NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission

NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission

NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission

Benchmark-Evidence-Based Practice Project: Literature Review

The attainment of patient safety requires nurses and other healthcare providers to establish interventions that will enhance quality care and minimize adverse events like hospital acquired infections (HAIs). Nurses must apply and leverage existing evidence-based practice interventions that include hand hygiene protocols and measures like handwashing with soap and water alongside sanitizers in the prevention and mitigation of hospital acquired infections (HAIs). Hospital acquired infections constitute a significant part of mortality and morbidity as well as poor patient outcomes and increased cost burden of care. The purpose of this paper is to offer a literature review of the articles that support the PICOT statement on using handwashing with soap and water alongside sanitizer compared to handwashing with soap and water alone to reduce hospital acquired infections among healthcare workers in a period of six months.  The paper addresses the search methods used in review of literature, synthesizes relevant articles based on the PICOT question, compares the articles and makes suggestions for future research on ways to mitigate hospital acquired infections.

Among healthcare workers in different settings (P), how does hand hygiene practices like handwashing with soap and water alongside using hand sanitizer (I), compared to handwashing with soap and water alone (C), reduce hospital acquired infections (O), within six months (T)?

Search Methods

Effective search for articles entails using appropriate approaches and terms. In this case, I used the university library to get to the databases of journals and their published peer reviewed articles. Using terms like peer review and scholarly works on hospital acquired infections (HAIs), I got the articles that I will be analyzing in this paper. I ensured that these articles have been published in the last five years and were relevant to nursing use and content. I also ensure that they were on the aspects in my PICOT question and statement and supported my EBP project.

Synthesis of Literature

Article 1

The first article by Ni et al. (2020) explores an intervention project on hand hygiene improvement in a large healthcare facility in China. The objective of the article is to investigate the importance of implementing a hand hygiene initiative among healthcare workers to reduce and prevent hospital acquired infections. Using a qualitative design, the authors provide a summary of the effectiveness of the implementation of the hand hygiene measures in a 2500-bed teaching hospital. The findings from the study emphasizes the significance of implementing evidence-based practice interventions to prevent infections and enhance patient safety. The article recommends having handwashing measures that will reduce infections by healthcare workers. The article supports the PICOT as it explores the benefits of using translational research to implement hand hygiene measures. The article also supports the project by providing insightful information about the effectiveness of hand hygiene measures by healthcare workers in different settings.

Article 2

The second article is by Setty et al. (2019) on adapting translational research methods in water, sanitation and hygiene. The goal if the

NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission

study was to delineate existing translational research principles from different professions that include healthcare workers on the importance of applying the interventions in care practice. The authors use a narrative review approach to suggest interventions that can improve hand hygiene. The findings from the article demonstrate the need for increased hand hygiene measures in hospitals and other health settings to reduce infections and enhance patient safety. The article supports the PICOT by illustrating the importance of using translational research approaches in improving hand hygiene measures in healthcare. The article will also support the project by enhancing effective understanding of different approaches to hand hygiene in multiple settings.

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission

Article 3

The article by Zhao et al. (2017) discusses the need to make hand hygiene interventions more attractive to nurses. Using a discrete choice experiment, the authors’ aim is to improve understanding about the kind of interventions that can make nurses embrace effective hand hygiene measures. Conducted in three tertiary settings where 200 nurses participated, the study shows that healthcare providers can develop effective interventions that attract these professionals to embrace handwashing. Outlining five different interventions, the authors show that with better training and awareness, nurses can make better decisions and take effective actions to prevent hospital acquired infections. The article supports the PICOT by giving more information on different approaches that nurses can use to prevent hospital acquired infections within a certain period.

Article 4

The by Staniford et al. (2020) is a systematic review of hand hygiene and environmental-disinfection interventions to improve hygiene in children’s settings. The authors identify interventions like behavioral change as essential in enhancing hand hygiene measures in these settings.  The findings show that these interventions are effective and supported by research. The article supports the PICOT as it demonstrates the need to integrate research-supported interventions in hand hygiene. The article also supports the need to use different approaches focused on health populations like nurses.

