Intervention Review

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Interventions to improve hand hygiene compliance in patient care

  1. Dinah J Gould1,*,
  2. Donna Moralejo2,
  3. Nicholas Drey1,
  4. Jane H Chudleigh3

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 8 SEP 2010

Assessed as up-to-date: 2 AUG 2010

DOI: 10.1002/14651858.CD005186.pub3

How to Cite

Gould DJ, Moralejo D, Drey N, Chudleigh JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD005186. DOI: 10.1002/14651858.CD005186.pub3.

Author Information

  1. 1

    School of Community and Health Sciences, City University, Adult Nursing Department, London, UK

  2. 2

    Memorial University, School of Nursing, St. John's, Newfoundland, Canada

  3. 3

    ICH/GOSH, Portex Unit, London, UK

*Dinah J Gould, Adult Nursing Department, School of Community and Health Sciences, City University, 24 Chiswell Street, London, EC1 4TY, UK.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 SEP 2010



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Gould 1997 {published data only}
Huang 2002 {published data only}
  • Huang J, Jiang D, Wang X, Liu Y, Fennie K, Burgess J, et al. Changing knowledge, behavior and practice related to universal precautions among hospital nurses in China. Journal of Continuing Education in Nursing 2002;33(5):217-24. [MEDLINE: 12269760]
Vernaz 2008 {published data only}
  • Vernaz N, Sax H, Pittet D, Bonnabry P, Schrenzel J, Harbath S. Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile. Journal of Antimicrobial Chemotherapy 2008;63:630-1.
Whitby 2008 {published data only}
  • Whitby M, McLaws M L, Slater K, Tong E, Johnson B l. Three successful interventions in health workers that improve compliance with hand hygiene: is sustained replication possible?. American Journal of Infection Control 2008;36:349-55.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Apisarnthananarak 2008 {published data only}
  • Apisarnthananarak A, Pinitchai U, Thongphubeth K, Yuekyen C, Warren D K, Fraser V J. A multifaceted intervention to reduce pandrug-resistant Acinetobacter baumannii colonization and infection in 3 intensive care units in a Thai tertiary care center: a three year study. Clinical and Infectious Diseases 2008;47:760-7.
Assanasen 2008 {published data only}
  • Assanasen S, Edmond M, Bearman G. Impact of 2 different levels of performance feedback on compliance with infection control process measures in 2 intensive care units. American Journal of Infection Control 2008;36:407-13.
Avila-Aguero 1998 {published data only}
  • Avila-Aguero M, Umana MA, Jimenez AL, Faingezicht I, Paris MM. Handwashing practices in tertiary-care, pediatric hospital and the effect on an educational program. Clinical Performance and Quality Health Care 1998;6(2):70-2.
Baker 1998 {published data only}
Barchitta 2008 {published data only}
  • Barchitta M, Cipresso R, Giaquinta M, Romeo A, Denaro C, Pennisi C, et al. Acquisition and spread of Acinetobacter baumannii and Stenotrophomonas maltophilia in intensive care patients. International Journal of Hygiene and Environmental Health 2008;212:330-7.
Bellis 2006 {published data only}
  • Bellis K. Hand hygiene compliance in a Victorian multi-centred study. Australian Infection Control. 2006; Vol. 11, issue Part 4: Abstracts. Infection Control Association Fourth Biennial Conference 2006 ? The Key to Success 20-22 September 2006 ? Sydney, Australia.:141.
Berg 1995 {published data only}
Berhe 2006 {published data only}
  • Berhe M, Edmond M B, Bearman G. Measurement and feedback of infection control process measures in the intensive care unit: impact on compliance. American Journal of Infection Control 2006;34:537-9.
Bhojani 2008 {published data only}
  • Bhojani S, DCosta S, Gupta A. Hand hygiene: simple, inexpensive and effective. British Journal of Infection Control 2008;9:15-7.
Bhutta 2007 {published data only}
  • Bhutta A, Gilliam C, Honeycutt M, Schexnayder S, Green J, Moss M, et al. Reduction of bloodstream infections associated with catheters in paediatric intensive care unit; stepwise approach. British Medical Journal 2007;334:362-5.
Bischoff 2000 {published data only}
