Interventions to improve hand hygiene compliance in patient care

  • Review
  • Intervention




Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure.


To assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection.

Search strategy

We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. All databases were searched to July 2006; MEDLINE was searched from 1980, CINAHL from its inception, and the remainder from 1990 until July 2006.

Selection criteria

Randomised controlled trials; controlled clinical trials; controlled before and after studies; and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group. Studies reporting proxy indicators of hand hygiene compliance were considered. Studies to promote compliance with universal precautions were included providing data relating specifically to hand hygiene were presented separately.

Data collection and analysis

Two reviewers independently extracted data and assessed data quality.

Main results

Two studies met the criteria for review. One was a randomised controlled trial. The other was a controlled before and after study. Both were poorly controlled. Statistically significant post-intervention increase in hand washing was reported in one study up to four months after the intervention. In the other there was no post-intervention increase in hand hygiene compliance.

Authors' conclusions

There is little robust evidence to inform the choice of interventions to improve hand hygiene. It appears that single interventions based on short, 'one off' teaching sessions are unlikely to be successful, even short-term. There is a need to undertake methodologically robust research to explore the effectiveness of soundly designed interventions to increase hand hygiene compliance.

Plain language summary

Patients in hospital are at high risk of developing infections that they did not have before admission. Most health care-associated infection is spread by direct contact, especially via the hands of health workers. Traditionally hand hygiene, such as washing hands before and after seeing patients, has been considered the single most important way of reducing such infections. But compliance with hand hygiene protocols in health workers is poor.

This review sought to establish whether there are effective strategies to improve hand hygiene compliance, whether such strategies are effective over short or longer term, and whether increased compliance reduces health care-associated infections.

There were two studies that assessed the success of campaigns to improve hand hygiene compliance. Both were of low quality and looked at the effects of strategies over very short periods of time (less than six months).

There is not enough evidence to be certain about what strategies improve hand hygiene compliance. "One off" teaching sessions about hand hygiene may not improve hand hygiene, but again there is not enough evidence to be certain. More research is needed.