Hand hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review.

Summary 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 COVID-19 pandemic has further emphasized the need for global improvement in healthcare worker hand hygiene compliance. 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 for reduction of healthcare-associated infections using hand hygiene. Methods We searched CINAHL, Cochrane, EMbase, Medline, Pubmed, and Web of Science databases for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare professionals. From these searches, a total of 332 papers were identified of which 57 studies met criteria. Findings Forty-five of the 57 studies (79%) included were conducted in Asia, Europe and the USA. A large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses were the largest group of healthcare workers studied followed by physicians, represented in 44 (77%) and 41 (72%) studies, respectively. Thirty-six studies (63%) adopted the World Health Organisation multimodal framework or a variation of it, and many of these recorded hand hygiene opportunities at each of the five moments, although recording of hand hygiene technique was not common. Conclusion Both single intervention and multimodal hand hygiene strategies can achieve modestto moderate improvements in hand hygiene compliance among healthcare workers.