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    Literature review, effectiveness of hand hygiene in preventing hospital acquired infection in the delivery of elderly care?.

    Background Of The Study 

    Hand washing is widely accepted as the keystone of infection control in the intensive care unit. Nosocomial infections are frequently viewed as indicating poor compliance with hand washing guidelines (Chami and Pietsch, 2016). Hospital acquired infections are a major threat to patient safety and there is substantial evidence that good quality hygiene reduces the transmission of these diseases. However, most hand hygiene initiatives have focused on the role of the health care worker, caregiver and volunteer. Patient hand hygiene practices have been largely overlooked in infection prevention within hospitals. Washing hands in the hospitals is the best way to stop germs from spreading. It is also described by many health care workers as the single most important tool in preventing the spread of health care associated infections between patients. Environment in hospitals is highly infectious sometimes; therefore it affects elderly patients on higher extent.

    Health care associated infections occur worldwide and affect both developed and developing countries. In developed countries, around 5% to 10% of patients acquire one or more infections and more than 40% of patients admitted to critical care are thought to be affected. Hence, considering this aspect the present research study has been focusing on effectiveness of hand hygiene in preventing hospital acquired infection (Graves and et.al., 2016). This is specifically conducted in the area of elderly care who are supposed to be affected from hospital infection. Similarly, researcher has also emphasized on importance of hand hygiene in developing appropriate environment among the care providers and care users. The present research study is highly important for those researchers who wish to conduct the same sort of dissertation. Hence, it can be said that it can be referred for future investigations as well.  

    Research Aim and Objectives 


    The present research study has been carried out with the purpose of showcasing the effectiveness of hand hygiene in preventing hospital acquired infection in the delivery of elderly care.


    Research objectives have been prepared for the purpose of segregating the study in different sections. This is also useful for collecting appropriate data about the subject matter. With the help of research objectives, specific information about the topic can be acquired. The chief objectives of the study are discussed as under:

    • To analyze the need of hand hygiene in hospitals
    • To identify the effectiveness of hand hygiene in preventing hospital acquired infection while delivering care to elder people
    • To ascertain the issues that generates due to lack of hygienic aspects in hospitals   

    Research Question 

    Research question plays important role in the research study and it should be clear, focused and synthesized with multiple sources so that it can assist in presenting unique arguments. The development of research question is essential because it has a direct impact on other areas and phases of the dissertation. For the present study, research questions have been developed so as to decide what theoretical framework needs to be applied in the dissertation. It also helps in articulating the research problem or research gap. Research questions for the present study are mentioned in the below section:

    • What is the need of hand hygiene in hospitals?
    • How hand hygiene prevents hospital acquired infection?
    • Why hand hygiene is required for elderly care services in hospitals?


    The section of research methodology includes several tools and techniques which are useful for reaching towards the research aim and objectives. In the present study, researcher has used several sources for collecting data and after that the entire data has been analysed in discussion section (Brett, Traynor and Stapley, 2016). With the help of several key terms, data has been selected for the research work. However, at the same articles and resources are utilized after considering inclusion and exclusion criteria. This section plays crucial role in enhancing the feasibility of the research work because of the use of diverse tools and techniques.

    Search Strategy 

    Search strategy is termed as a systematic way of searching the terms for collecting suitable data according to the subject matter. However, the source is highly useful in grabbing appropriate data about the topic. The terms are combined with each other; hence it assists in generating the best outcomes. Thorough web browsing and extensive research, suitable data can be collected. The process initially starts with searching the content on internet sources and afterwards key words are used to collect specific data for the dissertation (Berdot and et.al., 2016). The present research study has been made on analysing the effectiveness of hand hygiene in preventing hospital infection; therefore for such purpose, different articles and journals have been reviewed.

    It also assist the researcher to test and refine the process of search work through abstracting data analysis from the literature studies. In the subsequent study, search strategy is used because it aids in providing comprehensive search results that improves the level of outcomes. Use of such thing offers approximate searching under systematic reviews; moreover it also aids in addressing specific issues that pertains in medical tests (Macleod and Nhamo‐Murire, 2016). Systematic research can be used with one or two approaches wherein all the possible tests can be applied to evaluate the results. However, at the same time, researcher can also focus on the issue and after that, test evaluation can be conducted to get the determined results.    

