Healthcare-Associated Infections and Resource Limitations: A Bioethical Perspective on the Enforceability of Hand Hygiene

Healthcare-associated infections (HAIs) pose a safety risk to patients and healthcare personnel. Although hand hygiene (HH) is a fundamental preventive measure, insufficient availability of the resources required to perform HH properly may limit its effectiveness and create a bioethical conflict in healthcare delivery. A documentary review of national and international scientific literature related to HAIs and HH was conducted to examine the bioethical enforceability of this practice in light of the principles of beneficence, non-maleficence, and justice. In this study, the bioethical enforceability of HH refers to the extent to which its performance may reasonably be required of healthcare personnel under specific circumstances, including those involving institutional resource limitations. The literature search was conducted in PubMed, Google Scholar, Scopus, and Web of Science, as well as in resources from the World Health Organization (WHO) and the Pan American Health Organization (PAHO), national and international regulatory instruments, and textbooks. The information was analyzed from a bioethical perspective. Greater resource availability, by itself, has not been shown to improve health outcomes. Effective HH depends on individual, institutional, and organizational factors. Therefore, when institutional limitations objectively hinder or prevent its effective implementation, they may modify the conditions under which HH is bioethically enforceable and affect the proportional attribution of individual responsibility, without implying that healthcare personnel should refrain from using available resources and adopting reasonable measures to protect patients.