Interventions to improve patient hand hygiene: a systematic review

Abstract

Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes.

Hand hygiene practices amongst patients

“…This study emphasises that there is a persisting different attitudinal perception among patients and nursing staff. Based on the findings of Srigley et al's systematic review, 17 there is a need for study designs that are more rigorous. This study, while only a descriptive study, builds on this body of work as there is a scarcity of literature on hand hygiene studies with patients at the core.…”

“…A recent systematic review conducted by Srigley et al 17 reported successful hand hygiene interventions in patients and health care workers. Their findings emphasise a lack of rigor in the study design of the 10 studies that were included in their review.…”

“…A recommendation by Srigley et al, 17 based on most of the patient interventions studies included in their review (n=7), was that ongoing education and training about the importance and compliance to hand hygiene practices and recognising the five moments for both patients and the nursing staff is necessary for creating lasting change that will curb the increase in hospital related infections.…”

“…Another issue that was found was that self-reporting may lead to an overestimation of real behaviour, which has been reported in Srigley et al 17 There were difficulties in the recruitment of nurses to complete surveys as is the common issue among researchers conducting research with nurses. 18 Given the small sample size, a follow up attempt was not fruitful so the researchers decided to distribute the surveys through the wards Nurse Unit Managers and getting the Nurse Unit Managers to request their nursing staff to complete the surveys.…”

Patient Hand Colonization With MDROs Is Associated with Environmental Contamination in Post-Acute Care

“…8 Building on patient hand hygiene as a concept for infection control, future studies should focus on well-designed trials with patient hand hygiene interventions, measures of pathogen colonization and infection, and what role patient hands may have in self-inoculation.…”