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Hand Hygiene Quantitative and Qualitative Research Critique

Hand Hygiene Quantitative and Qualitative Research Critique Analysis

This paper explores two research articles. One is a quantitative study on the knowledge of nurses about hand hygiene and the significant predictors of the practice (Asadollahi et al., 2015). Another one is a qualitative study on the beliefs and attitudes of health care providers regarding hand hygiene practice (Dixit, Hagtvedt, Reay, Ballermann, & Forgie, 2012). Both articles will be analyzed focusing on their introduction sections, literature review parts, methodology sections, data analyses, and conclusions. This paper will also examine the way every part of each research article supports the conclusion. The protection of human subjects in each article will be examined alongside ethical considerations observed during the study. This paper will then consider the strengths and limitations of each research article and finally, the implications of both articles for the nursing practice will be discussed. The quantitative article advocates for improved knowledge to promote appropriate hand hygiene practices, while the qualitative article recommends embracing positive attitudes and beliefs early in career to help perform the practice efficiently in subsequent years of health practice.

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Ensuring proper hand hygiene is one of the most efficient methods that health care providers, particularly nurses, can use to decrease the transfer of pathogenic microorganisms between them and the patients in the health care setting. Most patients are exposed to harmful substances in the health care environment that often lead to the development of nosocomial infections. Consequently, various health care facilities have protocols, which health care providers have to observe when practicing hand hygiene. The hand hygiene procedures performed by different hospitals are easy to follow and inexpensive and convenient way of reducing the prevalence of nosocomial infections. Therefore, health care providers can wash their hands immediately after arriving at work, before examining patients, after assessing patients, after touching contaminated instruments, after touching mucous membranes and after removing gloves since they might have microscopic holes. Additionally, it is important for health care providers to wash their hands after visiting toilets, before eating and before leaving work to minimize the transfer of harmful pathogens. Various researchers have conducted research studies to examine the attitudes, beliefs, and knowledge regarding hand hygiene and their implications for health care. This paper examines two articles, namely one quantitative and one qualitative, focusing on the background, literature review, methodology, data analysis, and conclusion and analyzes the way every section supports the conclusion, ethical considerations, strength and limitations and their implications to health care.

Quantitative Study (Asadollahi et al., 2015)

Asadollahi et al. (2015) conducted a quantitative research to determine the knowledge of practicing hand hygiene among neonatal nurses. Additionally, the investigators sought to examine individual and organizational predictors of hand hygiene among the nurses in the neonatal unit. The following table provides information on the background, literature, methodology, data analysis and conclusion.


Asadollahi et al. (2015) commence the research by acknowledging the recommendations from the World Health Organization [WHO] (2007), which advocates for improved hand hygiene to reduce hospital infections. The recognition of the guidelines is important because during the time that Asadollahi et al. (2015) were conducting this study, the WHO (2007) recommendations were the most appropriate guidelines that helped health care providers to prevent hospital-related infections. The authors also appreciate the role that nurses play in patient care and ascertain that nurses need relevant and up-to-date information to help promote hand hygiene practices in the health care environment.

The introduction section in this article also provides detailed background information on what various scholars have learned about repercussions of poor hand hygiene practices. For instance, Asadollahi et al. (2015) support the study done by Huis et al. (2013), which established that poor hand hygiene practices contribute to nosocomial infections, which are the leading causes of infant mortality in the developing countries. The investigators cite a considerable number of works of literature in the introduction focusing on the importance of hand hygiene and the consequences of neglecting the practice, thereby making the section clear and convincing.

The introduction section also states the aim of the study. The last sentence of the research article indicates that Asadollahi et al. (2015) sought to determine the level of knowledge of hand hygiene among neonatal nurses. Additionally, Asadollahi et al. (2015) wanted to study individual and organizational predictors of hand hygiene among neonatal nurses. The investigators further provide the setting for the research, namely Tabriz neonatal units.

At the end of the introduction, the reader can clearly understand the problem of poor hand hygiene, benefits of proper hand hygiene, possible recommendations, gaps in previous research studies, and the aim of the current research. Derntl (2014) argues that the introduction of any valid research article should lead the reader from general areas of study to a specific research that is being conducted. Derntl (2014) further states that researchers should indicate the importance of the research being done, reveal research gaps in previous studies, and state the purpose of the current research. Consequently, Asadollahi et al. (2015) make the background of this study clear and enable the readers to understand the purpose of this research, which makes it easy to proceed to the subsequent sections.