Article 5

The fifth article is by Moura et al. (2017) who explore the use of translational research in attaining hand hygiene compliance. The authors discuss interventions that support hand hygiene measures, especially in healthcare setting in low-income areas and regions. The findings from the study show that most of the interventions reviewed are effective in supporting hand hygiene measures and preventing hospital acquired infections. The article supports the EBP project by illustrating the significance of hand hygiene compliance among healthcare workers. The article supports the PICOT by offering more insightful view of interventions like handwashing with soap and water alongside sanitizer. The article shows that compared to no interventions, these strategies have the potential to improve care delivery.

Article 6

The article by Hillier (2020) is about effective use of hand hygiene practices to prevent and control infections. The aim of the study was to demonstrate to nurses and other healthcare workers correct procedure required for effective hand hygiene. The author also emphasizes the importance of nurses having current knowledge on evidence-based guidelines like increased use of sanitizers alongside washing hands with soap and water. The findings show that the use of hand hygiene measures and guideline is critical for healthcare workers to control and stop the spread of emerging diseases like the Coronavirus disease of 2019 (COVID-19). The study supports the PICOT since it shows that evidence-based interventions can increase compliance to hand hygiene measures among nurses and other healthcare workers.

Article 7

The seventh article by Akanji et al. (2017) is about the effectiveness of instituting formal hand hygiene education and feedback on compliance to hand hygiene standards by nurses to reduce and prevent hospital acquired infections. The aim of the study was to synthesize evidence to show the effective use of formal hand hygiene. In their findings, the authors assert the need for increased engagement of nurses to provide feedback on the most appropriate interventions to enhance hand hygiene measures and reduce and prevent HAIs. The article is important since it offers more insight on some of the protocols and measures that healthcare workers can use like using sanitizers alongside soap and water in handwashing.

Article 8

In their study, Azar et al. (2017) explore the use of agile implementation model in reducing central line-associated bloodstream infections (CLABIs) which are some the leading types of HAIs. The objective of the study is show how healthcare providers can use agile methodology to reduce and prevent CLABIs. Their finding indicate that healthcare workers can use agile model to reduce HAIs. The article supports the PICOT as illustrates the various interventions that healthcare workers can execute to prevent and reduce possible catheter-line infections which are common among the HAIs. The article allows for the development of translational approaches to improve quality care delivery.

Comparison of the Articles

The articles share a common aspect that entails approaches to reducing and preventing the occurrence of HAIs. The articles are also similar because their focus is to enhance patient safety and improve the quality of care. The articles also emphasize the need for healthcare workers to apply evidence-based interventions in mitigating hospital acquired infections. A majority of the articles use systematic reviews to show the various interventions based on evidence that can enhance quality care and lead to reduced chances of adverse medical events. A systematic review allows one to assess evidence from multiple sources to attain validity and reliability of their findings. The articles also have similarities as they make effective review of literature to demonstrate that HAIs are a public health concern but healthcare workers, particularly nurses, can develop EBP measures to enhance hand hygiene practices and embrace effective interventions. The articles share a common aspect of hand hygiene and other associated components that can lead to a reduction of HAIs).

The main themes of the article include hygiene, handwashing, need for patient safety and use of translational research and evidence-based project interventions for improved patient care and quality. The articles use different methods as some are systematic reviews while others are primary studies on their respective subjects. The articles have a common conclusion that stakeholders should develop more interventions to reduce and prevent HAIs, especially the use of evidence-based practice interventions. Each article has its unique limitations. However, a majority identify the need for more resources for better research studies in the future on how to prevent HAIs. No controversies exist in the article as in each, the researchers followed set guidelines to enhance validity and reliability of their findings.

Suggestion for Future Research

Based on the review and analysis of the literature, it is evident that more studies should be conducted to evaluate the effectiveness of hand hygiene measures like handwashing with soap and water alone or with sanitizer. Gaps in effective research demonstrating the relationship between enhanced hand hygiene measures and poor patient information is essential in demonstrating the need for all stakeholders to adhere to hand hygiene measures and not just healthcare workers alone.


