Ask an answerable question (PICO)：
With the prevalence of the new coronavirus pneumonia (COVID-19) outbreak, hand washing is an important means of eliminating the transmission of pneumonia and basic strategy for infection control. Although staff understand the importance of hand-washing, the rate of complete hand-washing implementation is not qualification, or the Hawthorne effect was overestimated due to direct observation and monitoring of hand-washing behavior. What are the strategies to promote the concept of patient safety and zero-tolerance policy in health care to increase hand-washing completeness, to maintain healthy lifestyle and to prevent infection?
The Method and Analysis of Literature Review：
The clinical questions were analyzed and put with PICO, Population: Nurs*, Intervention: Multi* Strateg*, Outcomes: Hand Hygiene Compliance, Handwashing. (Compliance), Search databases: Cochrane library, PubMed, Embase and Aririti Library, etc., and use the limit and filers search function. This question type is treatment. The search was mainly based on SR and RCT articles, and finally three papers were included for review.
Critical Appraisal：
According to the Oxford CEBM (2011), all three papers were graded as Level 1. Using the GRADE working group evidence quality scale scoring, three papers are rated as having no upgrade factor, and the downgrading factor is the risk of bias, so the quality of evidence is reduced to "medium", the hand washing strategy was harmless, and can effectively improve the complete rate of hand washing by nursing staff. Therefore, it is clearly show the effectiveness of intervention measures, the recommended strength is "strong".
Clinical Application of Evidence：
Based on the results of the literature, we set some specific and feasible hand-washing strategies : 1) hand-washing education: film a video on hand-washing; 2) reminder mechanism: include 1) hand-washing seconds reminder song, 2) hand-washing 5-moment reminder card, 3) medicine container reminder small objects, and an evaluation mechanism to monitor the hand-washing completeness rate randomly, regularly and irregularly to prevent the Hawthorne effect.
Evaluation of Effectiveness：
The hand washing multivariate strategy intervention was conducted for 13 weeks, and the 6th surveillance was conducted. 25 nurses were collected, the hand washing completeness rate increased from 71.7% to 94.2%, and the infection rate decreased by 0.13% compared to the same period last year. The overall satisfaction rate of the hand washing strategy was 98%.
Conclusions and Recommendations：
According to the results of the empirical literature and the results of the application in this project, multiple hand-washing strategies are regarded as feasible, safe, cost-effective, non-harmful and safe for staff.
