DIKW Model: Hand Hygiene and Infections

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Hand Hygiene

While working with patients, I am required to follow the rules regarding appropriate hand hygiene. In particular, it is required to wash hands with soap and water and use alcohol-based solutions for hand hygiene (Chatfield, Nolan, Crawford, & Hallam, 2016). I was always wondering whether these rules are useful for clinical practice. Thus, this paper is dedicated to the use of data/information/knowledge/wisdom model to answer the question whether the use of proper hang hygiene decreases the number of hospital-associated infections.

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Hand Hygiene in Nursing Practice

Hand hygiene is highly important in nursing practice. This procedure allows preventing hospital-associated infections among patients (Chatfield et al., 2016). Center for Disease Control and Prevention (CDC, 2018) provided clear recommendations on hand hygiene for healthcare workers. According to these recommendations, there are two methods of hand hygiene: washing hands with soap and water and using alcohol-based agents. In general, washing hands with antibacterial soap and water should be used if visible signs of dirtiness are present, after suspected exposure to Clostridium difficile, Bacillus anthracis, or norovirus, after visiting restroom, and before consuming the food. The use of alcohol-based solutions for hand hygiene is required before and after direct contact with patient or organism fluid and before donning sterile gloves (CDC, 2018). Thus, strict rules for hand hygiene of healthcare practitioners are provided.

Research Question

Based on these recommendations, one can develop the research question. The question is the following: does proper nursing hand hygiene decrease the rate of in-hospital infections? The purpose of the question is to understand whether the current requirements for hand hygiene are useful. If one found the confirmation of the importance of these rules, he/she would follow the procedure with understanding of its necessity and having wisdom regarding this issue. For answering the research question, data/information/knowledge/wisdom (DIKW) continuum model can be applied.

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Data/Information/Knowledge/Wisdom Model

DIKW model is widely used in nursing information technologies. The model was developed by Graves and Corcoran with the purpose to support nursing practice with information technologies. According to authors, healthcare practitioners should proceed through data, information, knowledge, and wisdom steps in patients care. Moving in this direction help nursing to gai data, integrate them into the information, obtain knowledge, and, finally, develop wisdom regarding any particular question and issue of practice. Importantly, it is not easy to strictly separate each stage. All four steps should be considered as one-direction flow from data to wisdom (Ronquillo, Currie, & Rodney, 2016). DIKW model can be applied for investigation of the usefulness of hand hygiene rules for improving patients’ safety and decreasing hospital-associated infections.


Data stage is in the base of this conceptual framework. Data can be considered as simple facts without interpretation. These facts can be obtained from observation for patients or from literature search (Ronquillo et al., 2016). In particular, data can be used for searching the information. Data are the key words and known problem related to the investigated question. Specific key words are “hand hygiene,” “antibacterial soap,” “alcohol-based agents,” and “hospital-associated infections.” The last one is the crucial problem of my research inquiry.


Information is the second step of DIKW conceptual model. It can be described as interpreted data. After interpretation, the data can be used in the practice. These key words for searching in the following medical databases were used: PubMed, CINAHL, and Cochrane Library. Search results are papers related to the topic investigated. It is possible to gain the information from these papers and to obtain new knowledge. The search in stated databases provided multiple resources related to the topic investigated. In particular, nearly 2,000 of peer-reviewed journal articles, case studies, and clinical trials were found after searching in CINAHL database, nearly 800 papers were found while searching in PubMed database, and five literature reviews were indicated in the search in Cochrane Library database. Only full-text articles published within five years were included in the search. The information from these papers can be used for developing knowledge related to the nursing practice.


Knowledge can be determined as the information synthesized from different sources with the purpose to answer the practice-related question. In other words, knowledge is the information organized in the structure (Ronquillo et al., 2016). In relation to the stated question, it is important to determine whether there is enough of information and whether different sources of information provides pieces of evidence that create a consistent picture. Multiple sources provide the consistent knowledge on the effectiveness of hand hygiene for reducing in-hospitals infections. For instance, the study of McCall et al. (2016) revealed that introducing the automate hand hygiene compliance system led to the decrease of catheter-associated infections in patients. It was also found that the use of hand-hygiene protocol decreased hospital-associated respiratory infections (Finco et al., 2018) and Staphylococcus aureus infection (Grayson et al., 2018). Thus, these studies as well as other indicated researches provide the knowledge that the use of hand hygiene protocol reduces different hospital-associated infections. Based on this knowledge, nursing wisdom can be developed.

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According to the DIKW model, wisdom is the appropriate use of knowledge. It means that a nurse should be capable to recognize the situation where obtained knowledge should be applied and used them in patients care (Ronquillo et al., 2016). In relation to the stated research question, wisdom is the use of standard hand-hygiene protocol determined by the CDC (2018). The wisdom is that after conducting the research, I understand that this protocol is useful for patients safety. Thus, I will applied hand hygiene in patients care with the full awareness of the procedure importance.


Nursing informatics provides the effective approach for developing nursing wisdom. The approach is the DIKW model that can be applied for answering various research questions related to nursing practice. I applied this model for answering the following research question: does proper nursing hand hygiene decrease the rate of in-hospital infections? I used the key words and care-related problem (data) for developing the search request in medical databases and obtaining pieces of evidence from peer-reviewed journals (information). I synthesized the obtained information and determined whether it is consistent to obtain knowledge related to the research question. Based on this knowledge, I developed nursing wisdom related to the practice. According to this wisdom, hand hygiene protocol is useful for decreasing hospital-associated infections and should be applied in patients care.

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