Note: The following synopsis is derived mainly from Chapter 8: Brief Update Review on Interventions To Improve Hand Hygiene Compliance, from the Agency for Healthcare Research and Quality document “Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices” (AHRQ 2013).
Epidemiologic evidence supports that hand hygiene reduces the transmission of health care associated pathogens and the incidence of health care associated infections (HCAI), but the link between hand hygiene and improvements in HCAI is hard to prove definitely in modern-day health care. Nevertheless, the importance of hand hygiene is universally acknowledged by organizations such as the World Health Organization (WHO) and national bodies responsible for ensuring patient safety and quality of care.
In the last ten years, two major systematic reviews on this topic have been published: one review investigated the impact of interventions on hand hygiene compliance in the hospital setting (Gould et al 2010), while the other addressed the relationship between hand hygiene interventions and the incidence of HCAI in acute and long-term care settings (Backman et al 2008).
The 2010 Cochrane systematic review by Gould et al (an update of a 2007 review) included four studies reporting indicators of hand hygiene compliance e.g. by direct observation and proxy indicators such as product use. Two studies evaluated simple education initiatives; one study presented three separate interventions within the same paper (simple substitutions of product with alcohol-based hand rub and two multifaceted campaigns); the fourth study presented two separate multifaceted campaigns. Three of the four studies showed a significant impact of the interventions on hand hygiene compliance. The authors conclude that although multifaceted campaigns with social marketing or staff involvement appear to have an effect, there is insufficient evidence to draw a firm conclusion regarding which interventions are most effective.
The review by Backman et al from 2008 included studies with multimodal hand hygiene initiatives, the introduction of alcohol sanitizers, the implementation or changes of the infection control practices or infection control policies, and other organizational interventions. Eighteen of 31 included studies reported a statistically significant reduction in HCAI with the intervention compared with the control group; some studies also contained other factors that may have influenced the reductions in HCAI. The authors conclude that there is a lack of rigorous evidence linking specific hand hygiene interventions with the prevention of HCAI.
In summary, although there is evidence that improved hand hygiene through multimodal implementation strategies can increase the compliance of health care workers and reduce infection rates, high quality evidence demonstrating the relative effectiveness of specific hand hygiene interventions is lacking.