Capstone Experience Assignment 4

Being a global health concern, nosocomial infection is a relevant topic. Factors contributing to its relevance include its impact on the general quality of life, mortality and morbidity (Ban et al., 2017). Despite various attempts to reduce the infections, the prevalence and incidences are still overwhelming. Recently, the World Health Organization projected that about 10% and 7% of all patients in developed and developing countries, respectively, will acquire at least one health-associated infection (HAI) in their lifetime (Meng et al., 2019).

The statistics have spurred worldwide efforts to reduce the occurrences of the infections. A common preventative intervention towards infections includes hand washing. Technology has been used to improve the efficacy of hand washing, such as through behavior monitoring systems (Meng et al., 2019). The paper addresses the main issue (HAI), interventions and expected outcomes in a PICO format.

Impact of Topic on Nursing Practice and Profession

Due to limited surveillance systems, the epidemiology of nosocomial infections is not well established. However, existing studies provide estimates of the burden of the infections, indicating a global health concern. The impact of the infections on nursing practice and the profession is evident. Studies have shown nearly the same 30-day mortality rate of about 10% in patients with the infections (Sikora & Zahra, 2020). Further, Sikora and Zaha (2020) note that critically ill patients tend to have an even greater mortality rate of 25% compared to other patients. The deaths cause dysphoria and demoralization of healthcare workers (Zheng et al., 2017).

Additionally, studies in German hospitals have confirmed that patients with HAI spend a lot more time in hospitals as compared to other patients (Sikora & Zahra, 2020). The prolonged hospital stay causes an increased burden on the healthcare sector and increased associated costs in managing infections (Sikora & Zahra, 2020). In the United States adult inpatient hospitals, circa $9.8 billion is estimated to be incurred in managing the infections. In addition to the associated complications, it is evident that the infections impact the nursing practice negatively. However, the subtle positive impact cannot be undermined since the burden of the infections has inspired increased efforts in the search for effective preventative strategies.

PICO Format

            The probable PICO question in this case is as follows: Does the contribution of behavior monitoring systems in hand washing, compared to direct observation methods, reduce nosocomial infections in a critical adult care unit among healthcare workers and patients? PICO is an evidence-based practice format used in framing and answering clinical questions. The P refers to the population or the problem. In this case, the issue is nosocomial infections, while the populations at risk are the healthcare workers and the patients.

I refer to the intervention in place to treat or mitigate the problem. The use of behavior monitoring innovations to improve hand hygiene adherence is the intervention studied. C is the comparison or the control intervention. In this case, a direct observation method is compared with the behavior monitoring systems. Further, O refers to the expected outcome. The intent of the interventions is to reduce the rate of nosocomial infections within the critical care unit. In this case, the PICO question helps explore the advantage behavior monitoring systems have over directly observed hand washing techniques.

According to Meng et al. (2019), direct observation is the gold standard for hand hygiene monitoring. However, it is costly and biased and the adherence or compliance rates are underwhelming. Therefore, technological innovations that are aimed at improving the adherence rates, such as behavior monitoring devices, are crucial. An example of such behavior monitoring systems include electronic sensors that counts, observe, and report hand hygiene adherence actions (Meng et al., 2019). Various studies have also proven the impact of technology in improving hand hygiene adherence and, ultimately, patient outcomes.


The quest for preventative interventions towards HAI is in progress. A commonly practiced preventative intervention includes hand washing; however, reports of adherence rates are underwhelming. To increase the efficacy of hand washing in the prevention of HAI, technology can be applied. Currently, addressed in the study are the behavior monitoring systems to improve hand washing adherence in a bid to increase the fight against nosocomial infections.


  • Ban, K., Minei, J., Laronga, C., Harbrecht, B., Jensen, E., Fry, D., Itani, K., Dellinger, E., Ko, C., & Duane, T. (2017). American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. Journal Of The American College Of Surgeons, 224(1), 59-74.
  • Meng, M., Sorber, M., Herzog, A., Igel, C., & Kugler, C. (2019). Technological innovations in infection control: A rapid review of the acceptance of behavior monitoring systems and their contribution to the improvement of hand hygiene. American Journal Of Infection Control, 47(4), 439-447.
  • Sikora, A., & Zahra, F. (2021). Nosocomial Infections. Retrieved 19 January 2021, from
  • Zheng, R., Lee, S., & Bloomer, M. (2017). How nurses cope with patient death: A systematic review and qualitative meta-synthesis. Journal Of Clinical Nursing, 27(1-2), e39-e49.