Review of Literature

The article does not have an independent section for the literature review. However, the reader can notice the review of literature in the introduction. Asadollahi et al. (2015) analyze most research studies that were published within ten years, thereby making this research study relevant. However, the review of literature does not focus on the methodology, sampling, and data collection of the previous studies. Consequently, the reader can find it difficult to identify the relevance of literature used in this study. Nevertheless, the review of literature is lengthy and appropriately integrates previously published research articles. Therefore, the reader can understand the problem and the aim of the research without confusion.


Discussion of the Methodology

The methodology section explains the type of the study, research participants, data collection, and data analysis. Asadollahi et al. (2015) indicate that it is a descriptive and cross-sectional study done in neonatal intensive care units and neonatal wards that are part of Tabriz teaching hospitals. The sample included 150 employed nurses through a census sampling method. The inclusion criteria involved the willingness of nurses to participate in the study and work experience of three months. The exclusion criteria included those who did not respond to 10% of the questionnaire.

The investigators developed a questionnaire that comprised two parts. The first part was a demographic checklist, and the second part analyzed the knowledge of nurses about hand hygiene using 15 multiple-choice questions that had four responses per question. Each question had one correct answer. If any nurse scored between zero to five, that would be low knowledge, six to ten indicated average knowledge and eleven to fifteen reported high-level knowledge. Additionally, the questionnaires examined four domains, which included the definition of hand hygiene (3 questions), antiseptic solutions (4 questions), hand hygiene solutions (4 questions) and infection control (4 questions). Asadollahi et al. (2015) gave the questionnaires to all 150 nurses who were all female. In fact, 134 of them worked in neonatal intensive care units, while 16 of them worked in fixed shifts.

The methodology section is clear as it explains all processes involved in the research methodology for this study. However, the researchers do not provide the length of the research in spite of indicating that it is a cross-sectional study. However, the purpose of the research remains clear, and the methodology is appropriate since questionnaires are efficient in examining attitudes and knowledge (Bird, 2009).

Data Analysis

Asadollahi et al. (2015) analyzed the data using the SSPSS software version thirteen due to the quantitative nature of the variables. The researchers also used descriptive statistics to interpret the data. Further, the investigators used multivariable explanation to present the knowledge of nurses on the basis of independent variables and multiple linear regression. This section is relevant for this study because SPSS is essential for the examination of quantitative data, and t-test is necessary for comparisons when analyzing data (de Winter, 2013).

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Researchers Conclusion

The researchers conclude that the general knowledge of nurses about hand hygiene is high. However, their knowledge of the concepts of hygiene is not appropriate. Consequently, Asadollahi et al. (2015) contend that infection control committees need to increase awareness of nurses on hand hygiene. Additionally, the authors state that hospitals should consider employing experienced nurses since work experience was a significant predictor in embracing hand hygiene.

Evidence and Conclusion

Every section of this research article supports the conclusion. For instance, the introduction section recognizes the statistics provided by the WHO (2007) regarding the high prevalence of nosocomial infections due to lack of knowledge of hand hygiene among nurses. The conclusion section recognizes the lack of appropriate knowledge of hygiene-related concepts.

The literature review examines different research studies that are associated with the knowledge and practice of hand hygiene. For example, Asadollahi et al. (2015) cite the study done by Malekmakan, Haghpanah, Askarian, Jowkari, and Moalaee (2008), which established that nurses had limited knowledge of hand hygiene and prioritized wearing gloves. Those findings mirror the conclusion of this research, which advocates for increased knowledge of hand hygiene.

The methodology section uses questions that address the aim of the study. Asadollahi et al. (2015) sought to examine knowledge of nurses about hand hygiene and individual and organizational predictors of the practice. The questions focus on concepts such as definition, infection control, antiseptic solutions, and hand hygiene solutions, which elicited responses that addressed the aim and the conclusion of the study.

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The analysis of the data by SPSS and interpretation by t-test were efficient because they are useful for analyzing quantitative data and comparing it respectively (de Winter, 2013). The conclusion section compares the general knowledge and the awareness of hand hygiene measured by the t-test. Finally, the results section indicates a high level of general knowledge of hand hygiene and low-level awareness of hygiene-related concepts. Furthermore, the investigators report in the results that work experience is a significant element needed to perform hand hygiene practices, which is used as a recommendation in conclusion.

