A systematic review of hand hygiene improvement strategies: a behavioural approach

Abstract

BackgroundMany strategies have been designed and evaluated to address the problem of low hand hygiene (HH) compliance. Which of these strategies are most effective and how they work is still unclear. Here we describe frequently used improvement strategies and related determinants of behaviour change that prompt good HH behaviour to provide a better overview of the choice and content of such strategies.MethodsSystematic searches of experimental and quasi-experimental research on HH improvement strategies were conducted in Medline, Embase, CINAHL, and Cochrane databases from January 2000 to November 2009. First, we extracted the study characteristics using the EPOC Data Collection Checklist, including study objectives, setting, study design, target population, outcome measures, description of the intervention, analysis, and results. Second, we used the Taxonomy of Behavioural Change Techniques to identify targeted determinants.ResultsWe reviewed 41 studies. The most frequently addressed determinants were knowledge, awareness, action control, and facilitation of behaviour. Fewer studies addressed social influence, attitude, self-efficacy, and intention. Thirteen studies used a controlled design to measure the effects of HH improvement strategies on HH behaviour. The effectiveness of the strategies varied substantially, but most controlled studies showed positive results. The median effect size of these strategies increased from 17.6 (relative difference) addressing one determinant to 49.5 for the studies that addressed five determinants.ConclusionsBy focussing on determinants of behaviour change, we found hidden and valuable components in HH improvement strategies. Addressing only determinants such as knowledge, awareness, action control, and facilitation is not enough to change HH behaviour. Addressing combinations of different determinants showed better results. This indicates that we should be more creative in the application of alternative improvement activities addressing determinants such as social influence, attitude, self-efficacy, or intention.

A qualitative study of senior hospital managers¿ views on current and innovative strategies to improve hand hygiene

“…However, despite the widely recognised importance of hand hygiene, considerable investment by governments, organisations and health facilities, and that hand-hygiene is a relatively simple act particularly with the availability of agents such as alcohol hand-rub, health care workers' compliance with best practice has historically been variable (<40% to approximately 80% on average internationally) [10][11][12]. While research has been conducted in recent years to identify the most effective strategies for improving hand hygiene compliance [13,14], a systematic review concluded that there is a dearth of high quality, robust evidence demonstrating which interventions are the most effective for improving and sustaining hand hygiene compliance [13]. Furthermore, "there remains an urgent need to undertake methodologically robust research" [13].…”

Breaking a Guinness World Record on Hand Sanitizing Relay, initiating a call for vital research in overcoming campaign fatigue for hand hygiene

“…Another review by Huis et al reported in 2012 was conducted but with a focus on classifying the improvement activities based on their determinants of behavior change 7 . It was stated in the review that the criteria for inclusion were not as stringent as Gould et al 6 but rather the standards of Anderson and Sharpe were used 8 .…”

Systematic reviews of hand hygiene in patient care post 2010

“…It is likely that this The review provides a useful descriptive account of the geographical locations and clinical settings of the included studies. In line with the findings of previous reviews (3,6,7), the selected studies focus primarily on hand hygiene practices of nurses, doctors and healthcare assistants, highlighting a continuing omission of other health care…”