Sample Paper for EBP Change: Improving Hand Hygiene Compliance in Acute Care

Posted: October 27th, 2025

EVIDENCE-BASED PROJECT, PART 4: RECOMMENDING AN EVIDENCE-BASED PRACTICE CHANGE

Introduction

The collection of evidence is an activity that occurs with an endgame in mind. It’s truly rewarding to see how gathering solid facts leads to smarter choices that benefit everyone involved. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes. Embracing this mindset helps us all stay focused on what really matters in patient care.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach. Tackling real-world challenges like this builds your confidence in driving positive shifts where they count most.

Resources

Be sure to review the Learning Resources before completing this activity. These resources are designed to spark your thinking and equip you with practical insights for the task ahead.

Click the weekly resources link to access the resources.

• WEEKLY RESOURCES

Preparation Steps

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT. Revisiting those appraisals often reveals fresh perspectives that strengthen your approach.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection. We all have those moments where a simple observation highlights areas ripe for improvement.
• Consider the best method of disseminating the results of your presentation to an audience. Sharing your work effectively can inspire colleagues and lead to broader adoption of great ideas.

The Assignment: Evidence-Based Project

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following: Feeling supported in this creative process makes it easier to convey your passion for change.

1. Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.) Starting here sets the stage for why your proposal fits perfectly in that setting.
2. Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general. Outlining these details thoughtfully shows the depth of your understanding and preparation.
3. Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered. Grounding your suggestion in reliable data feels empowering and reassures others of its value.
4. Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. Planning this out step by step ensures smooth transitions and lasting impact.
5. Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy. Tailoring your method to the audience’s needs often leads to more meaningful engagement and feedback.
6. Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change. Defining success upfront keeps everyone aligned and motivated.
7. Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking. Incorporating these sources adds credibility and invites deeper discussions among peers.
8. Add a lessons learned section that includes the following:
   1. A summary of the critical appraisal of the peer-reviewed articles you previously submitted
   2. An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

   Wrapping up with these reflections reinforces the lessons that stick with you long after the project ends.

Alternate Submission Method

You may also use Kaltura Personal Capture to record your narrated PowerPoint. Many find this tool intuitive and helpful for bringing presentations to life in a personal way. This option will require you to create your PowerPoint slides first. Then, follow the Personal Capture instructions outlined on the Kaltura Media Uploader guide. Familiarizing yourself early avoids last-minute stress and lets your creativity shine.

When you are ready to begin recording, you may turn off the webcam option so that only “Screen” and “Audio” are enabled. Start your recording and then open your PowerPoint to slide show view. Once the recording is complete, follow the instructions found on the “Posting Your Video in the Classroom Guide” found on the Kaltura Media Uploader page for instructions on how to submit your video. For this option, in addition to submitting your video, you must also upload your PowerPoint file which must include your speaker notes. Including those notes ensures your full thoughts are captured for anyone reviewing your work later.

Submission Information

By Day 7 of Week 10

Submit Part 4 of your Evidence-Based Project. Review the following submission instructions for the type of submission you choose. Meeting this deadline gives you a sense of accomplishment and frees up time for reflection.

Narrated PowerPoint Submission

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area. Using this step protects your hard work and upholds academic integrity we all value.

1. To submit your completed assignment, save your Assignment as WK11Assgn_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review. Following these simple steps makes the process feel straightforward and reliable.

Kaltura Personal Capture Submission

To submit your Kaltura media:

1. Click on Start Assignment near the top of the page.
2. Next, click Text Entry and then click the Embed Kaltura Media button.
3. Select your recorded video under My Media.
4. Check the box for the End-User License Agreement and select Submit Assignment for review. Completing this wraps up your efforts with a polished touch.

Conclusion

Congratulations! After you have finished all of the assignments for this module, you have completed the course. Please submit your Student Evaluation of Learning and Teaching by Day. You’ve earned this milestone, and your feedback helps shape better experiences for future learners.

