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What articles were used in this answer below
B. Theoretical/Conceptual Framework
Theoretical Framework: Using an Ecological Framework to Understand Social Systems
According to the social ecology model (SEM), a wide range of variables, including those at the individual, interpersonal, organizational, societal, and policy levels, have an impact on health outcomes. At the individual level, factors such as age, gender, and genetics can influence health. Interpersonal level factors include social support, family relationships, and intimate partner violence. Organizational factors include access to care, provider-patient communication, and continuity of care. Community level factors include socioeconomic status, community violence, and access to healthy food. Policy level factors include insurance coverage, public health policies, and regulations. Consider all of these aspects while attempting to enhance health outcomes, according to the SEM. With regard to the effectiveness of hand hygiene practices, variables such as skin-type and medical conditions might play a role. Hand hygiene requirements may be affected by interpersonal variables, such as the interaction between healthcare personnel and patients. Community level factors such as the prevalence of healthcare associated infections can influence the importance placed on hand hygiene by healthcare workers and patients. Policy level factors such as state or federal regulations can influence the hand hygiene practices of healthcare organizations. The SEM is a useful framework for understanding the many factors that can influence the efficacy of hand hygiene in preventing healthcare associated infections. By understanding the many factors that can influence hand hygiene compliance and efficacy, healthcare organizations can develop interventions that are more likely to be successful in improving hand hygiene practices and preventing healthcare associated infections.
C. Literature Review
systematic review article which focuses on the effects of handwashing under running water in comparison to using hand sanitizer. The study evaluated hand washing with water and soap was better than just using hand sanitizer. This systematic review included searches from three different databases, narrowing the articles down to 2010-2019 and using keywords such as handwashing, hand sanitizer, and effective. 22 relevant articles were found, which 17 of those were selected for systematic review. This article summarized the results of multiple studies by eliminating any errors and biasness to support the evidence presented in each article about the effects of hand washing versus just using hand sanitizer.
Searches of PubMed, CINAHL, and PsychInfo for peer-reviewed publications using the following keywords: hand hygiene, healthcare-associated illnesses, alcohol-based hand sanitizers, soap and water, and compliance were conducted. Hospital-based research from January 1, 2000 through December 31, 2016, as well as English-language studies published between those dates, were considered. The evaluation comprised a total of 21 research papers.
Studies have shown that hand hygiene is an important part of preventing healthcare associated infections (1-4). In a systematic review of the literature, it was found that hand hygiene compliance rates among healthcare workers ranged from 30-40% (5). Hand washing with soap and water has been compared against alcohol-based hand sanitizer in several trials, and the results have been mixed at best (6-8). When it comes to reducing healthcare-associated illnesses, some studies have indicated that soap and water is more effective than alcohol-based hand sanitizers (9) but others have concluded that there is no difference between them (11,12).
A number of factors have been found to influence hand hygiene compliance among healthcare workers, including individual factors such as age and gender (13-15), interpersonal factors such as the relationship between healthcare workers and patients (16-18), healthcare-associated infections (HAIs), as well as variables such as the availability of disinfectant including soap and water.
Studies that have examined the effect of interventions on hand hygiene compliance have found that interventions that focus on changing individual behavior, such as education and reminders, are less effective than interventions that focus on changing the environment, means includes making soap and water and alcohol-based hand sanitizers readily available (24-26).
D. Conclusion
Hand washing with soap and water vs alcohol-based hand sanitizers in avoiding healthcare-associated illnesses has mixed results, according to the evaluation of the literature. A number of factors have been found to influence hand hygiene compliance, including individual, interpersonal, organizational, and community level factors. When it comes to hand sanitizers, interventions that target the environment, such as simple access to soap and water, are more successful than those that target person behavior.
E. Implications for Practice
The findings of this literature review have a number of implications for practice. First, healthcare organizations should focus on changing the environment to improve hand hygiene compliance, rather than focusing on changing individual behavior. To begin with, healthcare facilities should have simple access to hand sanitizers, such as soap and water. Third, healthcare organizations should focus on improving hand hygiene compliance among all healthcare workers, not just those who work in high-risk areas.

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