A Systematic Review of Hand Hygiene Practices Among Healthcare Workers Worldwide and Policy Implications

Objectives: We systematically reviewed qualitative research exploring healthcare workers’ perspectives regarding interpersonal, socio-environment, and health system factors associated with hand hygiene compliance, and discussed policy implications.

Methods: We searched five computer-based literature indexes - Medline (PubMed), PSYCINFO, CINAHL, EMBASE, and Web of Science Core Collection to identify relevant peer-reviewed publications. We used the Critical Appraisals Skills Programme to evaluate the quality of research. We extracted, synthesized, and meta-summarized themes to integrate the interpretations for better practice.

Results: Use of individual criteria was more likely than hand hygiene guidelines. Lack of resources was a greater barrier in developing countries. Self-protection motivated higher compliance than reducing cross infection. Among new healthcare workers, work-site norm had more influence on compliance than previous training or education. Positive peers, supervisors, role models, and regular audits or performance feedback facilitated long-term compliance.

Conclusions: Achieving optimal hand hygiene compliance is a complex challenge that benefits from developing a positive practice norm. Adequate infection control policy or resource planning could improve population health at healthcare facilities worldwide.