Hospital acquired infections (HAIs) remain a patient safety concern that impacts quality care and safety, especially for inpatient patients in different health care settings. While nurses play a critical role in care delivery, they should not be the only professionals required to improve their hand hygiene measures to reduce and prevent HAIs. The findings show that nurse practitioners and other healthcare workers can prevent and reduce HAIs through effective use of EBP interventions on hand hygiene. The articles demonstrate the need for improved care quality for better patient outcomes.


Akanji, J., Walker, J. &Christian, R. (2017). Effectiveness of formal hand hygiene education and

feedback on healthcare workers’ hand hygiene compliance and hospital-associated. JBI Database System Review and Implementation Repository, 15(5): 1272-1279. doi: 10.11124/JBISRIR-2016-003019.

Azar, J., Kelley, K., Dunscomb, J., Perkins, A., Wang, Y., Beeler, C., … & Boustani, M. (2017).

Using the agile implementation model to reduce central line-associated bloodstream infections. American journal of infection control, 47(1), 33-37. doi: 10.1016/j.ajic.2018.07.008.

Hillier, M. D. (2020). Using effective hand hygiene practice to prevent and control infection.

Nursing Standard. doi: 10.7748/ns.2020.e11552

Moura, M. L., Fenley, J., Baraldi, M. & Boszozowski, I. (2017). Translational Research in Hand

Hygiene. Current Treatment Options in Infectious Diseases, 7(1). DOI:10.1007/s40506-015-0041-9

Ni, L., Wang, Q., Wang, F., Ni, Z., Zhang, S., Zhong, Z., & Chen, Z. (2020). An interventional

implementation project: hand hygiene improvement. Annals of Translational Medicine, 8(18). doi: 10.21037/atm-20-5480

Setty, K., Cronk, R., George, S., Anderson, D., O’Flaherty, G., & Bartram, J. (2019). Adapting

translational research methods to water, sanitation, and hygiene. International journal of environmental research and public health, 16(20), 4049.

Staniford, L. J. & Schmidtke, K. A. (2020). A systematic review of hand-hygiene and

environmental-disinfection interventions in settings with children. BMC Public Health, 20(195).

Zhao, Q., Yang, M. M., Huang, Y. Y. & Chen, W. (2017). How to make hand hygiene

interventions more attractive to nurses: A discrete choice experiment. PLoS ONE 13(8): e0202014.

Patient safety and improved quality of care requires providers and organization to use evidence-based practice (EBP) interventions to tackle issues that may cause adverse events like patient falls. Patients in medical-surgical units are susceptible to falls because of their delicate nature. The Centers for Medicare and Medicaid Services (CMS) considers falls as never events since they are preventable (Melnyk et al., 2022). Falls lead to increased stay in hospitals, poor patient outcome and serious fractures and head injuries that can lead to death. The use of bundled care approach through TIPS (tailoring interventions for patient safety) is considered one of the most effective ways to reduce and prevent falls in medical-surgical settings. The purpose of this literature review paper of the EBP project is to compare articles on the use of TIPS toolkit to reduce and prevent falls in medical-surgical settings.

PICOT Statement and Question

Nationwide, patient falls while in hospitals, particularly in medical-surgical units, are a leading cause of permanent disability and even death. Further, hospitalization increases one’s fall risk as close to three percent of patients fall while in hospitals. Nearly 30% of those who experience falls sustain injuries with a rise in the number of days in hospitals by close to 7 days. Again, under Medicare, the CMS does not reimburse falls and hospitals cannot get a Magnet designation when their fall rates are not below the national average (Khasnabish et al., 2020). The implication is that hospital managers and leaders must seek ways, through the use of evidence-based practice, to reduce the occurrence of falls. The use of TIPS toolkit is considered one of the most effective ways to reduce and mitigate falls and their occurrences as well as effects on patients in medical-surgical units.