    Electronic Search

    In the source of electronic search, the process of searching begins with investigating the bibliographic aspects; therefore for such aspect online sources are reviewed. The entire process of electronic search is managed by key managed; hence only specific words are utilized for collecting suitable data (Carter, Creedy and Sidebotham, 2016). The process is operated by combination of words in which key terms plays crucial role in getting the outcomes.

    Search programs are essential for the purpose of identifying all the records that contains the word especially at the time of searching data in the research field. An electronic database is a collection of data that is arranged in such a manner which makes the process of searching easy and fast. Hence, this makes the process easy to carry out. Since, it is a computer based collection of information, therefore the possibilities of feasibility is higher. Hence, considering this aspect researcher has applied the source in the present dissertation. Further, in the study information is also being taken from published sources wherein databases are selected as per the areas of requirements (Conley and Redeker, 2016). In the below section, information about the databases have been stated that are considered for the present research dissertation.

    Search Selection 

    The process of search selection has been carried out on the basis of assessing the validity and reliability of the outcomes. In the present research study, researcher is emphasizing on specific search selection criteria so that only accurate and prominent data can be collected (Christensen, Wildgaard and Wildgaard, 2016). While searching for the content, researcher has accessed several sources and more than 5897 results appeared for a single search; thus during that time, focus has been laid on specific selection criteria only. Search selection is based on the terms that are associated with the subject matter and it also denotes the ways through which accurate results for the dissertation can be ascertained.

    Thus, this has been used as an information collection source which is earlier used by thousands of researchers in diverse research studies. In the present research work, researcher has emphasized on The Cochrane Library which includes a collection of database in the field of medicine and other health care specialities (Vermeerbergen, Van Hootegem and Benders, 2016). Further, PsychInfo is also selected as a source of data collection in which various articles and journals are reviewed. Another database that has been used by researcher is BioMed Central which is a profit scientific publisher and which gives numerous studies in the form of journal publication.

    Search Outcome 

    In terms of search outcome, it can be said that researcher has emphasized on several key terms so that data can be collected as per the subject matter (Whitaker and et.al., 2016). Moreover, it has also been observed that with the help of keyword search, appropriate data is being collected and that also assists in maintaining inclusion and exclusion criteria. Search outcome shows the best results of the selected data and it also depicts the efficacy of the searching tools. Hence, considering this aspect researcher has selected all the defined tools and techniques.

    Study Quality Assessment 

    At the time of conducting the study, quality materials and techniques have been accessed and that has been reviewed on the basis of published materials and articles (Abraham, 2016). Thus, it can be said that the entire study has been made through researching all the contents which are feasible in nature. Moreover, emphasis has also been laid on those terminologies which are specific according to the research study. Thus, it can be said that the research has met all the criteria related to the subject matter.

    Data Extraction 

    In order to extract the data, researcher has emphasized on several journals and articles for the purpose of completing the section of literature review (Van Eechoud and et.al., 2016). Data has been collected through different sources and all lies under secondary search terms. Further in the study researcher has also emphasized on all those sources that aids in creating authentic and appropriate research study.

    Ethical Issues

    The present research study has been developed inappropriate manner and it has also considered all the essential requirements of a reliable research study. Thus, to complete it in successful manner, only authentic and appropriate sources have been considered (Keyko and et.al., 2016). Research work completed after 2005 have been included in the dissertation to meet all the basic criteria. Hence, it can be said that all the essential criteria have been fulfilled in the present dissertation.  


    World Health Organization have started giving high priority to the improvement of hand hygiene with an aim to minimize the nosocomial infection (which is usually observed in hospitals). The promotion of effective measures to improve hand hygiene is one of the foremost goals of the WHO’s current worldwide patient safety initiative (Role of hand hygiene in healthcare-associated infection prevention. 2009). As per the views of Septimus and Moody, (2016), it is clear that health care associated infections are drawing increasing attention from patients, insurers and regulatory bodies. The medical community has been witnessing in tandem unprecedented advancements in the understanding of pathophysiology of infectious diseases and the global spread of multi- drug resistant infections in health care set-ups. These factors are associated by the paucity of availability of new antimicrobials which have necessitated a re-look into the role of basic practices of infection prevention in modern healthcare area.

