Additional exclusions were articles that examined surgical scrubs as their aims

Additional exclusions were articles that examined

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involving acute care such as schools, primary care clinics or community centers. Additional exclusions were articles that examined surgical scrubs, as their aims are different from routine hand hygiene practices. The search initially resulted in 98 articles. After removing duplicates, reviewing references, and screening for included and excluded criteria, nine articles resulted for this review (See Appendix A). Seven were systematic reviews and two were randomized control trials (RCTs). These articles represent approximately 1421 studies on hand hygiene interventions .
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12 Running Head: EVIDENCE-BASED PRACTICE PROPOSAL Summary of Results Key findings from the nine articles used in this review is that all agree multi-modal interventions for hand hygiene can improve compliance among healthcare staff in an acute care setting. However, the reduction in HAIs after multi-modal hand hygiene interventions is less clear. All nine articles in this review provide evidence supporting the implementation of multimodal interventions to improve hand hygiene compliance. The most common combinations of multimodal interventions in these articles include: leadership, education, visual cues, feedback, and proper hand hygiene product placement. Summary of Studies 1. Alshehari, et al. (2016). This is a systematic review has an evidence level of 1. The aim was to identify effective interventions to increase hand hygiene compliance among intensive care unit (ICU) staff. Of the 14 articles included, all were peer-reviewed and reliable sources. The study provided internal validity as they all agree that multi-modal interventions are effective in raising hand hygiene compliance to a certain point (51.5%- 80.1%), but not to the desire standard of 100%. The results were measurable. Participants were random adults working in the ICU. Studies varied by design, setting, and sample size with common interventions making the study externally valid. 2. Doronina et al. (2016). The purpose of this systematic review was to identify interventions that improve hand hygiene compliance among staff in a hospitals. Evidence level of 1. 303 articles were screened for eligibility and reliability, six were included and an assessment of risk of bias to ascertain internal and external validity was performed. Results were measured before and after interventions and were markedly improved. Participants were random and blind, studies varied in design, setting, interventions and sample size. All articles agreed that multi-modal interventions did improve hand hygiene practices.
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13 Running Head: EVIDENCE-BASED PRACTICE PROPOSAL 3. Schweizer et al. (2014). This systematic review’s purpose was to evaluate existing bundles of interventions and identify high-quality studies. Evidence level is 1. 8148 studies were evaluated and 91 were included that contained control groups, measurable data on hand hygiene compliance and interventions implemented for improved hand hygiene. All studies agree that bundled interventions increase compliance of hand hygiene and include education, reminders and feedback.
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