Interventions to improve healthcare workers’ hand hygiene compliance: a systematic review of systematic reviews

Lesley Price*, Jennifer Macdonald, Lucyna Gozdzielewska, Tracey Howe, Paul Flowers, Lesley Shepherd, Yvonne Watt, Jacqui Reilly

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

22 Citations (Scopus)
325 Downloads (Pure)


To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC).

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.

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 on HCW HHC, whereas 3 reviews evaluating monitoring 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.

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.
Original languageEnglish
Pages (from-to)1449-1456
Number of pages8
JournalInfection Control and Hospital Epidemiology
Issue number12
Early online date11 Dec 2018
Publication statusPublished - Dec 2018


  • healthcare associated infection
  • hand hygiene
  • compliance
  • healthcare workers
  • nursing

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases


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