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    On the other hand, it has been observed that hand hygiene is important to practice in health care sector in which health care providers should spread awareness among people regarding infection in hospitals. While treating the patients, it is crucial for the practitioners to wash the hands so that the chances of speeding infection can be minimized. Nonetheless, Arntz (2016), said that hand hygiene is a different way of thinking about safety and patient care as that involves everyone in the hospital including patients and health care providers (The Importance of Hand Hygiene. 2012). Along with this, it has also been observed that effective hand hygiene practices in hospitals play a key role improving patient’s health and similarly, it also provides safety to the patients. Hence, it can be said that hand hygiene aspects should be considered on higher extent so that the possibilities of infection can be minimized. This is also essential in terms of preventing the spread of health care associated infections.

    Apparently, most of the germs are spread through hands; therefore hand hygiene aspects must be suitably adhered in health care sector. This not only prevents the health dimensions of patients; but also aids the service providers to develop appropriate environment at the care setting. Moreover, in this area it has also been identified that there should be proper monitoring in the health care services so as to maintain the existing health standards in the society (Infection prevention in hospitals: The importance of hand hygiene. 2014).

    This is the most important fact that eradicates the health care constraints. Health care providers move from patient to patient and room to room during care services; thus it totally changes hospital environment. Gregory (2016), also contended that it is equally important that all health care staff members clean their hands before and after contacting any of the patient. Patients can also remind the health care practitioners to use the alcohol gel and hand wash prior treating them.

    Supporting the facts, Graves and et.al., (2016), also said that the wearing of protective gloves is a sensible precaution in various clinical situations which aids to prevent contamination. It may also break the chain of infection more effectively than hand- washing or hand disinfection. Wearing gloves is another action that can be taken to keep the hands hygienic and this can also assist the patient to remove dirt from the hands (Patient Hand Hygiene: The missing link in preventing Hospital Acquired Infections. 2015). The significance of hand washing in patient care was conceptualized in the early 19th century. It has been analysed that hand decontamination can markedly reduce the incidence of puerperal fever and maternal mortality.

    There are basically two types of microbes colonizing hands such as the resident flora (which consists of microorganisms that resides under the superficial cells of the stratum corneum) and the other one is transient flora which colonizes the superficial layers of the skin. This is more amendable to remove by routine hand hygiene.

    However, looking towards the concern, CRAVEN, (2016), said that patients are not aware about the health conditions; hence sometimes they do not consider the importance of hand hygiene and that creates further issues.

    Thus, regarding this after using toilet or bedpan, patients must wash hands so as to keep the environment clean and safe. This is also essential for the safety of others; hence there should be certain regulations for the same prospect. This can also assist in reducing the number of health hazards in the same sector (Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses’ Hand Washing. 2015).

    Elder patients are more prone to health hazards; hence suitable health standards should be followed for the same. Further, while treating any of the patients, health care service providers should use antiseptic gel so that contamination issues can be reduced. Syringes are the most apparent tools that develops infection in the hospital environment; hence while using it appropriate care is required to be given. Elderly patients are unable to take care of themselves; therefore it is vital for the care practitioners to use sanitizer at the same time. This avoids the need of frequent hand washing; similarly it can remove contamination from the hospital environment (The effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a teaching hospital. 2013).  

    Green (2016), also said that washing with soap and water is much less effective than hyena hand disinfection and even washing for several last minutes assignment reduces resident flora from the skin hardly. Washing also reduces the transient flora by only 2 to 3 log levels. The same is also true for bacterial spores which not only aids in preventing hand contamination; but also reduces the chances of communicable diseases (Improved Hand Hygiene to Prevent Health Care-Associated Infections. 2007). For health care practitioners, hand hygiene is essential because they have to deal with numerous patients who have different sorts of health issues and hazards. Contradicting the views, King and et.al. (2016), said that hand hygiene is essential especially when health care workers come in contact with those patients who have communicable diseases. Thus, for such aspect health aspects needs to be maintained so that micro-organisms may not come in contact with contaminated particles.