  • Bischoff WE, Reynolds TM, Sessier CN, Edmond MB, Wenzel RP. Handwashing compliance by health care workers: The impact of introducing accessible, alcohol-based hand antiseptic. Archives of Internal Medicine 2000;160(7):1017-21.
Bittner 2002 {published data only}
  • Bittner MJ, Rich EC, Turner PD, Arnold WH Jr. Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit. Infection Control and Hospital Epidemiology 2002;23(3):120-6.
Brown 2003 {published data only}
  • Brown SM, Lubimova AV, Khrustalyeva NM, Shulaeva SV, Tekhova I, Zueva LP, et al. Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infection Control and Hospital Epidemiology 2003;24(3):172-9.
Cantrell 2009 {published data only}
  • Cantrell D, Shamriz O, Cohen M J, Stern Z, Block C, Brezis M. Hand hygiene compliance by physicians: marked heterogeneity due to local culture?. American Journal of Infection Control 2009;37:301-5.
Capretti 2008 {published data only}
  • Capretti MG, Sandri F, Tridapalli E, Galletti S, Petracci E, Faldella G. Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants. American Journal of Infection Control 2008;36:430-5.
Chan 2007 {published data only}
  • Chan PC, Huang LM, Lin HC. Control of an outbreak of pandrug-resistant Acinetobacter baumanni colonization and infection in a neonatal intensive care unit. Infection Control and Hospital Epidemiology 2007;28:423-9.
Chimango 2009 {published data only}
  • Chimango JL, Kaponda CN, Jere DL, Chimwaza A, Criittenden KS, Kachingwe SI, et al. Impact of a peer-group intervention on occupation-related behaviors for urban hospital workers in Malawi. Journal of the Association of Nurses AIDS Care 2009;20:293-307.
Christiaens 2009 {published data only}
  • Christiaens G, Barbier C, Mitsers J, Warnotte J, De Mol P, Bouffioux C. Hygiène des mains: première mesure pour la maîtrise des infections nosocomiales. Revue Medicale de Liege 2009;61:31-6.
Coghill 2009 {published data only}
  • Coghill E. Using high-impact interventions to reduce infection risk by standardising good practice. Nursing Times 2009;105:14-6.
Coignard 1998 {published data only}
  • Coignard B, Grandbastien B, Berrouane Y, Krembel C, Queverue M, Salomez JL, et al. Handwashing quality: impact of a special program. Infection Control and Hospital Epidemiology 1998;19(7):510-3.
Colombo 2002 {published data only}
  • Colombo C, Giger H, Grote J, Deplazes C, Pletscher W, Luthi R, et al. Impact of teaching interventions on nurse compliance with hand disinfection. Journal of Hospital Infection 2002;51(1):69-72.
Conly 1989 {published data only}
  • Conly JM, Hill S, Ross J, Lertzman J, Louie TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. American Journal of Infection Control 1989;17(6):330-9.
Creedon 2005 {published data only}
Creedon 2006 {published data only}
  • Creedon S. Health care workers’ hand decontamination practices; an Irish study. Clinical Nursing Research 2006;15:6-26.
Cromer 2008 {published data only}
  • Cromer AL, Latham SC, Bryant KG, Hutsell S, Gansauer L, Bendyk HA, et al. Monitoring and feedback of hand hygiene compliance and the impact of facility-acquired methicillin-resistant Staphylococcus aureus. American Journal of Infection Control 2008;36:672-7.
das Neves 2006 {published data only}
  • das Neves ZC, Tipple AF, Silva e Souza AC, Pereira MS, Melo Dde S, Ferreira LR. Hand hygiene: the impact on incentive strategies on adherence among healthcare workers from a newborn intensive care unit. Revista Latino-Americana de Enfermagen 2006;14:546-52.
Diekema 1995 {published data only}
  • Diekema DJ, Schuldt SS, Albanese MA, Doebbeling BN. Universal precautions training of preclinical students: impact of knowledge, attitudes, and compliance. Preventive Medicine 1995;24(6):580-5.
Diersson-Sotos 2008 {published data only}
  • Diersson-Sotos T, Robles-Garcia y M, Vabaena-Maya S. Hand washing: experience in two Spanish autonomous regions. Medical Clinics Monogram (Barcelona) 2008;131(Supplement 3):60-3.
Donowitz 1986 {published data only}
Dorsey 1996 {published data only}
Dubbert 1990 {published data only}
Duerink 2006 {published data only}
  • Duerink DO, Farida H, Nagelkerke NJ, Wahyono H, Keuter M, Lestari ES, et al. Preventing nosocomial infections: improving compliance with standard precautions in an Indonesian teaching hospital. Journal of Hospital Infection 2006;64:36-43.
