Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review

Abstract

Background: There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. Aim: This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcareassociated infections using hand hygiene. Methods: CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. Findings: Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multimodal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the 'Five Moments'. However, recording of hand hygiene technique was not common. Conclusion: Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.

Compliance with hand disinfection in the surgical area of an orthopedic university clinic: results of an observational study

“…While we, like others [ 1 , 2 ], did observe higher compliance for nurses than for physicians, the differences across the medical specialties involved, i.e., anesthesia versus surgery, were considerably larger. Anesthesia staff had higher compliance than surgical staff, especially among physicians.…”

“…Hand hygiene (HH) using alcoholic hand rub solution is one of the most important measures to prevent nosocomial infections, including surgical site infections and transmission of pathogens (e.g., multidrug resistant bacteria) in hospitals, but implementation is not easy in practice [ 1 , 2 ]. Compliance with surgical hand disinfection before putting on sterile gloves just prior to surgery is high and a routinized part of professional surgical practice [ 3 ].…”

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

“… 46 However, it is precisely that the observation and monitoring of HHC itself cannot achieve relative consistency and is affected by whether the monitors are professionally trained, the personal observation bias of the monitors. 47 , 48 , 49 The state of the World's HAND HYGIENE documented that there is also growing interesting in electronic monitoring, focused on the point of care, as reliable systems are developed. 50 In addition, the manual monitoring of HH also costs a certain amount of manpower, and it cannot be systematic and sustainable.…”

“…Healthcare-associated infections (HAIs) have had a negative impact on insurers and health systems globally due to prolonged hospitalization days, as well as increased hospitalization expenses, disease burdens, and waste of health resources. 1 , 2 The additional total medical expenditure per HAI-Antimicrobial resistance inpatient was US$15,557.25 compared with that of the non-HAIs, and the additional length of per hospital stay of the HAI-Antimicrobial resistance inpatient was 41 days compared with that of the non-HAIs in China. 3 It has been well established that hand hygiene (HH) is a cost-effective measure to reduce HAIs.…”

Antimicrobial Photodynamic Coatings Reduce the Microbial Burden on Environmental Surfaces in Public Transportation - a Field Study in Buses

“…In health care settings, clear evidence exist that contaminated human hands are a major vehicle for germs to inanimate surfaces [23,24]. Nevertheless, even in health care the compliance of hand hygiene and surface cleaning is not sufficient [25,26].…”