    Therefore, from the discussion it is clear that hand hygiene is imperative from several aspects because that impedes the overall environment of the health care entity (Hand hygiene: Back to the basics of infection control. 2011). Thus, it can be said that in order to protect the environment, stern health hygiene dimensions should be followed upon. The hands of HCWs are commonly colonized with pathogens like methicillin resistant.

    The present research study was expected to reach towards the research outcomes and afterwards extracting the data, it has been found out that the up to some extent, research aim is fulfilled. All the studies assessed in the present research work have been focusing on effectiveness of hand hygiene in preventing infection. All such studies have also made it clear that frequent hand washing is essential because it simply leads to create appropriate environment in the health care setting (Hand Hygiene for the Prevention of Nosocomial Infections. 2009). The study has also made it clear that health hazards typically increases when hands are contaminated because they are more prone to risk and uncertainties.

    Health care practitioners have to be more concerned about the health benefits because that it has a direct impact on environment of the hospital where people come to get medicated services. This is also vital for encouraging the interest of clients and at the same time, it can promote health standard in the community.

    From the research studies, it has been observed that hand sanitizing is important because all the major activities (eating, drinking and others) are performed through hands. Thus, it clearly denotes that hand sanitizing is must especially in health care setting. Sickbert-Bennett and et.al., (2016), has discussed that hand hygiene is crucial because that avoids the possibility of germs spreading and it also enhances health standards in optimum manner. From the past studies, it has been observed that patients when communicate with each other, they forgot to sanitize their hands and as a consequence, they come in contact with several diseases and issues. From the present study, thorough analysis has been conducted on effectiveness of hand hygiene in preventing infection at hospitals (Graves and et.al., 2016).

    The studies have also made it clear that elder patients should carefully follow the health schedule made for them because they are likely to come in contact with communicable diseases while staying in the residential care home.

    One of the key elements in improving hand hygiene practice is the use of an alcohol based hand rub instead of washing with soap and water. An alcohol based hand rub requires less time and it is also regarded as microbiologically more effective. Most of the care practitioners have been using this source because it is less irritating to skin and as compared to traditional hand washing, it is more feasible and convenient. In most of the cases, switching to alcohol hand disinfecting would decrease the time that is necessary for hand hygiene from 1.3h to 0.3h. However, in the study of Gregory, Chami and Pietsch, (2016), it has also been analysed that in most of the health care institutions, adherence to recommended hand washing practices remain unacceptably low. From the basic concept, it has been ascertained that hand hygiene reflects the attitude, behaviour and beliefs towards health facets; hence that needs to be maintained in effective manner.

    This is the most important source through which issues prevailing in the health care sector can be prevented. Thus, from the entire discussion it has been ascertained that health hazards are increasing among older people because of hand hygiene aspects (Koff and et.al., 2016).



    As per the discussion, multimodal strategies have been shown to be more successful in improving the rate of adherence with hand hygiene in HCWs than single intervention (Septimus and Moody, 2016). On the other hand, it has also been observed that targeted multi- faceted approaches focuses on system change which improves the condition of hand hygiene. Recent studies have also supported that interactive educational programmes combined with free availability of hand disinfectants significantly increases the hand hygiene compliance.

    From the study, it has been discussed health care worker’s hand are the most common vehicle for the transmission of health care associated pathogens from patient to patient and within the health care environment (Arntz and et.al., 2016). Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing health care associated infections.

    It is essential for the health care entities to comply with all the legal aspects so that they can promote the health standards in effective manner and this can also minimize issues prevailing in the same sector (Jayaraman and et.al., 2016). Available evidence also highlights that multimodal intervention strategies lead to improved hand hygiene and it also reduces the value of HCAI. However, other studies have articulated that there is a need to evaluate the relative efficacy of each strategic component which on the other hand also identifies the most successful intervention particularly in setting with limited resources. While handling elder patients, it is essential to use sanitizing so that the contact of germs can be avoided. Moreover, this can also enhance health standards in the community. While using an alcohol based surgical hand rub product with sustained activity, specific requirements a measures should be followed upon. Hands can easily come in contact with germs and disinfectants; hence it is crucial for the healthcare practitioners to ensure that hands are properly cleaned and sanitized (CRAVEN, 2016).    