Duggan 2008 {published data only}
  • Duggan JM, Hensley S, Khuder S, Papadimos TJ, Jacobs L. Inverse correlation between level of professional education and rate of handwashing compliance in a teaching hospital. Infection Control and Hospital Epidemiology 2008;29:534-8.
Earl 2001 {published data only}
Ebnother 2008 {published data only}
  • Ebnother C, Tanner B, Schmid F, La Rocca V, Heinzer I, Bregenzer T. Impact of an infection control program on the prevalence of nosocomial infections at a tertiary care center in Switzerland. Infection Control and Hospital Epidemiology 2008;29:38-43.
Eckmanns 2006 {published data only}
  • Eckmanns T, Bessert J, Behnke M, Gastmeier P, Ruden H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infection Control and Hospital Epidemiology 2006;27:931-4.
Eldridge 2006 {published data only}
  • Eldridge NE, Woods SS, Bonello RS, Clutter K, Ellingson L, Harris MA, et al. Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units. Journal of General Internal Medicine 2006;21(Supplement 2):S35-S42.
Elola-Vicente 2008 {published data only}
  • Elola-Vicente P, Aroca-Palencia J, Huertas-Paredero MV, Diez-Sebastian J, Rivas-Bellido L, Martinez- Martinez G, et al. A hand hygiene education program. Comparison between handwashing and the use of alcohol solutions [Programa de formacion sobre la hygiene de las manos. Estudio comparative aleatorizado del lavado higienico y el uso de soluciones alcoholicas]. Enfermia Clinica 2008;18:5-10.
Giannitsioti 2009 {published data only}
  • Giannitsioti E, Athanasia S, Antoniadou A, Fytrou H, Athanassiou K, Bourvani P, et al. Does a bed rail system of alcohol-based handrub antiseptic improve compliance of health workers with hand hygiene?. American Journal of Infection Control 2009;37:160-3.
Golan 2006 {published data only}
Gopal Rao 2009 {published data only}
  • Gopal Rao G, Jeanes A, Russell H, Wilson D, Atere-Roberts E, O'Sullivan D, et al. Effectiveness of short-term, enhanced, infection control support in improving compliance with infection control guidelines and practice in nursing homes: a cluster randomized trial. Epidemiology and Infection 2009;137:1465-71.
Graham 1990 {published data only}
Grayson 2008 {published data only}
  • Grayson ML, Jarvie LJ, Martin R, Johnson PDR, Jodain ME, McMullan C, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Medical Journal of Australia 2008;188:633-40.
Haas 2008 {published data only}
Harbarth 2002 {published data only}
  • Harbarth S, Pittet D, Grady L, Zawacki A, Potter-Bynoe G, Samore MH, Goldmann DA. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatric Infectious Disease Journal 2002;21(6):489-95.
Harrington 2007 {published data only}
  • Harrington G, Watson K, Bailey M, Land G, Borrell S, Houston L, et al. Reduction in hospitalwide incidence of infection or colonization with methicillin-resistant Staphylococcus aureus and use of antimicrobial hand-hygiene gel and statistical process control charts. Infection Control and Hospital Epidemiology 2007;28:837-44.
Hon 2008 {published data only}
  • Hon CY, Gamage B, Bryce EA, LoChang J, Yassi A, Maultsaid D, et al. Personal protective equipment in health care: can online infection control courses transfer knowledge and improve proper selection and use?. American Journal of Infection Control 2008;36:33-7.
Howard 2009 {published data only}
  • Howard DP, Williams C, Sen S, Shah A, Daurka J, Bird R, et al. A simple effective clean practice protocol significantly improves hand decontamination and infection control measures in the acute surgical setting. Infection 2009;37:34-8.
Huang 2006 {published data only}
  • Huang SS, Yokoe, Hinirichsen VL, Yokoe DS, Hinrichsen VL, Spurchise LS, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clinical Infectious Diseases 2006;43:971-8.
Huang 2008 {published data only}
Hughes 1986 {published data only}
Hugonnet 2002 {published data only}
Hussein 2007 {published data only}
  • Hussein R,  Khakoo R,  Hobbs G. Hand hygiene practices in adult versus pediatric intensive care units at a university hospital before and after intervention. Scandinavian Journal of Infectious Diseases 2007;39(6-7):566-70.
