Compliance with Hand Hygiene Among Healthcare Workers in Preventing Healthcare Associated Infections – A Systematic Review

1 Ema Buković
2 Biljana Kurtović
2,3 Cecilija Rotim
2,4 Vesna Svirčević
2,5 Adriano Friganović
2,6 Damir Važanić
1 Graduate nursing student, School of Medicine University of Zagreb, Croatia
2 University of Applied Health Sciences, Zagreb, Croatia
3 Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
4 Department of Neurosurgery, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia
5 Department of Anaesthesiology and Intensive Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
6 Croatian Institute of Emergency Medicine, Zagreb, Croatia



Introduction: Healthcare associated infections (HCAIs) represent a major public health issue. In Europe, 37 000 patients are affected annually by some sort of HCAI. HCAIs are preventable, and hand hygiene is an important measure in their prevention. During daily clinical practice, hands of healthcare workers (HCWs) are exposed to surfaces, various substances and objects; therefore, proper hand hygiene is the first step in preventing microorganism transmission.

Aim: To determine the HCWs hand hygiene compliance with the guidelines of the World Health Organization through a systematic review of literature.

Methods: A systematic review of literature based on the PRISMA statement guidelines using the PubMed database in a search for articles that evaluate the hand hygiene compliance among HCWs.

Results: Six articles were taken into consideration by the availability of full-text articles and years of publication between 2010 and 2020. Results showed that compliance rate was the highest in studies that implemented World Health Organisation’s Multimodal Hand Hygiene Improvement Strategy or its modifications.

Conclusion: The multimodal approach, as World Health Organisation’s multimodal strategy or its local modifications, has been shown as the best approach addressing the problem of hand hygiene compliance. Further areas for research include finding a better method of measuring compliance, technology-driven solutions for both delivery of alcohol-based handrub and monitoring of its use, a greater focus on evaluating proper hand hygiene techniques, and insuring longer-term programs of training and education to achieve the best effectiveness of hand hygiene compliance among HCWs.

Keywords: hand hygiene, World Health Organisation, compliance rate, healthcare workers