How the Four Articles Support Solving the Nursing Adherence to Hand Hygiene Problem

The four articles selected can help answer the PICOT questions as they all present quality evidence on the factors that influence how nurses and HCWs adhere to hand hygiene protocols across various care settings and how to improve their adherence to the protocols. For instance, Douno et al. (2023) identify the HCWs’ knowledge, attitudes, and practices toward hand hygiene as major influencing factors for compliance with HH protocols. In this case, training and mandating can improve compliance. Similar views are presented by Van Nguyen et al. (2020), in which the authors identify and relate attitudes and knowledge of protocols with the levels of adherence to such protocols. Van Nguyen et al. also argue that training and promoting positive attitudes can improve compliance levels among HCWs. The evidence presented in the article by Stangerup et al. (2021) identifies factors such as workload, work pressure and stress, time and resource availability, and changes in practice routines to reduced levels of compliance. Further, Hammerschmidt and Manser (2019) also identify knowledge levels and behaviors to comply with protocols and suggest modeling HH-compliant behaviors by nursing managers to improve compliance.

Subsequently, the interventions and comparison groups focused on the articles are similar to those identified in the PICOT question. All articles selected focus on HCWs, including nurses as the main sample, as in the developed PICOT question. The major interventions identified by the articles, for instance, by Stangerup et al. (2021)  and Douno et al. (2023), identify training as the main intervention. Comparatively, the PICOT question focuses on hand hygiene education as the main intervention.

Method of Studies

Four articles were selected where: the article by Douno et al. (2023) used qualitative, the article by Hammerschmidt and Manser (2019 used mixed methods and the other two articles used quantitative methods, the article by Stangerup et al. (2021) and the article by Van Nguyen et al. (2020). The qualitative methods employ a more human-centered approach to study. Data is usually collected using interviews. The researchers using qualitative studies aim to explore the participants’ thoughts, feelings, and experiences to understand the studied phenomenon and identify similarities and differences in perception and interpretation of experiences. Data is majorly analyzed using thematic and concept analyses. On the other hand, quantitative methods focus on exploring observable causes and effects and are thus more outcome-oriented. Numerical data is utilized and statistically analyzed to determine patterns of data. Finally, the mixed methods approach combines both qualitative and quantitative methods. It aims to overcome the methods’ shortcomings, provide a deeper exploration of a phenomenon, and make better-informed generalizations.

One key benefit of the qualitative approach is that it enables the researcher and others to develop an in-depth understanding of a specific problem or phenomenon. However, the results developed using qualitative methods can be too subjective and hard to generalize. On the other hand, the quantitative methods allow for the statistical analysis of data from a large population sample, allowing for better results and generalizability. However, the quantitative methods are limited by their rigid and structured approaches to exploring a research problem. Combining the qualitative and quantitative methods, the mixed methods, enables researchers to explore a research problem both qualitatively and quantitatively. However, the approach can be too expensive to employ in low-resource research settings.

Results of Studies

Stangerup et al. (2021) found that compliance with hand hygiene was highest and lowest at 58% and 34% during and past the pandemic, respectively. The article also found compliance depends on workload, work pressure stress, time, and resource availability. These findings support hand hygiene interventions past a pandemic. Subsequently, Van Nguyen et al. (2020) found that HCWs have enough knowledge and positive attitudes toward the WHO’s hand hygiene protocols and training could improve adherence to the protocols in high-risk and high-exposure settings. The study has implications for nursing practice in applying multimodal strategies to improve adherence to HH protocols.

Hammerschmidt and Manser (2019) found that 79% of the nurses included in the study understood the need for hand hygiene, while 61% understood hygiene standards. 56% of staff noted that ensuring hand hygiene while caring for residents is always possible. Additionally, 61% of the nurses link the availability of organizational factors to adherence levels of hand hygiene protocols. The interview also found that nurses find it easy to understand and follow pri