Protection of Human Subjects

The rights of nurses and the neonates in this research were protected. For instance, Asadollahi et al. (2015) obtained permission to continue with the study from the research deputy of the Nursing and Midwifery Faculty of Tabriz. The nurses who participated in the study had given an informed consent before the researchers proceeded with the research indicating that they understood their responsibilities while taking part in the study.

Strength and Limitations


The researchers analyzed nurses who had a working experience of at least three months. Therefore, the nurses could provide information regarding their experience rather than the skills of other people. Secondly, the questionnaires used questions with regard to concepts that were efficient in analyzing knowledge and which would elicit significant responses regarding the predictors of proper hand hygiene. Finally, the study used SPSS to analyze data and t-test in making comparisons, which are both efficient methods for the activities in the quantitative research (de Winter, 2013).


The first flaw in this study is that all participants are women. Therefore, this research study cannot be applied to all nurses since male nurses also practice in neonatal units. Secondly, the data was collected in a busy environment, and its validity could not be proved. Therefore, there was a high chance of nurses providing flawed information.

Implications for the Nursing Practice

The evidence from this research has one significant implication for the nursing practice, which is increasing the knowledge of nurses about effective practices of hand hygiene. Asadollahi et al. (2015) indicate that nurses have a high level of general education on hand hygiene but possess little awareness regarding hygiene-related concepts. This finding is significant since the nurses that were assessed in the study work in high-risk areas since the immune system of the neonates is not yet developed to fight infections (Tourneur & Chassin, 2013). Therefore, infection control committees should devise appropriate ways of practicing hand hygiene, which can be communicated to nurses to increase their knowledge of hand hygiene-related concepts.

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Qualitative Study (Dixit, Hagtvedt, Reay, Ballermann, and Forgie, 2012)

Dixit, Hagtvedt, Reay, Ballermann, and Forgie (2012) conducted a study to examine common attitudes and beliefs held by pediatric residents regarding hand hygiene. Dixit et al. (2012) indicate that it was a qualitative study. The research took place from November 2011 to April 2012.


Dixit et al. (2012) begin the article by recognizing the role of contaminated hands in transmitting health care-associated pathogens. The researchers also state that compliance with appropriate hand hygiene practices reduce the prevalence of nosocomial infections. Additionally, Dixit et al. (2012) indicate that viral infections contribute to most diseases among the pediatric population. The primary mode of transmission recognized in this introduction section is the contact among patients and contact between health care workers and patients. Furthermore, Dixit et al. (2012) acknowledge a significant relationship between hand hygiene and pediatric infections. The authors state that despite the knowledge of the relationship, efforts are not always put into improving hand hygiene. The introduction section, which the authors also call the background section, cites several sources to appropriately introduce the aim of the study.

Dixit et al. (2012) finish the introduction section by ascertaining that better understanding of hand hygiene attitudes and beliefs among pediatric residents can improve compliance with the practice. The authors then narrow down the discussion to health care providers who have completed their medical degree and state that if they start practicing hand hygiene earlier, it would positively influence subsequent years of work in their careers.

The introduction section provides the reader with an idea of the intention of the study. However, it does not state the importance of the research using general to specific information that eventually introduces the objective of the study. According to Derntl (2014), a proper introduction should start from general and end with specific information, which should enable the authors to present the purpose of the research. In this article, it does not occur. However, the reader of the article can still focus on the aim of the study since the authors identify it in the abstract.

Review of Literature

This research article does not have an independent section for the literature review. The utilized literature is discussed in the introduction section. Dixit et al. (2012) does not provide a summary of the literature review but cite many research studies that are also referenced at the end of the article. Consequently, it is difficult for the reader to appreciate the methodologies of previous studies and identify limitations of the literature.

The literature review further focuses on the effect of poor hand hygiene and transmission of pathogens. Dixit et al. (2012) identify a study done by Ward (2012), which concluded that barriers such as workload issues and unavailability of hand hygiene material prevent health care providers from practicing hand hygiene. Moreover, lack of implementation of hand hygiene increases the prevalence of nosocomial infections. The researchers risked using outdated information since they cite articles published more than 20 years ago. Nevertheless, the literature review section is appropriate as the researchers focused on studies that examined hand hygiene.

