid measures for structural management practices, developing reliable and valid Hospital linked infections management practice standard survey and integrating findings for the management practices toolkit for hospital linked infection reduction. Chatfield et al., (2017) did not rely on research questions but aimed at integrating findings on the compliance of hand hygiene among healthcare workforce. Zhao et al., (2018) did not rely on research questions but aimed at exploring features that make hand hygiene intervention attractive. Luangasanatip (2015) did not rely on research question but aimed at compiling relevant resources related to promotion of hand hygiene. Mitchell (2017) research question was whether educational material on hand hygiene would improve the knowledge of healthcare providers.

Comparison of Sample Populations

With reference to the similar studies, it is important to examine the size of populations relied on during the study to weigh the strength of evidence provided. Danasekaran, Mani and Annadurai, (2017), relied on 54 articles retrieved from database of MEDLINE and CINHAL, Wavra et al., (2015) obtained from 24 articles retrieved from MEDLINE database, McAlearney et al., (2017) obtained data targeted hospital site visits, Chatfield et al., (2017), used 36 healthcare reports, Zhao et al., relied on 200 Nurses in healthcare institutions (2018), Luangasanatip (2015) relied on 142 studies while Mitchell et al., 2017 relied on 96 Healthcare professionals. 

Comparison of the Limitations of The Study

The methodological techniques for acquiring data for the various studies has biased the findings since most of the studies have relied on generalizable findings. The studies offered generalizable results rather than looking into particular units within the hospital. There was moderate strength of evidence from the studies on the importance of hand hygiene to prevent hospital related infections. This is because the studies failed to rely on strong and highly valid study designs that will examine the effectiveness of hand hygiene and prevention of hospital related infections.

Conclusion and Recommendations for Further Research

Using the research studies was very essential in finding response to the PICOT question with reference to effectiveness of hand hygiene on preventing nosocomial infections in healthcare settings. There is valid proof and evidence that hand hygiene is essential in preventing nosocomial infections. The studies found similar results on the importance of implementing proper hand hygiene practices to lower the nosocomial infections thus improving the patient’s safety. The most recommended practices for reducing the health related infection is hand hygiene. It is also clear that the hospitals should monitor the hospital related infections and instill the healthcare professionals with knowledge concerning on infection prevention practices. To improve on the validity of the research, there is need for national systems where data that is linked to hospital related infections. Further studies should offer more precise findings on increased compliance on improved hand hygiene practices. Relatively, it would be important to assess the impact of hospital related infections in various hospital unites to understand which

unites require much attention. Also, it would be effective if researchers investigated further on sustainability and cost effectiveness of hand hygiene improvements as supportive techniques towards the infection control.


Chatfield, S., DeBois, K., Nolan, R., Crawford, H., & Hallam, J. (2017). Hand hygiene among healthcare workers: A qualitative Meta summary using the GRADE-CERQual process.Journal of Infection Prevention, 18(3), 104-120. Doi: 10.1177/1757177416680443.

Danasekaran, R., Mani, G., & Annadurai, K. (2017). Prevention of healthcare-associated infections: protecting patients, saving lives. International Journal Of Community Medicine And Public Health, 1(1), 67-68.

Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., & van 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.

Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., … & Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224.

Luangasanatip. N. (2015). Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. The British Medical Journal, 351. Doi: 10.1136/bmj.h3728.

McAlearney, A., et al. (2017).Searching for management approaches to reduce HAI transmission (SMART): A study protocol.Biomed Central, 12(82). Doi: 10.1186/s13012-017-0610-z.

Mitchell, A., Boisvert, E., Wilson, T., & Hogan, S. (2017). Hand Hygiene: A Quality Improvement Project.Biomedical Journal of Scientific & Technical Research, 1(7), 1985-1988. Retrieved from

Zhao, Q., Yang, M., Huang, Y., & Chen, W. (2018). How to make hand hygiene interventions more attractive to nurses: A discrete choice experiment. Plos One. Doi: 10.1371/journal.pone.0202014.



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