The Evolution of Hand Hygiene Interventions and Surveillance in Healthcare Settings: A Critical Literature Review

Healthcare associated infections (HAIs) are illnesses that patients acquire as a result of ongoing, or recently received, medical services. These infections are of major public health importance because of the enormous burden they pose on the US healthcare system and the significant risks created for patients. Moreover, despite the now long-established connections between hand washing and preventing the spread of disease, hand hygiene (HH) practices continue to be an area for improvement. Given there has been no recent review focused on examining HH monitoring systems in context of approaches to HH interventions, this essay seeks to critically review the current state of literature on HH surveillance and interventions in US healthcare settings. The primary objective of this review is to understand how these areas have evolved since the early 2000’s in order to best project how they will continue to change in future years. To meet these aims, a critical systematic literature review was conducted. A search using Ovid Medline was performed with ten keywords directly related to HH used in varying combinations, such as “hand hygiene," and “hand disinfection.” In total, 692 unique articles resulted, but only 17 were included as within the scope of this essay for review. Exclusion of articles occurred for a variety of reasons, such as “not being a US study,” or being primarily about non-HH disease prevention strategies. Nearly all of the resulting articles employed a method of indirect (e.g., consumption of HH products) or direct surveillance (e.g., direct observation) to monitor HH compliance. Additionally, several standard interventional approaches to promote HH among HCWs emerged from the literature, such as increasing the availability of HH products like alcohol-based hand rubs (ABHRs), and education for when to perform HH. According to the literature, novel approaches, including mindful moments or financial incentive, may increase HH compliance as well. Next steps for this area of infection prevention include cost-benefit analyses, additional studies to assess the accuracy and acceptability of automated monitoring systems (AMSs) and determining the impact that the Hawthorne effect and observer bias have reported on HH compliance rates.