Khatib 1999 {published data only}
Kohli 2009 {published data only}
  • Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB. Variability in the Hawthorne Effect with regard to hand hygiene performance in high- and low-performing inpatient care units. Infection Control and Hospital Epidemiology 2009;30:222-5.
Kusachi 2006 {published data only}
Lam 2004 {published data only}
  • Lam BC, Lee J, Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics 2004;114(5):565-71.
Larson 1991 {published data only}
  • Larson E, McGeer A, Quraishi ZA, Krenzischek D, Parsons BJ, Holdford J, et al. Effect of an automated sink on handwashing practices and attitudes in high-risk units. Infection Control and Hospital Epidemiology 1991;12(7):422-8.
Larson 1997 {published data only}
Larson 2000 {published data only}
  • Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organisational climate intervention associated with increased handwashing and decreased nosocomial infections. Behavioral Medicine 2000;26(1):14-20.
Larson 2007 {published data only}
Lausten 2009a {published data only}
  • Lausten S, Bibby B, Kristensen B, KjØlseth MØller, Thulstrup AM. E-learning may improve adherence to alcohol-based hand rubbing: a cohort study. American Journal of Infection Control 2009;37:565-8.
Lausten 2009b {published data only}
  • Lausten S, Lund E, Bibby B, Kristensen B, Thulstrup AM, Moller JK. Cohort study of adherence to correct hand antisepsis before and after performance of clinical procedures. Infection Control and Hospital Epidemiology 2009;30:172-8.
Lee 2009 {published data only}
  • Lee TC, Moore C, Raboud JM, Muller MP, Green K, Tong A, et al. Impact of a mandatory infection control education program on nosocomial acquisition of methicillin-resistant Staphylococcus aureus. Infection Control and Hospital Epidemiology 2009;30:249-56.
Macdonald 2006 {published data only}
  • Macdonald DJ, McKillop EC, Trotter S, Gray A. Improving hand-washing performance - a crossover study of hand-washing in the orthopaedic department. Annals of the Royal College of Surgery England 2006;88:289-91.
Madani 2006 {published data only}
  • Madani TA, Albarrak AM, Alazraqi TA, Alazraqi TA, Ishaz AH. Steady improvement of infection control services in six community hospitals in Makkah following annual audits during Hajj for four consecutive years. BMC Infectious Diseases 2006;6:135.
Marena 2002 {published data only}
  • Marena C, Lodola L, Zecca M, Bulgheroni A, Carretto E, Maserati R, Zambianchi L. Assessment of handwashing practices with chemical and microbiologic methods: Preliminary results from a prospective crossover study. American Journal of Infection Control 2002;30:334-40.
Marra 2008 {published data only}
  • Marra AR, Darco C, Bravim BA, Martino MDV, Correa L, Silva CV, et al. Controlled trial measuring the effect of a feedback intervention on hand hygiene compliance in a step-down unit. Infection Control and Hospital Epidemiology 2008;29:730-5.
Maury 2000 {published data only}
  • Maury E, Alzieu M, Baudel JL, Haram N, Barbut F, Guidet B, et al. Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. American Journal of Respiratory and Critical Care Medicine 2000;162(1):324-7.
Mayer 1986 {published data only}
McDonald 2007 {published data only}
  • McDonald JR, Carriker CM, Pien B, Trinh JV, Engemann JJ, Harrell LJ, et al. Methicillin-resistant Staphylococcus aureus outbreak in an intensive care nursery: potential for institutional spread. Pediatric Infectious Diseases Journal 2007;26:678-83.
McGuckin 1999 {published data only}
  • McGuckin M, Taylor A, Martin V, Porten L, Salcido R. Evaluation of a patient education model for increasing hand hygiene compliance in an impatient rehabilitation unit. American Journal of Infection Control 2004;32(4):235-8.
McGuckin 2004 {published data only}
  • McGuckin M, Waterman R, Porten L, Bello S, Caruso M, Juzaitis B, et al. Patient education model for increasing handwashing compliance. American Journal of Infecton Control 1999;27(4):309-14.
McGuckin 2006 {published data only}
