Impact of hand washing vs. using hand sanitizer at controlling

Inside the NICU, what is the impact of hand washing vs. using hand sanitizer at controlling

Summary of Clinical Issue: Hand Hygiene

Thousands of people lose lives daily as a result of infections acquired in the process of receiving care. About 25% of the more than 2.8 million neonatal deaths that occur every year around the world are due to infections (Kuti et al., 2021). Many of such deaths take place in low‐ and middle‐income nations. In a neonatal intensive care unit (NICU) setting, healthcare delivery involves attending to patient care needs of sick or premature newborns. Such patients need regular checkups and assessments for the achievement of better outcomes (Ramasethu et al., 2017). In such a busy health care environment, it is necessary for the healthcare providers to ensure hand hygiene.

Hands serve as the major pathway through which germs are transmitted during care. Many disease spread quickly through contaminated hands. Therefore, maintenance of proper hand hygiene plays a significant role in preventing the spread of germs. By doing so, it helps to reduce hospital stay duration, cost of care, morbidity, and unnecessary death (Pittet et al., 2017). Despite the fact that hand hygiene is an important measure in preventing nosocomial infections, its usefulness depends on compliance by healthcare workers. Low compliance affects neonatal safety by increasing the risk of infections that can be easily prevented (Ramasethu et al., 2017). This situation calls for sensitization of the healthcare providers on the importance of hand hygiene.

The simplest way of maintaining hand hygiene is through hand washing. This entails washing hands with water and soap. This method is effective in the removal of blood traces and other body fluids from the hand (Pittet et al., 2017). Apart from hand washing, hand hygiene can also be maintained through the use of a hand sanitizer. This involves rubbing the hands using an alcohol-based solution.  This approach is useful in the removal of germs that are not visible (Pittet et al., 2017). Whether one of these methods is more effective than the other in preventing infection is debatable. The proponents of hand washing argue that the method is cheap. On their part, the proponents of hand sanitizer note that this particular method is faster and efficient. This paper examines the impact of hand washing versus use of hand sanitizer in controlling infections in a NICU. It is guided by the following PICOT statement:

Inside the NICU (P), what is the impact of hand washing (I) versus using hand sanitizer (C) at controlling infection (O) over three months (T)?

Articles Supporting the Issue

Article 1: Abed, N. T., & Eldesouky, R. S. (2020). Infection Control: Hand Hygiene Practices among Nurses in the Neonatal Intensive Care Unit at Benha University Hospital. The Egyptian Journal of Hospital Medicine, 80 (1): 619-626. DOI: 10.21608/ejhm.2020.92540

Article 2: Sharma, V. S., Dutta, S., Taneja, N., & Narang, A. (2013). Comparing hand-hygiene measures in a neonatal ICU: A randomized cross-over trial. Indian Pediatr,  50: 917–921.

Table 1

Evaluation of articles that support the hand hygiene issue

Evaluation CriteriaArticle 1Article 2
How does the article relate to the PICOT question?This article examines the impact of hand washing, and compliance with hand hygiene practices among NICU nurses.The article compares various hand hygiene measures embraced in a NICU.
Quantitative, Qualitative (How do you know?)The study is qualitative. This is due to the fact it involved the collection of qualitative data using qualitative data collection tools such as the observational checklist.The study is quantitative. It uses statistical measures such as median and percentages in presenting the collected data.
Purpose StatementThe purpose of the current study was to assess hand washing practices embraced by nurses in a NICU, examine factors contributing to improper hand hygiene, and determine the availability of various hand hygiene equipment.The purpose of this study was to compare the efficiency of plain soap, iodophors, and alcohol hand rub in maintaining hand hygiene within NICU.
Research QuestionThe research question of the study is not specified in the article. However, it revolves around hand hygiene compliance and hand hygiene practices.In this article, the research question of the study has not been specified. However, it can be derived from the efficiency of the hand hygiene measures being compared.
OutcomeFrom the study, it is shown that compliance with hand hygiene practices such as hand washing is poor among nurses working inside NICU.The study reveals that  povidone-iodine scrub and alcohol hand rub are more effective than hand washing with soap.
Setting (Where did the study take place?)The study took place at a NICU of Benha University Hospital, in Egypt.This study was conducted in a level III NICU of a healthcare facility.
SampleThe current study was based on a sample of 28 nurses serving on NICU.The study comprised 35 NICU nurses.
MethodThe study derived from a qualitative approach , and it adopted an observational cross-sectional study design.This study was based on a quantitative approach. It employed a randomized cross-over trial.
Key findings of the StudyFrom the results of the study, it was established that hand hygiene compliance was poor among the nurses. It was also found that most nurses do not embrace proper hand washing practices.From the study results, it was found that plain soap hand wash is inferior to alcohol hand rub and use of povidone-iodine in the decontamination of NICU nurses’ hands.
Recommendations of the ResearcherThe researchers recommended that there is need for further training of nurses and other healthcare providers on the importance of compliance with hand hygiene.It is recommended that there is need to establish how various hand hygiene techniques used in NICU can be improved.    


Abed, N. T., & Eldesouky, R. S. (2020). Infection Control: Hand Hygiene Practices among Nurses in the Neonatal Intensive Care Unit at Benha University Hospital. The Egyptian Journal of Hospital Medicine, 80 (1): 619-626. DOI: 10.21608/ejhm.2020.92540

Kuti, B. P., Ogunlesi, T. A., Oduwole, O., Oringanje, C., Udoh, E. E., & Meremikwu, M. M. (2021). Hand hygiene for the prevention of infections in neonates. Cochrane Database of Systematic Reviews.

Pittet, D., Boyce, J. M., & Allegranzi, B. (2017). Hand hygiene: A handbook for medical professionals. Chichester Wiley Blackwell 2017.

Ramasethu, J.  (2017). Prevention and treatment of neonatal nosocomial infections. Matern Health, Neonatol and Perinatol, 3 (5).

Sharma, V. S., Dutta, S., Taneja, N., & Narang, A. (2013). Comparing hand-hygiene measures in a neonatal ICU: A randomized cross-over trial. Indian Pediatr,  50: 917–921.

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