Cochrane Summaries

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Methods to improve healthcare worker hand hygiene to decrease infection in hospitals

Gould DJ, Moralejo D, Drey N, Chudleigh JH
Published Online: 
10 August 2011

Patients in hospital, nursing homes and long-term care facilities are at high risk of developing infections that they did not have before admission. Most healthcare-associated infections are spread by direct contact, especially via the hands of healthcare workers. Traditionally, hand hygiene, such as washing hands before and after touching patients, has been considered the single most important way of reducing infections. Increasingly, the use of alcohol-based hand rub is used alongside or in replacement of traditional washing with soap and water. However, compliance with hand hygiene is poor.

This updated review sought to establish whether there are effective strategies to improve hand hygiene compliance, whether such strategies are effective over short or longer term and whether increased compliance reduces healthcare-associated infections.

There were four studies, two from the original review in 2007 and two from the update, which assessed the success of campaigns to improve hand hygiene compliance. Follow-up continued for longer than 12 months in two of the studies, but none of the studies was of high quality. Success in improving hand hygiene was inconsistent among the four studies.

There is still not enough evidence to be certain what strategies improve hand hygiene compliance. Introducing alcohol-based hand rub accompanied by education/training is not enough, while using multiple strategies, including involvement of staff in planning activities or applying social marketing strategies, may be helpful. More research is needed.