Skip to main content Accessibility help
×
Home

Interventions to improve healthcare workers’ hand hygiene compliance: A systematic review of systematic reviews

  • Lesley Price (a1), Jennifer MacDonald (a1), Lucyna Gozdzielewska (a1), Tracey Howe (a2), Paul Flowers (a1), Lesley Shepherd (a3), Yvonne Watt (a2) and Jacqui Reilly (a1) (a3)...

Abstract

Objective

To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC).

Methods

PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed.

Results

Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness.

Conclusions

This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.

Copyright

Corresponding author

Author for correspondence: Lesley Price, Safeguarding Health through Infection Prevention Research Group, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK. E-mail: L.Price@gcu.ac.uk

Footnotes

Hide All

PREVIOUS PRESENTATION: Results based on a search of the literature up to June 2016 were presented on September 19, 2017, at the Annual Conference of the Infection Prevention Society, held in the Manchester Central Convention Complex, England, United Kingdom. This presentation resulted in the following abstract: Price L, MacDonald J, Gozdzielewska L, et al. An overview of systematic reviews of interventions designed to improve healthcare workers’ hand hygiene compliance. J Infect Prev 2017;18:S56–S57.

Cite this article: Price L, et al. (2018). Interventions to improve healthcare workers’ hand hygiene compliance: A systematic review of systematic reviews. Infection Control & Hospital Epidemiology 2018, 39, 1449–1456. doi: 10.1017/ice.2018.262

