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 healthcare-associated 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 multi-modal 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.