Defining the Problem and Research Questions

The Problem

Many strategies have been implemented in the United States health care system to improve the quality of care that patients receive. Many of these strategies have been successful in improving patient outcomes. However, healthcare-acquired infections (HAIs) are still a significant issue affecting the health care system. HAIs are infections that are acquired by patients in the course of receiving surgical and medical care. There are many invasive treatment options in the current health care systems that are designed to improve the health of patients, but in some cases, they put them at the risk of acquiring various types of infections (Healthy People 2020, 2014). HAIs are a serious public health issue because they are one of the leading causes of mortality and morbidity in the United States healthcare institutions (Sievert et al., 2013). In addition to the increased rate of mortality and morbidity, HAIs have also increased the United States’ cost of health care. Therefore, there has been dire need to enhance the quality of healthcare delivery in medical institutions to minimize the rate of the infections that occur in the course of receiving treatment. Eradicating HAIs can help not only to reduce patient deaths but also to reduce the cost of healthcare. The purpose of this paper is to examine the problem of HAIs in the United States and develop a research strategy that can help to devise techniques to be used in reducing the rate of infections in the course of patient care.


The environment that is the problem is based on the healthcare setting. HAI is a population health problem that affects people who are in healthcare institutions receiving care for various other issues. HAIs may occur across multiple healthcare environments such as acute care centers, surgical centers, outpatient centers, and long-term care facilities.

Healthcare-Acquired Infections

The following is a summary of HAIs as a population health problem regarding epidemiologic factors of person, place, and time.


Every person who visits a medical institution is at the risk of acquiring an infection because this environment is usually rich in various pathogens. However, some populations have a higher risk of HAIs than others because of their unique characteristics. The elderly community is one of the population groups that have the highest risk of acquiring HAIs because of their deteriorated immune capabilities (Sievert et al., 2013). The older adults usually have a lower immune system because of the reduced capabilities of the body’s organs; hence, they stand a higher chance of them being infected by the disease-causing pathogens present in the hospital environment.


HAIs do not have a specific location of occurrence, as long as it is a healthcare facility. Cases of HAI have been reported in all the states in America. The Centers for Disease Control (CDC) tracks the HAI infection using two surveillance programs which help to record the trends and monitor the rate at which people are getting infected while receiving treatment. According to the CDC reports, at least one in every 25 patients in the healthcare setting acquire some infection originating from this environment (Umscheid et al., 2011). The most common areas where diseases are acquired are in various hospital units such as the intensive care units, and surgical centers.


Healthcare-acquired infections are not seasonal as they can be acquired at any time of the year provided that the patient is exposed to the organisms causing the infection. However, the patients tend to be a higher risk when they are undergoing procedures that increase the risk of infection such as surgical care.

Research Question/Hypothesis

Does hand washing education among healthcare workers compared to lack of hand washing education help to reduce the rate of healthcare-associated infections among the elderly population in healthcare facilities within a year?

P: Elderly population within healthcare facilities

I: hand washing education

C: lack of hand washing education

O: reduce the rate of healthcare-associated infections

T: a year

The Research Methods

Epidemiologic Study Design

The epidemiologic study design selected for this study is a case-control study. A case-control is a type of observational study that evaluates two different groups of the population, one with the intervention and the other without, to determine the differences in the outcomes based on a given causal attribute (Kleinbaum, Sullivan & Barker, 2013). These two groups which include the control group, where the intervention is not administered, and the case group where the intervention is included.

This study seeks to investigate the impact of hand washing education for nurses in a healthcare facility on reduced healthcare-acquired infections. The nurses who receive the hand washing education will be considered as the intervention group while those who do not receive the education will be the control group. It is expected that there will be a difference in the outcome of hospital-acquired infections for both groups (Friis & Sellers, 2014). This design is based on the assumption that the case group and the control group will yield different results because of the difference in the administered intervention. Therefore, this will help to determine whether nurses’ education really has an impact on reduced rates of infections on patients in the course of care.

Assessment Strategies

In this case-control study, both the case and the control groups are nurses. The only difference between the two is that the case group is expected to receive education on handwashing while the control group is not expected to receive the education on hand washing. A criterion for the inclusion of the case and the control group will be developed to ensure that the results are valid. First, the case and control groups will both come from the United States health care facilities with access to almost similar kinds of medical resources. This will help to ensure that in each facility there is a similarity with the types of risks of infections that the patients face. It will also minimize the impact of other confounding factors that could impact the rates of infections such as poor management. A group of nurses from one of the medical facilities will go through a six weeks’ education program teaching them techniques of enhancing handwashing hygiene to minimize the transfer of pathogens to the patients under their care. On the other hand, the control group will continue handling their care without receiving the education program.

Data will be collected on the rate of HAIs in both the case and the control group’s areas of work before the education program. After the education program, the data will be collected on the new rate of HAIs in the respective areas of case and control to measure the differences in the rates before and after the education program in each of the groups. The results will later be compared to show the difference between the rates before and after the education for the case group in comparison with those of the control group.

The assessment strategies that have been selected above are convenient for this study because they minimize the impact of external factors on the case and control group. The data will also be easy to collect because each of the medical facilities is expected to keep a record of the hospital-acquired infections.

Summary of Data Collection Activities

The data for this study will be collected from the databases of the respective hospital where the research will be done. Each medical facility in the United States keeps a record of the hospital-acquired infections. With the consent of the facilities included in the study, a history of the HAIs from the beginning of the study to its maturity will be collected for analysis to determine the impact of the intervention on the case group and the lack of intervention on the control group. The patient identities from the data collected will be kept private according to the HIPAA guidelines.

The data will be collected three times in the course of the research. First, the data will be collected at the beginning of the study before the education program is administered. The data will also be collected six months after the education program to assess the immediate impact that the program had on the rates of HAI infections. Lastly, the data will be collected a year after the education program to follow up on the impact of the education program after an extended period.


HAIs are significant public health problems that affect the United States health care system. Even though many strategies have been implemented to eradicate hospital infections, there is still a significantly large percentage of patients who acquire infections in the course of care. Therefore, there is a need for more research to determine new strategies that can reduce HAIs further or possibly eradicate them. This research seeks to investigate whether nurses’ education on hand washing can help to reduce infections among the elderly population in a period of one year. Case-Control study design has been recommended for this study because it will help to investigate the difference between the infection rates in the case population and the control population. If this study is successful, it can help to reduce the rates of HAIs among the elderly community in healthcare facilities, which has a higher risk than other population communities.


Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5thed.). Sudbury, MA: Jones & Bartlett.

Healthy People 2020 (2014). Healthcare-associated Infections. Retrieved from:

Kleinbaum, D. G., Sullivan, K. M., & Barker, N. D. (2013). Epidemiologic Study Designs. In ActivEpi Companion Textbook (pp. 37-66). Springer, New York, NY.

Sievert, D. M., Ricks, P., Edwards, J. R., Schneider, A., Patel, J., Srinivasan, A., … & Fridkin, S. (2013). Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infection Control & Hospital Epidemiology34(1), 1-14. Doi:

Umscheid, C. A., Mitchell, M. D., Doshi, J. A., Agarwal, R., Williams, K., & Brennan, P. J. (2011). Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mo


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