  • McGuckin M, Shubin A, McBride P, Lane S, Struass K, Butler D, et al. The effect of random voice hand hygiene messages delivered by medical, nursing and infection control staff on hand hygiene compliance in intensive care. American Journal of Infection Control 2006;34:673-5.
McLaws 2009 {published data only}
  • McLaws ML, Pantle AC, Fitzpatrick KR, Hughes C. Improvements in hand hygiene across New South Wales public hospitals: clean hands save lives, Part III. Medical Journal of Australia 2009;191(Supplement):S18-S25.
Milward 2007 {published data only}
Miyachi 2007 {published data only}
  • Miyachi H, Furuya H, Umezawa K, Itoh Y, Ohshima T, Miyamoto M, et al. Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches. American Journal of Infection Control 2007;35:115-21.
Moongtui 1999 {published data only}
  • Moongtui W. Compliance with components of universal precautions guidelines: Using peer feedback program as a cue to action among health care workers in Thailand. PhD Dissertation: The University of Alabama at Birmingham 1999.
  • Moongtui W, Gauthier DK, Turner JG. Using peer feedback to improve handwashing and glove usage among Thai health care workers. American Journal of Infection Control 2000; Vol. 28, issue 5:365-9.
Moore 1980 {published data only}
  • Moore M, Abbott NR. Can handwashing practice be changed?. American Journal of Nursing 1980;80:80.
Muto 2000 {published data only}
Muto 2007 {published data only}
  • Muto CA, Blank MK, Marsh JW, Vergis EN, O'Leary MM, Shutt KA, et al. Control of an outbreak of infection with the hypervirulent Clostridium difficileB1 strain in a university hospital using a comprehensive "bundle" approach. Clinical Infectious Diseases 2007;45:1266-73.
Nouira 2008 {published data only}
  • Nouira A, Ounis H, Khediri M, Helali R, Bannour W, Njah M. Healthcare workers hand hygiene: compliance of the recommendations. Tunisian Medical 2008;86:451-6.
Panhotra 2004 {published data only}
  • Panhotra BR, Saxena AK, Al-Arabi AM. The effect of a continuous educational program on handwashing compliance among healthcare workers in an intensive care unit. British Journal Infection Control 2004;5(3):15-8.
Pessoa-Siilva 2007 {published data only}
  • Pessoa-Siilva CL, Hugonnet S, Pfister R, Touveneau S, Dharan S, Posfay-Barbe K, et al. Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics 2007;120:382-90.
Picheansathian 2008 {published data only}
Pittet 2000 {published data only}
  • Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000;356(9238):1307-12.
Prieto 2005 {published data only}
  • Prieto J, Macleod Clark J. Contact precautions for clostridium difficile and methicillin-resistant staphylococcus aureus (MRSA). Journal of Research in Nursing 2005;10(5):511-26.
Raju 1991 {published data only}
Randle 2006 {published data only}
Raskind 2009 {published data only}
  • Raskind CH, Worley S, Vinski J, Goldfarb J. Hand hygiene compliance rates after an educational intervention in a neonatal intensive care unit. Infection Control and Hospital Epidemiology 2009;28:1096-8.
Roberts 2009 {published data only}
  • Roberts C, Roberts J, Roberts RJ. Investigation into the effect of an alcohol-based hand product on infection rate in a nursing home setting. Journal of Infection Prevention 2009;10:138-42.
Rose 2009 {published data only}
  • Rose L, Rogel K, Redl L, Cade JF. Implementation of a multimodal infection control program during and Acinetobacter outbreak. International Journal of Nursing Care 2009;25:57-63.
Rosenthal 2003 {published data only}
  • Rosenthal VD, McCormick RD, Guzman S, Villamayor C, Orellano PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. American Journal of Infection Control 2003;31(2):85-92.
Rosenthal 2008 {published data only}
  • Rosenthal, VD. Device-associated nosocomial infections in limited-resources countries: findings of the International Noscomial Infection Control Consortium (INICC). American Journal of Infection Control 2008;36:7-11.
Rummukainen 2009 {published data only}
  • Rummukainen M, Jakobsson A, Karppi P, Kautianen H, Lyytikäinen O. Promoting hand hygiene and prudent use of antimicrobials in long-term care facilities. American Journal of Infection Control 2009;37:168-71.
Rupp 2008 {published data only}
