Infection Control & Hospital Epidemiology (2018), 39, 1449–1456 doi:10.1017/ice.2018.262
Original Article
Interventions to improve healthcare workers’ hand hygiene compliance: A systematic review of systematic reviews
Lesley Price PhD1, Jennifer MacDonald PhD1, Lucyna Gozdzielewska BA1, Tracey Howe PhD2, Paul Flowers PhD1, Lesley Shepherd MSc3, Yvonne Watt MSc2 and Jacqui Reilly PhD1,3 1Safeguarding Health through Infection Prevention Research Group, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland,
United Kingdom, 2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom and 3Health Protection Scotland, Glasgow, Scotland, United Kingdom
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 onHCWHHC, whereas 3 reviews evaluatingmonitoring 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.
(Received 15 May 2018; accepted 10 September 2018)
Healthcare-associated infections (HAIs) have serious con- sequences for patients and healthcare systems, leading to longer hospital stays, increased mortality and morbidity, and financial burden.1,2 In Europe, ~80,000 hospital patients suffer at least 1 HAI on any given day, yielding an overall prevalence of 5.7%.3 HAIs also affect millions of patients worldwide annually.3–7 Organisms that cause HAIs can be transmitted to patients
through healthcare worker (HCW) hands contaminated by patient contact or touching the patient environment.2 Effective hand hygiene (HH) is thus critical to preventing HAIs,8 which is reflected by the emphasis on HCW compliance with HH guide- lines. Such HH guidance relates to both opportunity and tech- nique. Opportunity concerns when to do HH, and the World
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 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, MacDo- nald 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
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
Methods Protocol and registration
This systematic review followed a published protocol19 and is reported according to the PRISMA guidelines.20
Inclusion criteria Systematic reviews were included if they evaluated any inter- vention to improve HHC among HCWs. Interventions could
Health Organization (WHO) specify Five Moments.2 Technique relates to how to enact HH, with 2 main procedures inter- nationally: the Six Step2 and Three Step9 techniques. However, HCW compliance with this guidance is suboptimal.2,10–17 A major challenge within healthcare systems is how to
improve hand hygiene compliance (HHC) among HCWs. An early systematic review identified 21 primary studies evaluating HH interventions for HCWs.18 A plethora of primary studies and a growing number of systematic reviews have since assessed the effectiveness of interventions to improve HCW HHC. To assist practitioners in optimizing HHC among HCWs, this review aims to synthesize the evidence base of systematic reviews of inter- ventions to improve HCW HHC.
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