Footnotes

References

Hide All
1. Marchetti, A, Rossiter, R. Economic burden of healthcare-associated infection in US acute care hospitals: societal perspective. J Med Econ 2013;16:13991404.
2. World Health Organization. WHO guidelines on hand hygiene in health care. World Health Organization website. http://www.who.int/gpsc/5may/tools/9789241597906/en/. Published 2009. Accessed January 11, 2018.
3. European Centre for Disease Prevention and Control. Summary: Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. European Centre for Disease Prevention and Control website. https://ecdc.europa.eu/sites/portal/files/media/en/healthtopics/Healthcare-associated_infections/point-prevalence-survey/Documents/healthcare-associated-infections-antimicrobial-use-PPS-summary.pdf. Published 2009. Accessed January 11, 2018.
4. Allegranzi, B, Nejad, SB, Combescure, C, et al. Burden of endemic health-care-associated infection in developing countries: SYSTEMATIC review and meta-analysis. Lancet 2011;377:228241.
5. Cassini, A, Plachouras, D, Eckmanns, T, et al. Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med 2016;13:e1002150.
6. Ling, ML, Apisarnthanarak, A, Madriaga, G. The burden of healthcare-associated infections in Southeast Asia: a systematic literature review and meta-analysis. Clin Infect Dis 2015;60:16901699.
7. Nejad, SB, Allegranzi, B, Syed, SB, Ellis, B, Pittet, D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ 2011;89:757765.
8. Allegranzi, B, Pittet, D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009;73:305315.
9. Boyce, JM, Pittet, D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep 2002;51:145.
10. Arias, AV, Garcell, HG, Ochoa, YR, Arias, KF, Miranda, FR. Assessment of hand hygiene techniques using the World Health Organization’s six steps. J Infect Public Health 2016;9:366369.
11. Erasmus, V, Daha, TJ, Brug, H, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283294.
12. Laustsen, S, Lund, E, Bibby, BM, Kristensen, B, Thulstrup, AM, Møller, J. Effect of correctly using alcohol-based hand rub in a clinical setting. Infect Control Hosp Epidemiol 2008;29:954956.
13. Park, H, Kim, S, Lim, Y, et al. Assessment of the appropriateness of hand surface coverage for healthcare workers according to World Health Organization hand hygiene guidelines. Am J Infect Control 2014;42:559561.
14. Reilly, JS, Price, L, Lang, S, et al. A pragmatic randomized controlled trial of 6-step vs 3-step hand hygiene technique in acute hospital care in the United Kingdom. Infect Control Hosp Epidemiol 2016;37:661666.
15. Thivichon-Prince, B, Barsotti, O, Girard, R, Morrier, J. Hand hygiene practices in a dental teaching center: measures and improve. Eur J Dent 2014;8:481486.
16. Tschudin-Sutter, S, Sepulcri, D, Dangel, M, Schuhmacher, H, Widmer, AF. Compliance with the world health organization hand hygiene technique: a prospective observational study. Infect Control Hosp Epidemiol 2015;36:482483.
17. Widmer, AF, Conzelmann, M, Tomic, M, Frei, R, Stranden, AM. Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infect Control Hosp Epidemiol 2007;28:5054.
18. Naikoba, S, Hayward, A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers: a systematic review. J Hosp Infect 2001;47:173180.
19. Currie, K, Duguid, C, Flowers, P, et al. An overview of systematic reviews and meta-analyses of interventions designed to improve healthcare workers’ hand hygiene compliance. York: PROSPERO 2016 CRD42016040027. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016040027. Published 2016. Accessed January 11, 2018.
20. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264269.
21. Price, L, MacDonald, J, Melone, L, et al. Effectiveness of national and sub-national infection prevention and control interventions in high and upper-middle income countries: outcomes of a systematic literature review. Lancet Infect Dis 2018;18:e159e171.
22. Search filters. Edinburgh: Scottish Intercollegiate Guidelines Network website. http://www.sign.ac.uk/methodology/filters.html. Published 2013. Accessed January 11, 2018.
23. Whiting, P, Savović, J, Higgins, JP, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol 2016;69:225234.
24. Popay, J, Roberts, H, Sowden, A, et al. Guidance on the conduct of narrative synthesis in systematic reviews. ESRC Research Methods Programme website. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.178.3100&rep=rep1&type=pdf. Published 2006. Accessed January 11, 2018.
25. Cherry, MG, Brown, JM, Bethell, GS, Neal, T, Shaw, NJ. Features of educational interventions that lead to compliance with hand hygiene in healthcare professionals within a hospital care setting. A BEME systematic review: BEME Guide No. 22. Med Teach 2012;34:e406e420.
26. Doronina, O, Jones, D, Martello, M, Biron, A, Lavoie-Tremblay, M. A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. J Nurs Scholarsh 2017;49:143152.
27. Gould, DJ, Moralejo, D, Drey, N, Chudleigh, JH, Taljaard, M. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2017;9:CD005186.
28. Huis, A, van Achterberg, T, de Bruin, M, Grol, R, Schoonhoven, L, Hulscher, M. A systematic review of hand hygiene improvement strategies: a behavioural approach. Implement Sci 2012;7:92.
29. Kingston, L, O’Connell, NH, Dunne, CP, O’Connell, NH. Hand hygiene-related clinical trials reported since 2010: a systematic review. J Hosp Infect 2016;92:309320.
30. Luangasanatip, N, Hongsuwan, M, Limmathurotsakul, D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ 2015;351:h3728.
31. Mitchell, MD, Betesh, J, Ravitz, N, Runyan, D, Umscheid, CA. Automated Hand Hygiene Monitoring Systems. Philadelphia, PA: Center for Evidence-based Practice, 2014.
32. Neo, JRJ, Sagha-Zadeh, R, Vielemeyer, O, Franklin, E. Evidence-based practices to increase hand hygiene compliance in health care facilities: an integrated review. Am J Infect Control 2016;44:691704.
33. Ofek Shlomai, N, Rao, S, Patole, S. Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2015;34:887897.
34. Picheansathian, W. A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. Int J Nurs Pract 2004;10:39.
