Nosocomial Infections Sample Paper

Nosocomial Infections Sample Paper

Patients admitted to hospital are at high risk of nosocomial infections which have been noted to increase medical costs, result to poor patient outcomes and even prolong patient’s hospital stay. Hospital acquired infections are of much public health significance  since they have also been noted to result to increase mortality and morbidity rates yet they can be prevented through basic hygiene practices such as hand washing. This therefore leads to the following PICOT question: Nosocomial Infections Sample Paper


Among adult hospitalized patients (P), how may hand washing (I) as compared to the use of alcohol-induced sanitizers(C), help to reduce the incidence of Infections Acquired in Hospital (O), before and after patient care(T)?

Population Adult hospitalized patients
Intervention hand washing
Comparison Use of alcohol-induced sanitizers
Outcome Reduce the incidence of Infections Acquired in Hospital
Time Before and After patient care


            A comprehensive online search in scientific databases of PubMed, Cochrane and CINHAL were searched for medical and nursing journals using the following keywords: Infections Acquired in Hospital, infection prevention, washing hands, hand cleanliness and infection control. Thousands of results were obtained.  However, in order to find articles that were the most relevant, the search was narrowed to include articles which were published in the last 5 years. A lot of preference was given to articles that had high evidence levels based on the rankings of Quality and Safety in Nursing (QSEN). Nosocomial Infections Sample Paper

Literature Synthesis

Article One

The article by Murni et al., (2015) acknowledges that infection control strategies provide an effective approach towards reducing hospital-acquired infections (HAI). The researchers identify that, whereas there exists a direct association between the maintenance of hand cleanliness and healthcare outcomes, compliance remains low among healthcare workers. Besides the reduction of HAI rates and infection control intervention within the hospital setting results in the reduction of mortalities, an increase in the compliance with hand cleanliness, and an improvement in the rational application of antibiotics (Murni et al., 2015). Nosocomial infections have been ranked among the leading causes of morbidity and mortality and their prevention results in the significant improvement of healthcare quality. Studies indicate that the introduction and sustained use of infection control strategies within healthcare institution reduces the risk of mortality by up to 23 percent.

Based on a multifaceted infection control and stewardship program that the researchers aimed to implement and evaluate how effective it was on reducing HAIs, a pre and after study was conducted within 27 months in an Indonesian teaching hospital, a daily observation of  all children who were admitted in the pediatric intensive care unit was done and assessed for HAIs. This program comprised of a campaign on hand hygiene among other practices for infection control. The researchers observes that the rates of HAIs reduced significantly from 22.6 percent to 8.6 percent (Murni et al., 2015).Thus, the inappropriate use of antibiotics also reduced from 43 percent to 20.6 percent. Hand washing compliance rose from 18.9 percent to 62.9 percent and inpatient mortalities reduced from 10.4 percent to 6 percent. It was thus concluded that such multifaceted interventions for infection control are highly effective in reducing the rates of HAIs, reducing inpatient mortalities and morbidities (Murni et al., 2015). This article supports my PICOT as it clearly explains how hospital acquired infections can be reduced through multifaceted approaches, more specifically, hand washing.

Article 2

Sickbert-Bennett et al., (2016) conducted a longitudinal inquiry between the years 2013-2015 in an 853 hospital capacity where a new hand cleanliness program was implemented titled ‘Clean in, clean out’. After a successful pilot program implementation over 17 months period of the study, the hand cleanliness compliance rates were noted to significantly increase (p<0.001) while the overall rates of HAIs decreased significantly (p = 0.0066). Fewer deaths were also witnessed and the reductions generally resulted to overall savings of costs of approximately US ≈$5 million (Sickbert-Bennett et al., 2016).It was concluded that programs that improve hand hygiene compliance among staff in hospital should engage all stakeholders to improve compliance with hand hygiene practices as this substantially lead to hospital wide reductions of HAIs (Sickbert-Bennett et al., 2016). This study enhances my PICOT as it discusses how HAIs can be reduced in inpatient populations by observing hand washing practices.

