In any health care organization it is important to adopt procedures to help reduce the number of nosocomial infections. Nosocomial infections are infections which can be acquired through improper sterilization, such as a lack of proper hand sanitation. In my area of work at the Richmond Supported Living Center, there are protocols in place to reduce nosocomial infections. One of these protocols is that of hand washing with soap and water before each patient.

However constant hand washing, due to the repeated wetting and drying of hands, can lead to the development of extremely dry hands and a condition known as hand dermatitis (Program, 2001). However, despite the risk for development of skin conditions among the staff, this procedure is in place because of it has been proven to help reduce nosocomial infections in patients. Research has shown that one of the most effective ways of reducing nosocomial infections is through proper hand hygiene practices, including hand washing (Mathur, 2011). However, because of the time required for hand washing, along with the drying effect, it has been suggested that alcohol rubs may be an appropriate substitute for constant hand washing. This is because in a healthcare setting there can be less than 40% compliance with hand washing procedures (Widmer, 2000). Therefore, in a nursing practice it may be useful to have an alternative to constant hand washing that will decrease nosocomial infections and increase compliance.

When designing any project one of the first steps is to determine potential research questions. Five research questions which could be used are: 1) How does hand washing compared to alcohol rubs effect the development of hand dermatitis in staff? 2) Does hand washing or alcohol rubs increase staff usage of lotion? 3) Does using alcohol rubs instead of hand washing increase staff compliance to hand sanitation procedures? 4) Is hand washing better at preventing nosocomial infections than alcohol rubs over 2 weeks of hospitalization? 5) Is hand washing better at preventing nosocomial infections than alcohol rubs over 4 weeks of hospitalization?

For question one, while it would be feasible to determine the occurrence of hand dermatitis in staff over a particular period, this does not address if rubs effect the development of nosocomial infections. The same argument can be used for question two, while saving on lotion could lead to cost savings, it does not address the major issue. As for question three, while it is important to ensure staff compliance, this question is not feasible as it would rely on self reported data from staff, many of whom may not be willing to answer this question truthfully (Short et al., 2009). With respect to question four, this answers the major question of if alcohol rubs reduce nosocomial infections. As well because it is evaluated in patients who are hospitalized for 2 weeks, the duration is short enough to ensure adequate sample size. Therefore of all the questions, question four is the most feasible. In contrast to question four, question five, while it would address the question of if alcohol rubs reduce nosocomial infections, because of the longer duration it may be difficult to obtain an adequate sample size, therefore this is not feasible.

For this project the preliminary PICOT question is: Does proper hand washing before and after care of high functioning psychiatric patients decrease the risk nosocomial infections as compared to alcohol rubs during 2 weeks of hospitalization? For the developed PICOT question the Patient or Problem (P) variable is patients at Richmond Supported Living Center. The intervention (I) is that of using alcohol rubs before and after each patient. The Comparison (C) is to the current method of hand washing before and after each patient. The anticipated outcome (O) is that alcohol rubs will be as effective or more effective in preventing nosocomial infections in patients. Finally the timeframe (T) would be that of 2 weeks, as this period is short enough to not be overly costly, but long enough to generate enough data to be useful (Davies, 2011).

The 10 possible keywords that can be used for conducting a literature search for the developed PICOT question are: 1) nosocomial infections 2) hospital acquired infections 3) hand washing 4) alcohol rubs 5) staff compliance 6) 7) hand hygiene 8) alcohol-based hand disinfection 9) Urinary Tract Infections 10) MRSA. For the first two key words, these were chosen as these terms are often used interchangeably to describe infections acquired in the healthcare system. The third and fourth terms were chosen as these are the two main types of hand sanitization that will be tested to see the effect on occurrence of nosocomial infection. The fifth term was chosen to locate literature associated with compliance of staff with hand washing procedures, which will be useful for providing relevant background information. The seventh and eighth term is the term used to describe methods of cleaning hands, and were found by looking at keywords other researchers have used in their publications (Pittet, 2001). Finally the ninth and tenth keywords were chosen because they are two of the main types of nosocomial infections (Khan, Ahmad, & Mehboob, 2015).

Overall, with the developed PICOT question and the generated keywords, now research can be conducted in order to determine what has been previously done. Throughout the course of conducting a literature search, while the 10 keywords are a useful starting point, throughout the searching more keywords may need to be used. This is to ensure that the literature review provides an accurate overview of what is known about the effects of hand washing vs. alcohol rubs on rates of nosocomial infections.