Hand hygiene: cornerstone of infection prevention and control

Hand hygiene saves lives. Even so, "compliance in health-care settings has been far from ideal worldwide", write Marlieke E A de Kraker and colleagues in a Review for The Lancet Infectious Diseases.

Hand hygiene sits at the core of effective infection prevention and control programmes. Health-care-associated infections (HAIs)—linked to considerable morbidity and mortality among hospitalised patients—are mainly transmitted through the contaminated hands of health-care workers. Therefore, strategies to keep hands clean are of utmost importance, and hand hygiene with alcohol-based hand rub is considered the most effective preventive strategy to reduce HAIs.

However, this seemingly simple concept has been inconsistently adopted. Aside from a lack of resources, barriers to hand hygiene include understaffing, workload, overcrowding, and irritant contact dermatitis, among others.

In response, WHO developed its Multimodal Hand Hygiene Improvement Strategy in 2009. A decade later, a study in The Lancet Infectious Diseases provided a snapshot of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey.

"More than half of the health-care facilities have achieved an intermediate hand hygiene level […] although this varied widely with country income level and health-care facility funding structure (private vs public)", report Marlieke E A de Kraker and colleagues. They continue, "Based on the survey, the level of hand hygiene implementation seems highly dependent on available resources."

But increasing funds alone will not be sufficient; "leadership engagement and organisational support are important elements that could further enhance hand hygiene implementation", authors state.

Outside of health-care settings, systematic reviews have consistently found that interventions promoting handwashing with soap reduce acute respiratory infection (ARI). A new study in The Lancet estimates interventions promoting handwashing with soap reduced ARI morbidity by about 17% in low- and middle-income countries, compared with no handwashing intervention.

During the COVID-19 pandemic, hand hygiene was among the first recommended measures and gained prominence among health-care workers and the public. "In comparison with the attention given to handwashing during epidemics of respiratory disease, handwashing campaigns in normal times are rare", write Ian Ross and colleagues.

The time is ripe to harness this opportunity to invest in hand hygiene globally, tackle the remaining barriers to implementation, and promote the adoption of this back-to-basics practice for infection prevention and control.

Articles featured:

'Hand hygiene in health care: 20 years of ongoing advances and perspectives' by Nasim Lotfinejad et al., The Lancet Infectious Diseases

'Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019' by Marlieke E A de Kraker et al., The Lancet Infectious Diseases

'Effectiveness of handwashing with soap for preventing acute respiratory infections in low-income and middle-income countries: a systematic review and meta-analysis' by Ian Ross et al., The Lancet