Article Three

Slayton et al., (2015) explain that effective treatments for   healthcare related infections attributed to bacteria that are resistant to antibiotics are limited despite the fact that a number of patients have developed infections that cannot be treated. They acknowledge that although evidence-based interventions exist, highly-coordinated tactics which interject the spread of HAIs would have a superior influence on altering the rapidly increasing occurrence of these infections. The researchers analyzed data from CDC infections program network to estimate the number of HAIs from C. difficile and other antibiotic resistant bacteria (Slayton et al., 2015). This analysis was done both with and without a large scale intervention that interrupted the spread and improved stewardship on antibiotics. It was found that, nationwide infection control practices such as hand washing can avert up to 619,000 HAIs within 5 years as compared to independent efforts. The researchers concluded that within 5 years, more than half a million antibiotic resistant HAIs can be prevented through a highly coordinated approach that interrupts transmission such as hand washing as compared to independent facility-based efforts (Slayton et al., 2015).This article supports my PICOT as it explains how HAIs can be reduced through nationwide infection control interventions such as hand washing as compared to independent facility based efforts. Nosocomial Infections Sample Paper

Article Four

The study by Luangasanatip et al., (2015) purposed to evaluate the efficacy of the campaign of the WHO of 2005 and other interventions that promote hand hygiene among hospital staff. The study was a meta-analysis and systematic review of sources from the databases of CINAHL, EPOC register, Medline and Cochrane. The review included randomised and non-randomised controlled trials. The researchers used 3639 studies, 41 falling within the inclusion criteria. 19 studies revealed significant clinical outcomes with highly consistent data of reduced rates of HAIs due to the improved hand cleanliness for some of the most important hospital pathogens. It was concluded that, when hand hygiene is promoted with WHO-5, compliance among healthcare workers increases and this helps to reduce HAIs rates.

Article Five

Jones et al., (2017) undertook a systematic review to identify some of the most effective intervention measures that promote hand cleanliness compliance among nurses. The reporting items for meta-analyses as well as systematic reviews were used   to evaluate some of the short and long term implications of intrusions that promote hand washing among nursing staff. Six studies were found to meet the inclusion criteria. Nurses’ education was found to improve hand hygiene compliance with positive health outcomes on HAIs. It was therefore concluded that, both combined and single interventions improve hand cleanliness practices among nurses with lower HAIs rates. This article supports my PICOT by discussing how HAIs can either be prevented or reduced by improving hand hygiene compliance among nurses, which basically includes hand washing.


Areas for Further Study

It is well known from all the studies that Hospital acquired infections pose significant mortality and morbidity to hospitalized patients. Apart from resulting to poor health outcomes, they also prolong patient’s stays in hospitals and incur additional healthcare costs for patients and healthcare institutions. It is also known that HAIs can effectively be prevented through basic infection control practices such as hand washing. Nosocomial Infections Sample Paper

Majority of the recent studies discuss how to reduce HAIs through multifaceted programs and system-wide interventions that interrupt transmission such as hand washing. Combining with intervention approaches such as the use of alcohol based sanitizers have proven to result to even more positive health outcomes. Further studies need to focus on how healthcare staff, especially nurses can be more compliant with hand washing/hand hygiene practices since they are spent the most time with patients and are directly involved in patient care.


Jones, D., Martello, M., Biron, A., & Lavoie‐Tremblay, M. (2017). A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. Journal of Nursing Scholarship49(2), 143-152.

Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A. S., Harbarth, S.,  & Cooper, B. S. (2015). Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. bmj351, h3728.

Murni, I. K., Duke, T., Kinney, S., Daley, A. J., & Soenarto, Y. (2015). Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Archives of disease in childhood100(5), 454-459.

Slayton, R. B., Toth, D., Lee, B. Y., Tanner, W., Bartsch, S. M., Khader, K., & Miller, L. G. (2015). Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities—United States. MMWR. Morbidity and mortality weekly report64(30), 826.

Sickbert-Bennett, E. E., DiBiase, L. M., Willis, T. M. S., Wolak, E. S., Weber, D. J., & Rutala, W. A. (2016). Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerging infectious diseases22(9), 1628.

Nosocomial Infections Sample Paper

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