Publication Date

Spring 2023

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Lisa Walker-Vischer

Second Advisor

Minal Kapoor


hand hygiene, HAIs, teaching Speak Up through AHRQ TeamSTEPPS, Auditing, Speak Up for Hand Hygiene


Background: Hand hygiene (HH) is one of the most cost-effective and simplest ways to reduce healthcare associated infections (HAIs). Incorporating Speak Up for hand hygiene enables healthcare workers (HCW) to communicate without fear when they observe noncompliance with HH requirements.
Objective: To increase HH compliance by utilizing Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS education to encourage Speak Up for HH and lead to reduction in HAIs.
Methods: The researcher provided educational training on “Speak Up for Hand Hygiene” and performed regular audits to examine its effects on one hospital unit in a California Bay Area healthcare system. A pretest/posttest was provided to measure the participants’ understanding of “Speak Up culture.” Trained auditors observed hand hygiene occurrences: entering and exiting patient care areas.
Results: The results were analyzed using a two-tailed paired sample t-test which was significant based on an alpha value of .05, t(17) = -5.43, p < .001, indicating the null hypothesis can be rejected. The results for HH compliance were statistically significant, increasing from 89.79% pre-Speak Up training to 94.71% post-intervention. A Chi-square Test of Independence was conducted, and the results showed they were independent of each other and were significant based on an alpha value of .05, χ2(1) = 4.97, p = .026.
Conclusion: The number of HAIs can be reduced by implementing Speak Up training for Hand Hygiene. Additionally, performance improvement can be sustained when leadership and the culture of the organization welcome transparency and empower Speak Up for Hand Hygiene.

Included in

Other Nursing Commons


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