NURS FPX 6030 Assessment 2 Problem Statement (PICOT)
Student Name
Capella University
NURS-FPX 6030 MSN Practicum and Capstone
Prof. Name
Date
Problem Statement (PICOT)
Hand hygiene (HH) remains one of the most effective strategies for preventing healthcare-associated infections (HAIs) and limiting the spread of multidrug-resistant organisms in clinical environments. Despite its importance, inconsistent adherence among healthcare personnel continues to increase infection risks and overall healthcare expenditures. HH refers to the systematic cleaning of hands by healthcare workers to eliminate pathogens and prevent cross-contamination between patients and environments.
Over the past decade, the emphasis on HH compliance has intensified due to rising elderly populations, increased patient acuity, and efforts to reduce hospital length of stay. In the United States, healthcare expenditures reached $102.3 billion in 2018, reflecting a 30% increase over five years (McDonald et al., 2020). Within Benedictine Healthcare, strengthening HH compliance is essential for minimizing preventable HAIs and improving quality of care. This project addresses these concerns through structured education and compliance monitoring.
PICOT Question and Breakdown
The guiding PICOT question is:
“In healthcare staff employed in acute care settings (P), does the execution of organized HH education (I), compared to standard HH practices without focused training (C), improve HH compliance rates (O) over four weeks (T)?”
PICOT Elements
| Component | Description |
|---|---|
| P (Population) | Healthcare staff in acute care settings |
| I (Intervention) | Structured hand hygiene education program |
| C (Comparison) | Standard HH practices without targeted training |
| O (Outcome) | Increased HH compliance rates |
| T (Timeframe) | Four weeks |
Needs Assessment
Improving HH adherence among Benedictine Healthcare staff is critical to reducing HAIs and strengthening patient safety. Evidence from the World Health Organization (WHO) indicates that one in three healthcare facilities globally lacks adequate HH access at the point of care, and compliance in some low-resource settings can be as low as 9% (WHO, 2021). In contrast, compliance in developed healthcare systems often exceeds 70%, demonstrating significant variability in practice.
Key contributing factors to poor HH compliance include:
- Inconsistent or insufficient training programs
- Limited reinforcement and reminders in clinical workflows
- Lack of accountability mechanisms
- Gaps in leadership support and monitoring
Structured educational interventions that incorporate demonstrations, visual prompts, and feedback mechanisms have been shown to significantly improve HH behavior and reduce infection transmission risks (Deryabina et al., 2021).
Population and Setting
The target population for this initiative includes healthcare workers at Benedictine Healthcare, an acute care facility where HAIs remain a persistent concern. Poor HH adherence directly contributes to patient safety risks and infection transmission across departments.
Observed Challenges in Similar Settings
| Factor | Observed Issue |
|---|---|
| Visual reminders | Only ~46% of facilities consistently display HH reminders |
| Communication tools | Approximately 10% use structured communication strategies |
| Leadership support | Present in only 51–56% of facilities (Deryabina et al., 2021) |
Despite the existence of HH guidelines, compliance gaps persist due to limited reinforcement and inconsistent education. Structured training interventions have demonstrated measurable improvements in adherence and infection control outcomes (McDonald et al., 2020).
Intervention Overview
The proposed intervention involves a structured HH education program designed to improve knowledge, behavior, and compliance among staff.
Key components include:
- Formal HH training sessions
- Practical demonstrations of correct techniques
- Visual reminders placed in clinical areas
- Ongoing compliance monitoring and feedback
This approach aims to strengthen awareness, promote consistent behavior, and reduce infection transmission risks (Assefa et al., 2021).
Additionally, integrating collaborative care principles supports shared accountability among healthcare teams, improving communication and reinforcing safety practices (Adams et al., 2023).
Comparison of Approaches
Two primary approaches are considered: traditional structured education versus technology-supported HH monitoring systems.
| Approach | Description | Strengths | Limitations |
|---|---|---|---|
| Structured Education | In-person training, demonstrations, reminders | Builds foundational knowledge, improves engagement | Requires sustained staffing and leadership support |
| Digital Monitoring Systems | Mobile apps, electronic alerts, real-time feedback | Continuous reminders, objective tracking | Cost, technology resistance, infrastructure needs (Blomgren et al., 2021) |
While digital systems enhance monitoring efficiency, traditional education remains essential for foundational skill development. A hybrid model may provide optimal outcomes in HH compliance.
Initial Outcome Expectations
The primary goal is to improve HH adherence among healthcare staff and reduce HAIs within Benedictine Healthcare.