PICOT Question

Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls (O) within 6 months (T)?

Search Methods

The evidence-based practice process implores researchers to seek evidence from previous research articles when doing their literature to obtain findings that support their proposed projects or interventions. The use terms, phrases and words associated with the topic under investigation and exploring databases to generate scholarly sources are some of the standard search strategies that one can deploy to attain relevant evidence. The study employed these strategies, starting with key terms and words in different databases. These included PubMed, Cochrane and Google Scholar as well as CINAHL. The strategy also entailed the use of CRAAP approach that involves searching for articles which are current, relevant, accurate, authoritative and purposeful to the area or topic under investigations (Melnyk et al., 2022). Using this criteria, the paper identified the reviewed articles and describes how they support the proposed EBP project to reduce and prevent the occurrence of falls in medical-surgical settings.

Research Synthesis

Article 1

The first article by Dykes et al. (2020) evaluates the use of a patient-centered fall prevention TIPS to lower falls and their associated injuries. Using non-randomized controlled trials with the study set in 14 medical units in Boston and New York, the researchers show a positive link between the intervention and a decline in number of falls. The researchers are categorical that nurse-led interventions can reduce injurious falls through providing information to families on fall management and prevention. The article demonstrates the efficacy of using TIPS as an intervention as depicted by the PICOT question.

Article 2

The second article by Tzeng et al. (2021) focuses on the impact of using TIPS program in reducing falls among older adults in nursing homes. Using a mixed method approach in a 15-bed nursing unit, the findings from the study shows that fall TIPS can reduce the rate of falls, especially injurious falls among older patients or adults. The TIPS program entails different approaches that include patient education and creating awareness about the harmful effects of falls. The article is critical to the EBP proposed project as it illustrates the increased role of TIPS initiative to reduce falls as depicted in the PICOT question. The article supports the EBP project since it shows that TIPS as an intervention is effective.

Article 3

In this article by Morris et al. (2022) the researchers conduct a systematic review of literature and meta-analysis on diverse interventions that can reduce falls. The researchers identify a host of interventions based on the data collected from the 43 studies that met their inclusion criteria. The findings show that tailoring or customization of interventions leads to reduced rates of falls for patients in such facilities. These interventions are effective when they consider the different components and factors impacting patient situations. As such, the article supports the EBP proposed project by demonstrating the effectiveness of diverse and tailored interventions for patients based on their level of acuity.

Article 4

The fourth article by Heng et al. (2020) is a scoping review of how hospitals can use patient education as a strategy to prevent falls. The researchers focused on 43 articles when analyzing the different approaches in patient education that confer benefits to patients to reduce their susceptibility to falls. The analysis shows that patient educational interventions can reduce falls that lead to injuries and bruises as well as lacerations and fractures. The study recommends the need to deploy TIPS as an effective approach to reducing and mitigating falls among patients. The article supports the EBP proposed project as it shows the need for diverse interventions like different approaches to educating patients on fall risks that they may be exposed to in their activities of daily living.

Article 5

In their article, LeLaurin et al. (201) aim at familiarizing different stakeholders about the benefits as well as the cons of various types of research studies on testing fall prevention interventions. The researchers opine that organizations and providers should focus on diverse interventions, one point at a time, to attain their efficacy and impact on patient fall management. The study’s findings are categorical that the effectiveness of each type of interventions depends on a host of factors. Therefore, customizing or tailoring these interventions is essential to attaining quality outcomes and helping patients avoid and reduce their susceptibility to falls. The article is important in the EBP project as it shows the need for tailoring each intervention to suit patient needs and situations.

Article 6

The article by Dykes et al. (2019) focuses on the effectiveness of tailoring interventions through a collaborative approach among providers. Using a qualitative approach or design, the article demonstrates that fall TIPS program is effective in reducing and preventing falls in diverse patient settings. The study is emphatic that TIPS model is important for providers to reduce and prevent falls. The article supports the EBP proposed project as it illustrates the importance of customizing interventions to meet patient needs and reduce susceptibility to falls.

