Objectives

• To assess the effectiveness of strategies designed to improve hand hygiene behaviour among healthcare workers

• To assess the barriers to hand hygiene compliance among health care professionals

Inclusion Criteria

• Interventional, observational & qualitative studies• Review articles • Editorials/letters from expert authorities • Guidelines/policy statements from expert

committees • Special lectures/discussion papers from expert

scientists • Reports from ongoing campaigns or research • conference proceedings via the conference paper

index.

Search Strategy

• Electronic databases • Medline, Cinahl, Embase and Cochrane

• Hand search – Grey literature– Conference proceedings (past 3 years)

• SHEA, ICAAC, APIC, HIS, IDSA, ECCMID

Screening

• Scanning of titles– Healthcare settings– HH related or IC precaution observations or

interventions– Knowledge, attitudes, practices related to HH

• 658 articles were reviewed by title

• Of those, 419 were kept

Abstract review

• Abstraction tool– Based upon Meade & Richardson’s recommendations– Piloted first to ensure completeness

• Two team members independently read the publications and evaluated the abstracts– target population – study design – intervention – outcomes

• Of the 419 abstracts reviewed, 162 were kept

Full article review

• Abstraction tool– Developed by the team– Piloted first to ensure completeness

• Two team members independently read the publications and evaluated the articles– More detailed info about outcome, intervention, study pop– analysis – results

• Of the 216 articles reviewed, 84 were kept

Barriers-Institutional

• Lack of sinks, alcohol rub, soap or towels • Poor accessibility to washing facilities• Skin irritation and dryness• Lack of time• Heavy workload • Lack of role models in colleagues,

superiors• Lack of administrative support

Barriers- Individual

• Lack of knowledge• Belief that glove use is enough• Belief that the risk is low for patients and self• Belief that HH interferes with providing care• Patient needs come first before HH• Forgot• Sceptical of the importance of HH

Factors associated with Hand Hygiene non-compliance that

cannot be modified

• Being a physician or nursing assistant• Male• Working in critical care• Duties with a high risk for cross-contamination• Wearing gowns or gloves• Working during the week• Number of indications for HH per hour of patient

care

Interventions

• Education• Monitoring

compliance• Performance

Feedback• Reminders

(i.e. buttons, posters)• Policy Change• Engage staff in HH

decisions

• Adding HH facilities (i.e. sinks, dispensers)

• Training• Demonstrations• Incentives• Patient involvement• Focus groups• Promote safety climate• Multimodal

Next steps

• Assess articles for methodological quality • Developing interview tools and surveys

targeting health professionals and experts in the field

• Develop a theoretical framework specific to hand hygiene that combinations models of behaviour change at the individual, inter-personal level, community and social levels.