Expected outcomes include:
- Increased HH compliance rates
- Reduced incidence of HAIs
- Improved staff knowledge retention
- Lower healthcare-associated costs (van Roekel et al., 2021)
NURS FPX 6030 Assessment 2 Problem Statement (PICOT)
Outcome evaluation will rely on:
- Direct observational audits
- Infection surveillance data
- Staff feedback and compliance reports
Quality Improvement Model: PDSA Framework
The Plan-Do-Study-Act (PDSA) cycle provides a structured framework for implementing and refining the HH intervention.
| Phase | Activities |
|---|---|
| Plan | Develop training materials, set compliance targets, design reminders |
| Do | Deliver training, implement visual cues, initiate monitoring |
| Study | Evaluate compliance rates and HAIs data |
| Act | Adjust strategies based on findings and feedback (Kumar et al., 2022) |
This iterative approach ensures continuous improvement in HH practices and patient safety outcomes.
Implementation Challenges
Potential barriers to implementation include:
- Variability in staff engagement
- Workforce shortages during training periods
- Resistance to behavioral change
- Supply limitations for HH resources
- Cultural and communication differences among staff
Addressing these challenges requires:
- Tailored training approaches
- Clear communication strategies
- Leadership support and reinforcement
- Continuous feedback mechanisms
Despite these barriers, iterative improvements through the PDSA cycle enhance sustainability and effectiveness.
Time Plan (Four-Week Implementation)
Phase 1: Planning and Training (Weeks 1–2)
| Period | Activities |
|---|---|
| Days 1–4 | Assess current HH compliance, identify gaps, evaluate resources |
| Days 5–9 | Develop training materials, finalize protocols, obtain approvals |
| Days 10–14 | Deliver initial training, introduce reminders, pilot intervention |
Phase 2: Implementation and Monitoring (Weeks 3–4)
| Period | Activities |
|---|---|
| Days 15–18 | Full rollout of HH program across facility |
| Days 19–23 | Monitor compliance, address barriers in real time |
| Days 24–28 | Evaluate outcomes and compile results |
Literature Review Synthesis
Existing literature consistently highlights HH as a primary determinant in preventing HAIs. Poor HH compliance increases infection transmission, hospital stays, and healthcare costs (Ahmadipour et al., 2022). Structured educational interventions significantly improve adherence and reduce infection rates (Alhumaid et al., 2021).
Global data indicate that HAIs affect approximately 7% of patients in high-income countries and up to 15% in low-income settings, with significant mortality implications (Chakma et al., 2024). Evidence also shows that combining education with monitoring systems enhances compliance and reduces infection rates (McDonald et al., 2020).
Health Policy Evaluation
The Affordable Care Act (ACA) supports quality improvement initiatives aimed at reducing HAIs through evidence-based interventions. By incentivizing patient safety measures and infection control programs, the ACA aligns with HH improvement strategies at Benedictine Healthcare (Shittu et al., 2020).
Emerging technologies such as automated monitoring systems, electronic reminders, and AI-supported compliance tracking further strengthen HH initiatives, though barriers such as cost and staff readiness remain (Alhusain, 2025).
Conclusion
Structured HH education is a critical intervention for reducing HAIs and improving patient safety at Benedictine Healthcare. Through a combination of training, monitoring, and feedback over a four-week period, this initiative addresses existing compliance gaps and promotes a culture of accountability. Sustained improvement in HH practices enhances care quality, reduces infection-related costs, and strengthens overall healthcare system performance.