References

• Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses—systematic review. Medicine, 98(39), e17209. https://doi.org/10.1097/MD.0000000000017209
• Melnyk, B. M., Hsieh, A. P., Gallagher‐Ford, L., & Thomas, B. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence‐Based Nursing, 20(1), 6-15. https://doi.org/10.1111/wvn.12621
• Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20, e6. https://doi.org/10.1017/S1463423618000488
• Beshir, K. B., Wube, M. C., & Tilahun, A. Y. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. PLOS ONE, 16(8), e0256600. https://doi.org/10.1371/journal.pone.0256600
• Tucker, S., McNett, M., Mazurek Melnyk, B., Hanrahan, K., Hunter, S. C., Kim, B., Cullen, L., & Kitson, A. (2019). Implementation science: Application of evidence‐based practice models to improve healthcare quality. Worldviews on Evidence‐Based Nursing, 18(2), 76-84. https://doi.org/10.1111/wvn.12495
• How to Recommend Evidence-Based Practice Changes in Healthcare

Evidence-Based Practice Change: Improving Hand Hygiene Compliance in Acute Care Settings

Organizational Context and Readiness for Change

The selected healthcare organization is a mid-sized acute care hospital serving a diverse urban population. The culture reflects a growing orientation toward patient safety and quality improvement, though operational inertia often impedes sustained practice change. Leadership supports innovation but expects measurable outcomes. Staff engagement fluctuates across units, with high compliance in some departments and visible lapses in others. The organization’s readiness for change, therefore, is moderate: awareness exists, but consistent reinforcement and accountability structures remain weak. The infection prevention committee has identified hand hygiene noncompliance as a persistent issue, linking it to preventable healthcare-associated infections (HAIs). These infections increase patient morbidity and extend hospital stays, costing the organization both reputational and financial capital. The impetus for change aligns with the institution’s quality metrics and its strategic plan to achieve zero preventable HAIs by 2026.

Current Problem and Opportunity for Change

Noncompliance with hand hygiene standards presents an enduring clinical problem that undermines patient safety. Despite the presence of hand sanitizer dispensers and periodic training, adherence rates hover around 68%, far below the World Health Organization’s (WHO) recommended target of 90%. Factors contributing to this include workflow interruptions, skin irritation from frequent use of alcohol-based rubs, and cognitive fatigue during busy shifts. The problem’s scope extends across all patient-care units, involving nurses, physicians, and ancillary staff. Stakeholders include clinical managers, infection prevention specialists, frontline nurses, and patients themselves. Failure to address this issue sustains elevated infection rates, potential legal liabilities, and regulatory scrutiny. Conversely, implementing an evidence-based approach to improve hand hygiene offers the opportunity to reduce HAIs, enhance patient outcomes, and reinforce a culture of accountability. The risk associated with this change primarily involves staff resistance due to perceived workflow disruption, but such resistance can be mitigated through structured education and visible leadership support.

Evidence-Based Proposal for Practice Change

The proposed change focuses on integrating real-time electronic hand hygiene monitoring systems combined with behavioral feedback interventions. Evidence from recent systematic reviews indicates that technology-assisted compliance tracking paired with feedback significantly improves adherence rates (Limper et al., 2021). The system would employ sensor-based devices attached to sanitizer dispensers and staff badges to capture compliance data in real time. Results would be accessible through dashboards visible to both unit managers and clinicians. Feedback would occur weekly during safety huddles, emphasizing trends rather than individual blame. Additionally, the intervention would integrate a short educational component reinforcing the clinical impact of HAIs and showcasing unit-level progress. To ensure credibility, the intervention must align with CDC and WHO guidelines and receive endorsement from infection control leadership.

Knowledge Transfer and Implementation Plan

Knowledge transfer follows a three-tier model: creation, dissemination, and adoption. Creation involves developing customized training modules and digital resources outlining evidence supporting electronic monitoring and behavioral reinforcement. Dissemination occurs through interdepartmental workshops and pilot sessions within two high-traffic units: medical-surgical and intensive care. Early adopters from these units will serve as peer champions, modeling adherence and sharing progress. Implementation requires close coordination between the infection control team, IT specialists, and clinical leaders. Performance data will be reviewed biweekly to identify early trends and modify strategies accordingly. Organizational adoption depends on leadership visibility and consistent reinforcement through policy updates, staff recognition programs, and inclusion of compliance data in quality dashboards. To maintain momentum, quarterly reviews will evaluate sustainability and explore system expansion across departments.

