Improving hand hygiene in community settings: a scoping review of current international guidelines

Abstract

Background: Hand hygiene is an important measure to prevent disease transmission in community settings, such as households, public spaces, workplaces, and schools. There exist various international guidelines with recommendations on how to improve hand hygiene in these settings, but no review to date has been conducted to summarise these recommendations and assess to what extent they are consistent and evidence-based. Methods: To identify international guidelines with recommendations on hand hygiene in community settings, categorised as either domestic, public, and institutional, we performed electronic and grey literature searches and contacted expert organisations and individuals. Recommendations extracted from included guidelines were mapped to four areas related to hand hygiene: i) effective hand hygiene; ii) minimum requirements; iii) behaviour change; and iv) government measures. We assessed if recommendations were supported by peer-reviewed literature and checked their consistency and concordance across settings. Results: We identified 51 guidelines published between 1999 and 2021 by multilateral agencies and international non-governmental organisations containing 923 recommendations. Handwashing with soap is consistently recommended as the preferred method for hand hygiene across all community settings. Most guidelines specifically recommend handwashing with plain soap and running water for at least 20 seconds; single-use paper towels for hand drying; and alcohol-based hand rub (ABHR) as a complement or alternative to handwashing. There are inconsistent and discordant recommendations for water quality for handwashing, affordable and effective alternatives to soap and ABHR, and the design of handwashing stations. Further, there are gaps in recommendations on soap and water quantity, behaviour change approaches, and government measures required for effective hand hygiene. Overall, less than 10% of recommendations are supported by evidence. Conclusion: While current international guidelines consistently recommend handwashing with soap in domestic, public, and institutional settings, the lack of consistent, evidence-based recommendations may constrain global efforts to ensure effective hand hygiene across community settings.

Current international tools and guidance for the implementation of hand hygiene recommendations in community settings: a scoping review

“…The public setting also includes spaces that vulnerable populations, such as people experiencing homelessness, may occupy. Institutional settings include the workplace, schools and universities, places of worship, and prisons and places of detention (12).…”

“…While clear and robust recommendations developed by the World Health Organization (WHO) exist for hand hygiene in health care settings, there are gaps in global normative guidance on hand hygiene in settings where health care is not routinely delivered (12). A recent scoping review of current international guidelines for hand hygiene in community settings – categorised as non-healthcare settings – highlighted a lack of consistent and evidence-based recommendations across four key areas: (1) what constitutes effective hand hygiene, (2) minimum requirements for practicing hand hygiene, (3) effective behaviour change approaches to sustain hand hygiene, and (4) the role of government (12). As part of its mandate to address demand for guidance on public health topics where there is uncertainty and demand from governments, WHO is developing Guidelines for hand hygiene in community settings, with a series of systematic reviews underway to inform this effort (13).…”

Recommendations for hand hygiene in community settings: a scoping review of current international guidelines

“…Our review is described according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)26 and a PRISMA-ScR checklist is included in the online supplemental table A1. The protocol was preregistered with OSF Registries 27…”

How can global guidelines support sustainable hygiene systems?

“…Government action on hand hygiene in community settings is constrained by a lack of consistent, evidence-based and internationally agreed upon global guidance 8. Forthcoming global guidelines will provide evidence-based recommendations on when, how and with what hand hygiene should be practised in community settings for effective protection against infectious diseases.…”