    Concluding the entire study, it can be said that hand hygiene is essential so that health of the patients can be prevented and this is also essential in keeping the environment safe and secure. Moreover, the study has also made it clear that practicing hand hygiene is a simple and effective way to prevent infection (Shrestha and et.al., 2016). Cleaning of hands not only prevents the spread of germs (those that are resistant to antibiotics and are becoming difficult to treat); but also aids in generating awareness about safe and healthy facets. Assessing past studies, it has been realized that transmission of health care associated pathogens takes place through direct and indirect contact, droplets and common vehicle.

    Health care associated pathogens can be recovered not only from infection or draining wounds; but also from frequently colonized areas of normal and intact patient skin. Defective hand cleansing leads to poor hand decontamination and it also leads to other hygienic problems that arise in the hospitals. Moreover, it has also been realized that when HCWs fail to clean their hands during the sequence of care of a single patient, then in this situation, microbial transfer is more likely to occur. Contanimated HCWs hands have been associated with endemic HCAIs and also with different HCAI outbreaks (King and et.al., 2016). Hand hygiene is necessary not only to reduce the level of contamination; but also to manage health aspects in prominent manner.

    This lies under the basic responsibilities of health care standards; hence suitable actions should be maintained for the same. Hand hygiene practices are most commonly followed in schools and day care centres where people have to take care of children. However, in the same manner such care is also required in health care setting where elder people come to get the services. Since, elder patients are more likely associated with health hazards; hence cleaning facilities should be more for such age groups (Green, 2016). At the same time, most of the health care practitioners wash hands with soap and water when they find their hands dirty and visibly soiled with blood or other body fluids. This helps them to remain safe and clean while treating numerous patients. All the articles used in the research dissertation have made it clear that there are several methods that can be used for the purpose of reducing the issues of hand contamination. At the same time, it has also been observed that antimicrobial soaps are highly used while treating the patients.      

    Table of Articles 

    • Abraham, A., 2016. Systematic review on Nursing staff's experiences of the use of Physical Restaints of older adults in residential care.
    • Arntz, P. R. H and et.al., 2016. Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department. American journal of infection control.
    • Berdot, S. and et.al., 2016. International Journal of Nursing Studies Interventions to reduce nurses’ medication administration errors in inpatient settings: A systematic review and.
    • Brett, L., Traynor, V. and Stapley, P., 2016. Effects of physical exercise on health and well-being of individuals living with a dementia in nursing homes: A systematic review. Journal of the American Medical Directors Association. 17(2). pp.104-116.
    • Carter, A.G., Creedy, D.K. and Sidebotham, M., 2016. Efficacy of teaching methods used to develop critical thinking in nursing and midwifery undergraduate students: A systematic review of the literature. Nurse education today. 40. pp.209-218.
    • Christensen, L., Wildgaard, L. and Wildgaard, K., 2016. Permanent catheters for recurrent ascites—a critical and systematic review of study methodology.Supportive Care in Cancer. 24(6). pp.2767-2779.
    • Conley, S. and Redeker, N., 2016. A Systematic Review of Self‐Management Interventions for Inflammatory Bowel Disease. Journal of Nursing Scholarship.
    • CRAVEN, D. E., 2016. Managing Ventilator-Associated Pneumonia: Antibiotic Therapy and Targeted Prevention. Respiratory Infections. p.126.
    • Graves, N. and et.al., 2016. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia. PloS one. 11(2). p.e0148190.
    • Green, R., 2016. A Systematic Review of the Efficacy of Environmental Decontamination and Personal Hygiene Practices in Reducing Methicillin Resistant Staphylococcus aureus Acquisition.
    • Gregory, A., Chami, E. and Pietsch, J., 2016. Emotional Motivators: Using Visual Triggers as an Infection Control Intervention to Increase Hand Hygiene Compliance throughout the Hospital. American Journal of Infection Control. 44(6). pp.S3.
    • Hand Hygiene for the Prevention of Nosocomial Infections. 2009. [Online]. Available through: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770229/>. [Accessed on 2nd December 2016].

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