  • Rupp ME, Fitzgerald T, Puumala S, Anderson JR, Craig R, Iwen PC, et al. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infection Control and Hospital Epidemiology 2008;29:8-15.
Rykkje 2007 {published data only}
  • Rykkje L, Heggelund A, Harthug S. Improved hand hygiene through simple interventions. Tidsskr Nor Laegeforen 2007;29(127):861-3.
Sacar 2006 {published data only}
  • Sacar S, Turgut H, Kaleli I, Cevahir N, Asan A, Sacar M, et al. Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets. American Journal of Infection Control 2006;34:606-9.
Salemi 2002 {published data only}
Sanchez-Paya 2007 {published data only}
  • Sanchez-Paya J, Fuster-Perez M, Garcia-Gonzalez RM, Garcia, Shimizu P, San Juan-Quiles A, et al. Evaluation of a program for updating recommendations about hand hygiene. An Sist Sanit Navar 2007;30:343-52.
Santana 2007 {published data only}
  • Santana SL, Furtado GH, Coutinho AP, Medeiros EA. Assessment of healthcare professionals adherence to hand hygiene after alcohol-based hand rub introduction at an intensive care unit in Sao Paulo, Brazil. Infection Control and Hospital Epidemiology 2007;28:365-7.
Schneider 2009 {published data only}
  • Schneider J, Moromisisato D, Zemetra B, Rizzi-Wagner L, Rivero N, Mason W, et al. Hand hygiene adherence is influenced by the behavior of role models. Pediatric Critical Care Medicine 2009;10:360-3.
Shaw 2003 {published data only}
  • Shaw S, Tanner J. Handwashing practices on a neonatal unit: the influence of teaching sessions. Journal of Neonatal Nursing 2003;9:162-6.
Siegel 2007 {published data only}
  • Siegel JH, Korniewicz DM. Keeping patients safe: an interventional hand hygiene study at an oncology center. Clinical Journal of Oncology Nursing 2007;11:643-6.
Simmons 1990 {published data only}
  • Simmons B, Bryant J, Neiman K, Spencer L, Arheart K. The role of handwashing in prevention of endemic intensiive care unit infections. Infection Control and Hospital Epidemiology 1990;11(11):589-94.
Snow 2006 {published data only}
Souweine 2009 {published data only}
  • Souweine B, Lautrette A, Aumeran C, Bendit M, Constatntin JM, Guelon D, et al. Comparison of acceptability, skin tolerance and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study. Intensive Care Medicine 2009;35:1216-24.
Stone 2007 {published data only}
  • Stone S, Slade R, Fuller C, Charlett A, Cookson B, Teare L, et al. Early communication: does a national campaign to improve hand hygiene in the NHS work? Initial English and Welsh experience from the NOSEC study (National Observational Study to Evaluate the CleanYourHands Campaign). Journal of Hospital Infection 2007;66:293-6.
Suchitra 2007 {published data only}
  • Suchitra JB, Lakshmi Devi N. Impact of an education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. Indian Journal of Medical Microbiology 2007;25:181-7.
Suresh 2007 {published data only}
  • Suresh G, Cahill J. How user friendly is the hospital for practicing hand hygiene? An ergonomic evaluation. Joint Commission Journal on Quality and Patient Safety 2007;33:171-9.
Swoboda 2004 {published data only}
  • Swoboda SM, Earsing K, Strauss K, Lane S, Lipsett PA. Electronic monitoring and voice prompts to improve hand hygiene and decrease nosocomial infections in an intermediate care unit. Critical Care Medicine 2004;32(2):358-63.
Swoboda 2007 {published data only}
Tenias 2009 {published data only}
  • Tenias JM, Mayordomo C, Mico ML, San Felix M, Esparza G, Angeles M, et al. Impact of an educational intervention for promoting handwashing and the rational use of gloves in a hospital. Revista de Calidad Asistencial 2009;24:36-41.
Thomas 2005 {published data only}
  • Thomas M, Gilespie W, Krauss J, Harrison S, Medeiros R, Hawkins M, et al. Focus group data as a tool in assessing effectiveness of a hand hygiene campaign. American Journal of Infection Control 2005;33(6):368-73.
Thomas 2009 {published data only}
  • Thomas BW, Berg-Copas GM, Vasquez DG, Jackson BL, Wetta-Hall R. Conspicuous vs. customary location of hand hygiene agent dispensers on alcohol-based hand hygiene product usage in an intensive care unit. Journal of the American Association of Osteotomy 2009;109:263-7.
Thu 2007 {published data only}