Dissemination Strategy and Rationale

The results of the project will be disseminated using a dual strategy: internal dissemination through grand rounds and external dissemination via a professional nursing conference. Grand rounds provide a structured platform to reach multidisciplinary teams, allowing open discussion and feedback. Presenting outcomes at a national infection control or nursing quality conference will extend the hospital’s visibility and attract peer review. This dual approach balances internal reinforcement with external validation, encouraging staff ownership while positioning the organization as a proactive participant in national quality improvement efforts. Scholarly dissemination ensures transparency and contributes to collective learning across institutions facing similar challenges.

Expected Measurable Outcomes

The primary outcome is an increase in hand hygiene compliance from 68% to at least 90% within six months of implementation. Secondary outcomes include a 25% reduction in HAIs, shorter average length of stay for affected patients, and improved patient satisfaction scores related to perceived cleanliness and safety. Additional indicators include reduced staff sick leave due to infection exposure and enhanced interdepartmental collaboration metrics. Measurement will employ continuous electronic monitoring data, infection surveillance reports, and staff feedback surveys. Data triangulation will ensure validity and reliability. Sustained compliance beyond one year will serve as an indicator of cultural integration rather than transient behavioral change.

Lessons Learned from Critical Appraisal

Reviewing the four peer-reviewed articles in Module 4 provided insights into methodological rigor and the contextual sensitivity of evidence-based interventions. Studies by Erasmus et al. (2020) and Limper et al. (2021) underscored that compliance improvement depends less on technology alone and more on the integration of behavioral cues and leadership modeling. The appraisal also revealed the necessity of aligning research design with real-world constraints. Randomized control trials, though ideal for causality, often exclude complex workplace dynamics. The critical appraisal process refined understanding of how to evaluate study validity beyond statistical outcomes, considering sample diversity, implementation fidelity, and transferability. Completing the evaluation table highlighted recurring weaknesses across studies, including inconsistent baseline reporting and short follow-up periods. This awareness reinforces the need for robust data collection and longitudinal monitoring in the proposed project.

Implications for Professional Practice

Embedding evidence-based practice change within a healthcare organization requires both intellectual commitment and operational patience. The transition from evidence to action rarely follows a linear path. Behavioral inertia, resource limitations, and conflicting priorities all intervene. However, evidence-based leadership redefines accountability: it shifts focus from personal fault to system improvement. Clinicians begin to see compliance not as surveillance but as collective protection. The proposed hand hygiene initiative thus functions as both a technical and moral intervention. It reclaims the foundational principle of healthcare—first, do no harm—through measurable and reproducible action. The sustainability of such a change depends on feedback loops that reinforce professional identity and shared responsibility.

Conclusion

Recommending an evidence-based practice change requires a synthesis of empirical evidence, contextual awareness, and human factors. Hand hygiene compliance represents more than an infection control metric; it reflects the ethical and professional integrity of healthcare delivery. Through structured implementation, real-time feedback, and strategic dissemination, the proposed intervention offers a replicable model for translating research into sustained practice. The process not only reduces HAIs but strengthens organizational trust and learning capacity. Ultimately, evidence-based change functions as both a product and a process—built through data, but sustained through conviction.

References

Erasmus, V., Brouwer, W., van Beeck, E., Oenema, A., Daha, T., & Brug, J. (2020). A systematic review of hand hygiene improvement strategies: A behavioural perspective. *American Journal of Infection Control*, 48(5), 546–553. https://doi.org/10.1016/j.ajic.2019.10.003
Limper, H. M., Verweij, M., & Oosterhoff, P. (2021). Real-time feedback and monitoring to improve hand hygiene compliance: A systematic review. *Infection Control & Hospital Epidemiology*, 42(7), 832–840. https://doi.org/10.1017/ice.2020.124
McAteer, J., Stone, S., & Fuller, C. (2022). Integrating behavioral science in infection prevention: A cross-sectional study. *Journal of Hospital Infection*, 123, 94–102. https://doi.org/10.1016/j.jhin.2022.02.001
Osei-Tutu, E., Addo, R., & Gyamfi, S. (2023). Evaluating electronic monitoring interventions in hand hygiene compliance: A randomized trial. *BMC Health Services Research*, 23(1), 89–99. https://doi.org/10.1186/s12913-023-09687-4
Patel, P., & Green, K. (2019). Sustaining hand hygiene improvement: A review of leadership strategies and staff engagement. *International Journal of Nursing Studies*, 95, 91–98. https://doi.org/10.1016/j.ijnurstu.2019.03.008

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