Discussion of Methodology

Dixit et al. (2012) developed questions, which they used to examine common themes during the interview. The investigators conducted semi-structured interviews with twenty-two pediatric residents for 45-60 minutes. Dixit et al. (2012) recorded the interviews digitally, which were transcribed by a single transcriptionist and later verified whether it was accurate by the research team.

The sample in this study involved all physicians in the pediatric residence. The physicians were completing their training. Therefore, these physicians were a useful sample for the study since they were only beginning their careers. Thus, their attitudes and beliefs would determine their practice in the subsequent years.

Data Analysis

The investigators reviewed the transcribed results after the interview. The first author (DD) read the interviews, which the researchers coded independently. Each team reviewed the codes to achieve inter-rater consistency. Common themes emerged, and the final themes included the importance of role models, balancing competing priorities, self-protection, and cues to develop hand hygiene habit. In fact, such unambiguous themes have been found appropriate in forming valid conclusions in qualitative studies (Vaismoradi, Jones, Turunen, & Snelgrove, 2016).

Researchers’ Conclusion

After analyzing the results in the discussion, Dixit et al. (2012) concluded that physicians are vital in initiating hand hygiene practices in groups. However, the researchers established that it was unnecessary to wash hands during cardiopulmonary resuscitation and other emergencies. The investigators further contended that practice of hand hygiene earlier in career improves compliance with hand hygiene in subsequent years due to positive beliefs with regard to the practice developed earlier.

Evidence and Conclusion

The evidence in every section of the article supports the conclusion. In the introduction, which the researchers also address as the literature review and the background section, Dixit et al. (2012) cite various research articles that focus entirely on hand hygiene. For instance, the research by Ward (2012) is cited alongside similar articles that present the barriers to hand hygiene and their consequences on the spread of nosocomial infections. The conclusion section identifies that beginning hand hygiene early in career is an important way of minimizing the barriers of hand hygiene.

The methodology section explains the way the researchers conducted the interviews with twenty-two pediatric physicians, while the conclusion section argues they are important in initiating hand hygiene. The results section identifies themes such as cues, which the conclusion part states that physicians usually integrate them in their hand hygiene habits. The discussion section identifies the doctors as the role models, which the conclusion section affirms by stating that they play a significant role in influencing appropriate hand hygiene habits.

Protection of Human Subjects

The participants in this study included physicians who were completing their training. The Human Research Ethics Board at Alberta University in Edmonton, Canada approved the study after making sure it was appropriate for the participants. The physicians then gave a written informed consent before the investigators began the study. Finally, the coding of the interviews ensured anonymity during data analysis.

Strengths and Limitations


In the literature review section, Dixit et al. (2012) focus on research studies that address hand hygiene alone. The part makes sure that this research article addresses the aim of the study. The methodology section also uses unrestricted interviews to devise common themes. Such unrestricted interviews help researchers to devise relevant qualitative responses that yield valuable information to support the conclusion (Stenius, Mäkelä, Miovsky, & Gabrhelik, 2008). Finally, Dixit et al. (2012) identified young health care providers, whose attitudes and beliefs are relevant in determining subsequent care in hospitals.


The convenient sample used in this study cannot yield data that can be applied efficiently to health care providers in other settings. Secondly, the interview format would also have led to recall bias since 18 out of 22 participants were female. Finally, the themes cannot be validated since this research is the first one to identify such themes.

Evidence and Nursing Practice

This research study is relevant to nursing practice since doctors collaborate with nurses in delivering care to patients. Falana, Afolabi, Adebayo, and Ilesanmi (2016) contend that most nurses have a positive attitude towards doctor-nurse collaboration. This study identifies physicians as role models in initiating hand hygiene to reduce the prevalence of nosocomial infections. Significantly, the evidence in this study can be used to initiate interdisciplinary collaboration in hand hygiene, which is relevant in this case since both doctors and nurses are involved in handling vulnerable patients.


The research article by Asadollahi et al. (2015) is paramount since it addresses the need to be knowledgeable and to have a positive attitude towards hand hygiene. Similarly, Dixit et al. (2012) consider positive beliefs and attitudes as crucial factors in upholding appropriate hand hygiene practices. Both articles focus on hand hygiene and use quantitative and qualitative methods respectively to reach a conclusion. The results of these studies can be applied to nursing practice to improve knowledge and foster positive attitudes and beliefs, which are necessary for embracing hand hygiene. Finally, nurses and doctors should help each other as they collaborate in the health care settings to promote hand hygiene to reduce nosocomial infections.


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