Article 7

In this article by Cuttloer et al. (2018), the researchers aim at reducing inpatient falls in medical-surgical settings through technology-enabled TIPS initiative. The researchers use a four-minute video to provide patient education and collect their views on the implementation based on their situation. The findings are consistent that TIPS initiatives reduce and prevent falls. Therefore, the article supports the EBP project by showing that tailoring interventions is essential in addressing patient falls in medical-surgical settings.

Article 8

In their study, Bargmann et al. (2020) evaluates the effects of implementing a multicomponent fall prevention program to improve patient safety because of risks associated with falls. Set in a 26-bed medical surgical telemetry unit, the study shows that these interventions are effective in reducing falls and risks associated with falling for fragile patients. The article supports the EBP project since it is categorical that TIPS model reduce and prevents the occurrence of falls.

Comparison of the Articles

The reviewed articles share certain aspects in their research findings and also differ in other areas. for instance, all the articles agree that tailoring interventions on falls is an effective strategy that all providers and facilities should leverage in their settings. Again, the article agree that the TIPS model gives hospitals and providers increased leeway to implement interventions that are appropriate to their facilities based on their cost and other components. Thirdly, all the articles demonstrate that multiple interventions are complementary to the efforts and policies developed by organizations to reduce and prevent falls in their articles.

None of the article demonstrates controversies but all agree conclusively that more studies are required to provide significant outcomes. The articles also share limitations like timelines to conduct the studies, use of same settings and need for beet support from management and other stakeholders (Khasnabish et al., 2020). The articles do not have significant differences as they are emphatic that these diverse interventions are necessary in reducing falls, especially injurious falls among older patients.

Suggestions for Future Research

An analytical perspective of the eight articles and others demonstrate the need for more research to tackle some of the gaps. For instance, the articles do not offer a standard TIPS approach that can be used across all facilities, irrespective of their patient’s acuity and needs. As such, it is important to have more studies on the development of a standardized tool or approach to falls based on the nature of the respective setting, from medical-surgical units to outpatient facilities.


Falls are a major health issue that impact overall quality of care and life for patients, especially the elderly admitted to medical-surgical units. The use of TIPS toolkit; either patient-centered or nurse-driven, is critical to reducing these falls because of their adverse effects like injuries and long-term fractures and disabilities. The articles are emphatic that using TIPS allows providers to offer the most effective interventions to reduce and prevent their occurrence. The review illustrates that sufficient evidence exists to support the proposed interventions based on the TIPS framework to reduce falls.


Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a multicomponent fall

prevention program: Contracting with patients for fall safety. Military medicine, 185(Supplement_2), 28-34.

Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2018). Reducing medical-surgical inpatient falls and

injuries with videos, icons and alarms. BMJ open quality, 6(2), e000119.

DOI: 10.1136/bmjoq-2017-000119

Dykes, P. C., Adelman, J. S., Alfieri, L., Bogaisky, M., Carroll, D., Carter, E., … & Spivack, L.

  1. (2019). The fall TIPS (tailoring interventions for patient safety) program: A collaboration to end the persistent problem of patient Falls. Nurse Leader, 17(4), 365-370.

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros,

  1. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries. JAMA Network Open, 3(11), e2025889.

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital

falls prevention with patient education: a scoping review. BMC geriatrics, 20, 1-12. DOI:

Khasnabish, S., Burns, Z., Couch, M., Mullin, M., Newmark, R., & Dykes, P. C. (2020). Best

practices for data visualization: creating and evaluating a report for an evidence-based fall prevention program. Journal of the American Medical Informatics Association, 27(2), 308-314. DOI: 10.1093/jamia/ocz190.

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the

science. Clinics in geriatric medicine, 35(2), 273-283. DOI: 10.1016/j.cger.2019.01.007

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &

            healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I.

(2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5), afac077.

Tzeng, H.-M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C.

(2021). Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home. Journal of Nursing Care Quality,