35. Ranji, SR, Shetty, K, Posley, KA, et al. Prevention of Healthcare-Associated Infections. Vol 6 of Shojania KG, McDonald KM, Wachter RM, and Owens DK (editors). Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Technical Review 9 (Prepared by the Stanford University-UCSF Evidence-based Practice Center under Contract No. 290-02-0017). AHRQ Publication No. 04(07)-0051-6. Rockville, MD: Agency for Healthcare Research and Quality, 2007. https://www.ahrq.gov/downloads/pub/evidence/pdf/qualgap6/hainfgap.pdf. Published 2007. Accessed January 11, 2018.
36. Ritchie, K, Iqbal, K, Macpherson, K, Riches, E, Stout, A. The provision of alcohol based products to improve compliance with hand hygiene. Healthcare Improvement Scotland website. http://www.healthcareimprovementscotland.org/previous_resources/hta_report/hta_7.aspx. Published 2005. Accessed January 11, 2018.
37. Stout, A, Ritchie, K, Macpherson, K. Clinical effectiveness of alcohol-based products in increasing hand hygiene compliance and reducing infection rates: a systematic review. J Hosp Infect 2007;66:308312.
38. Schweizer, ML, Reisinger, HS, Ohl, M, et al. Searching for an optimal hand hygiene bundle: A meta-analysis. Clin Infect Dis 2014;58:248259.
39. Srigley, JA, Corace, K, Hargadon, DP, et al. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. J Hosp Infect 2015;91:202210.
40. Srigley, JA, Gardam, M, Fernie, G, Lightfoot, D, Lebovic, G, Muller, MP. Hand hygiene monitoring technology: a systematic review of efficacy. J Hosp Infect 2015;89:5160.
41. Stiller, A, Salm, F, Bischoff, P, Gastmeier, P. Relationship between hospital design and healthcare-associated infection rates: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2016;5:51.
42. Vindigni, SM, Riley, PL, Jhung, M. Systematic review: handwashing behaviour in low- to middle-income countries: outcome measures and behaviour maintenance. Trop Med Int Health 2011;16:466477.
43. Ward, MA, Schweizer, ML, Polgreen, PM, Gupta, K, Reisinger, HS, Perencevich, EN. Automated and electronically assisted hand hygiene monitoring systems: a systematic review. Am J Infect Control 2014;42:472478.
44. Cheung, A, Weir, W, Mayhew, A, Kozloff, N, Brown, K, Grimshaw, J. Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior. Syst Rev 2012;1:36.
45. Lorimer, K, Kidd, L, Lawrence, M, McPherson, K, Cayless, S, Cornish, F. Systematic review of reviews of behavioural HIV prevention interventions among men who have sex with men. AIDS Care 2012;25:133150.
46. Cochrane Effective Practice and Organisation Care. What study designs should be included in an EPOC review and what should they be called? EPOC Resources for review authors website. http://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/Resources-for-authors2017/what_study_designs_should_be_included_in_an_epoc_review.pdf. Published 2017. Accessed January 11, 2018.
47. Chudleigh, J, Drey, N, Moralejo, D, Gould, DJ. Systematic reviews of hand hygiene in patient care post 2010. J Hosp Infect 2016;94:110111.
48. Cochrane Effective Practice and Organisation Care. Suggested risk of bias criteria for EPOC reviews. EPOC Resources for review authors website. http://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/Resources-for-authors2017/suggested_risk_of_bias_criteria_for_epoc_reviews.pdf. Published 2107. Accessed January 11, 2018.
49. Zingg, W, Castro-Sanchez, E, Secci, FV, et al. Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS). Public Health 2016;133:1937.
50. Wells, GA, Shea, B, O’Connell, D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. University of Ottawa website. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp Published 2000. Accessed January 11, 2018.
51. Jadad, AR, Moore, RA, Carroll, D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:112.
52. Rosella, L, Bowman, C, Pach, B, Morgan, S, Fitzpatrick, T, Goel, V. The development and validation of a meta-tool for quality appraisal of public health evidence: meta Quality Appraisal Tool (MetaQAT). Public Health 2016;136:5765.
53. Anderson, LA, Sharpe, PA. Improving patient and provider communication: A synthesis and review of communication interventions. Patient Educ Couns 1991;17:99134.
54. Downs, SH, Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377384.
55. Higgins, JPT, Altman, DG, Sterne, JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0 (updated March 2011). The Cochrane Collaboration website. http://handbook.cochrane.org/ Published 2011. Accessed January 11, 2018.
56. Systematic reviews: CRD’s guidance for undertaking reviews in healthcare. Centre for Reviews and Dissemination website. http://www.york.ac.uk/crd/guidance/. Published 2009. Accessed January 11, 2018.
57. Higgins, JPT, Green, S. Cochrane handbook for systematic reviews of interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration website. http://handbook.cochrane.org/. Published 2011. Accessed January 11, 2018.
58. SIGN 50: A guideline developer’s handbook. Edinburgh: Scottish Intercollegiate Guidelines Network website. http://www.sign.ac.uk/sign-50.html. Published 2015. Accessed January 11, 2018.
59. Michie, S, West, R. Behaviour change theory and evidence: a presentation to Government. Health Psychol Rev 2013;7:122.
60. NICE guidelines PH49 Behaviour change: Individual approaches (Recommendation 10 Ensure behaviour change is maintained for at least a year). National Institute for Health and Care Excellence website. https://www.nice.org.uk/guidance/ph49/chapter/1-recommendations#recommendation-10-ensure-behaviour-change-is-maintained-for-at-least-a-year. Published 2014. Accessed January 11, 2018.
Type Description Title
WORD
Supplementary materials

Lesley Price et al. supplementary material
Lesley Price et al. supplementary material 1

 Word (69 KB)
69 KB

Interventions to improve healthcare workers’ hand hygiene compliance: A systematic review of systematic reviews

  • Lesley Price (a1), Jennifer MacDonald (a1), Lucyna Gozdzielewska (a1), Tracey Howe (a2), Paul Flowers (a1), Lesley Shepherd (a3), Yvonne Watt (a2) and Jacqui Reilly (a1) (a3)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed