Education for hand hygiene compliance: a systematic literature review

Abstract

Abstract Aim The purpose of this systematic review was to identify and critically evaluate literature related to education for the promotion of hand hygiene knowledge and compliance amongst nurses. Additionally, an aim of this review was to identify trends in regards to the effects of educational strategies on knowledge and compliance specifically within nurses in practical settings. Background Hand hygiene is critical for reducing hospital acquired infections (HAI). Literature exists regarding individual hand hygiene interventions, showing that education is an important component. However, no known, recent, reviews exist synthesising the evidence base. Methods A search of the PubMed, Cochrane Library, and BioMed databases was performed, yielding six studies that met inclusion criteria. The Critical Appraisal Skills Programme (CASP, 2020) framework was used in order to evaluate each study included in this review based on its validity, methodological soundness, strength of results, and generalisability. Based on this systematic review process, it was determined that studies using educational interventions to promote knowledge and hand hygiene compliance in nurses are of a moderate level of quality. Additionally, a synthesis of the evidence was presented in regards to its ability to address the population, intervention comparator, and outcomes (PICO) question driving this research. Results Results from this step demonstrated that studies using randomised controlled designs, multi-component educational interventions, and which controlled for confounding and extraneous variables, were able to significantly improve knowledge of, and compliance to, hand hygiene standards and guidelines in nurses. However, studies using quasi-experimental designs and / or single-component interventions generally did not achieve high levels of statistical significance and were also more prone to biases and sources of error. Discussion Based on the evidence presented in this study, it is clear that randomised controlled designs involving multi-component educational interventions are effective and efficient for promoting hand hygiene and knowledge. There is a need for more research adopting such designs, as well as those which measure HAI. Additionally, theoretically driven interventions that incorporate behaviour change (e.g., the transtheoretical model, TTM) are needed. Conclusion Findings from this study may be used to improve guidelines and policies for the education and training of nurses in regards to hand hygiene knowledge and compliance.