  • Thu L, Dibley M, Nho V, Archibald L, Jarvis WR, Sohn A. Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam. Infection Control and Hospital Epidemiology 2007;28:583-8.
Tibbals 1996 {published data only}
Traore 2007 {published data only}
Trick 2007 {published data only}
  • Trick WE, Vernon MO, Welbel SF, Demarais P, Hayden MK, Weinstein RA. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infection Control and Hospital Epidemiology 2007;28:42-9.
Van de Mortel 1995 {published data only}
  • Van de Mortel T, Heyman L. Performance feedback increases the incidence of handwashing by staff following patient contact in an intensive care unit. Australian Critical Care 1995;8(2):8-13.
Van de Mortel 2000 {published data only}
  • Van de Mortel T, Bourke R, Fillipi L, McLoughlin J, Molihan C, Nonu M, et al. Maximising handwashing rates in the critical care unit through yearly performance feedback. Australian Critical Care 2000;13(3):91-5.
Van de Mortel 2006 {published data only}
  • Van de Mortel T, Murgo M. An examination of covert observation and solution sudit as tools to measure the success of hand hygiene interventions. American Journal of Infection Control 2006;34:95-9.
Venkatesh 2008 {published data only}
  • Venkatesh AK, Lankford MG, Rooney DM, Blachford T, Watts CM, Noskin GA. The use of electronic alerts to enhance hand hygiene compliance and decrease transmission of vancomycin-resistant Enterococcus in a haematology unit. American Journal of Infection Control 2008;36:199-205.
Wharton 2006 {published data only}
Whitby 2004 {published data only}
Widmer 2007 {published data only}
  • Widmer AF, Conzelmann M, Tomic Frei R, Stranden AM. Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infection Control and Hospital Epidemiology 2007;28:50-4.
Won 2004 {published data only}
  • Won SP, Chou HC, Hsieh WS, Chen CY, Huang SM, Tsou KI, et al. Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infecton Control and Hospital Epidemiology 2004;25(9):742-6.
Xue 2008 {published data only}
  • Xue, Xm kang Y, Liao Y. Efficacy of intensive hand hygiene for controlling methicillin-resistant Staphylococcus aureus. Chinese Journal of Infection and Chemotherapy 2008;8:60-2 (abstract in English).
Zingg 2009 {published data only}
  • Zingg W, Imhof A, Maggiorini M, Stoker R, Keller E, Ruef C. Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Critical Care Medicine 2009;372:2167-73.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Ballini 2010
  • Ballini L, Bero L, Eccles MP, Grimshaw J, Gruen RL, Lewin S, et al. Cochrane Effective Practice and Organisation of Care Group. About The Cochrane Collaboration (Cochrane Review Groups (CRGs)) 2010;Issue 3(Art. No.: EPOC).
Gould 2007
Grimshaw 2004
  • Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. Journal of Continuing Education in the Health Professions 2004;24:S31-S37.
Haas 2007
Hospital Infection Society 2007
  • Hospital Infection Society, Infection Control Nurses Association. Summary of preliminary results of The Third Prevalence Survey of Healthcare Associated Infections in Acute Hospitals (for England) (2006). 2007.
Jamtvedt 2006
Klevens 2007
  • Klevens RM, Edwards JR, Richards CL. Estimating health care-associated infections and deaths in US hospitals 2002. Public Health Report 2007;122(2):160-6.
Kotler 1971
Naikoba 2001
National Audit Office 1998
  • National Audit Office. The management and control of hospital-acquired infection in acute NHS trusts in England. London: National Audit Office, 1998.
Pittet 2004
Ramsay 2003
  • Ramsay CR, Matowe L, Griili R, Grimshaw JM, Thomas RE. Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies. International Journal of Technology Assessment in Health Care 2003;19(4):613-23.
Roethlisberger 1939
  • Roethlisberger, Fritz Jules. Management and the worker; and account of a research program conducted by the Western electric company, Hawthorne works, Chicago. Harvard University Press. Cambridge, 1939.
Teare 1999
Widmer 2008
Zoutman 2003
  • Zoutman DE, Ford DB, Bryce E, Gourdeau M, Herbert G, Henderson E, et al. The state of infection surveillance and control in Canadian acute care hospitals. Journal of Infection Control 2003;31(5):266-73.

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Gould 2007