References
Adams, F., Zimmerman, P.-A., Sparke, V. L., & Mason, M. (2023). Towards a framework for a collaborative support model to assist infection prevention and control programmes in low- and middle-income countries: A scoping review. International Journal of Infection Control. https://doi.org/10.3396/ijic.v19.21851
Ahmadipour, M., Dehghan, M., Ahmadinejad, M., Jabarpour, M., & Shahrbabaki, P. (2022). Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.968231
NURS FPX 6030 Assessment 2 Problem Statement (PICOT)
Alhumaid, S., Al Mutair, A., Al Alawi, Z., Alsuliman, M., Ahmed, G. Y., Rabaan, A. A., Al-Tawfiq, J. A., & Al-Omari, A. (2021). Knowledge of infection prevention and control among healthcare workers and factors influencing compliance: A systematic review. Antimicrobial Resistance & Infection Control, 10(1). https://doi.org/10.1186/s13756-021-00957-0
Alhusain, F. A. (2025). Harnessing artificial intelligence for infection control and prevention in hospitals: A comprehensive review of current applications, challenges, and future directions. Saudi Medical Journal, 46(4), 329–334. https://doi.org/10.15537/smj.2025.46.4.20240878
Assadian, O., Harbarth, S., Vos, M., Knobloch, J. K., Asensio, A., & Widmer, A. F. (2021). Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: A narrative review. Journal of Hospital Infection, 113. https://doi.org/10.1016/j.jhin.2021.03.010
Assefa, D., Melaku, T., Bayisa, B., & Alemu, S. (2021). Knowledge, attitude and self-reported performance and challenges of hand hygiene using alcohol-based hand sanitizers among healthcare workers during COVID-19 pandemic at a tertiary hospital: A cross-sectional study. Infection and Drug Resistance, 14, 303–313. https://doi.org/10.2147/idr.s291690
Blomgren, P.-O., Lytsy, B., Hjelm, K., & Swenne, C. L. (2021). Healthcare workers’ perceptions and acceptance of an electronic reminder system for hand hygiene. Journal of Hospital Infection, 108, 197–204. https://doi.org/10.1016/j.jhin.2020.12.005
NURS FPX 6030 Assessment 2 Problem Statement (PICOT)
Chakma, S. K., Hossen, S., Rakib, T. M., Hoque, S., Islam, R., Biswas, T., Islam, Z., & Islam, M. M. (2024). Effectiveness of a hand hygiene training intervention in improving knowledge and compliance rate among healthcare workers in a respiratory disease hospital. Heliyon, 10(5), e27286. https://doi.org/10.1016/j.heliyon.2024.e27286
Deryabina, A., Lyman, M., Yee, D., Gelieshvilli, M., Sanodze, L., Madzgarashvili, L., Weiss, J., Kilpatrick, C., Rabkin, M., Skaggs, B., & Kolwaite, A. (2021). Core components of infection prevention and control programs at the facility level in Georgia: Key challenges and opportunities. Antimicrobial Resistance & Infection Control, 10(1). https://doi.org/10.1186/s13756-020-00879-3
Douno, M., Rocha, C., Borchert, M., Nabe, I., & Müller, S. A. (2023). Qualitative assessment of hand hygiene knowledge, attitudes and practices among healthcare workers prior to the implementation of the WHO Hand Hygiene Improvement Strategy at Faranah Regional Hospital, Guinea. PLOS Global Public Health, 3(2), e0001581. https://doi.org/10.1371/journal.pgph.0001581
Islam, M., Chung, J., Sultana, S., Unicomb, L., Alam, M., Rahman, M., Ercumen, A., & Luby, S. P. (2021). Effectiveness of mass media campaigns to improve handwashing-related behavior, knowledge, and practices in rural Bangladesh. The American Journal of Tropical Medicine and Hygiene, 104(4). https://doi.org/10.4269/ajtmh.20-1154
Kumar, A., Kumar, R., Gupta, A. K., Kishore, S., Kumar, M., Ahmar, R., Prakash, J., & Sharan, S. (2022). Improvement of hand hygiene compliance using the Plan-Do-Study-Act method: Quality improvement project from a tertiary care institute in Bihar, India. Cureus, 14(6). https://doi.org/10.7759/cureus.25590
Lowe, H., Woodd, S., Lange, I. L., Janjanin, S., Barnett, J., & Graham, W. (2021). Challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings: A qualitative study. Conflict and Health, 15(1), 94. https://doi.org/10.1186/s13031-021-00428-8
NURS FPX 6030 Assessment 2 Problem Statement (PICOT)
McDonald, M. V., Brickner, C., Russell, D., Dowding, D., Larson, E. L., Trifilio, M., Bick, I. Y., Sridharan, S., Song, J., Adams, V., Woo, K., & Shang, J. (2020). Observation of hand hygiene practices in home health care. Journal of the American Medical Directors Association, 22(5). https://doi.org/10.1016/j.jamda.2020.07.031
Shittu, A., Hannon, E., Kyriacou, J., Arnold, D., Kitz, M., Zhang, Z., Chan, C., & Kohli-Seth, R. (2020). Improving care for critical care patients by strategic alignment of quality goals with a physician financial incentive model. Quality Management in Health Care, 30(1), 21–26. https://doi.org/10.1097/qmh.0000000000000281
van Roekel, H., Reinhard, J., & Grimmelikhuijsen, S. (2021). Improving hand hygiene in hospitals: Comparing the effect of a nudge and a boost on protocol compliance. Behavioural Public Policy, 6(1), 1–23. https://doi.org/10.1017/bpp.2021.15
World Health Organization. (2021). Key facts and figures. https://www.who.int/campaigns/world-hand-hygiene-day/2021/key-facts-and-figures