Theoretical Classifications and Criticisms of Hand Hygiene Interventions

Abstract

Hand hygiene is widely accepted as the best way to prevent hospital acquired infections. However, the current hand hygiene adherence rate is estimated to be 38.7%, which is unacceptably low (WHO, 2009). Many interventions to increase hand hygiene have been attempted, but their success varies greatly. The first goal of this paper is to analyze previously reported interventions. Each intervention will be briefly described and classified into theoretical categories, an approach that has not been used in other literature reviews. By using this approach we can examine the merits of using human factors and psychological theory in hand hygiene intervention design. The second goal of this paper is to review the methodological approaches that have been used to measure hand hygiene rates in hospitals. We argue that there are common methodological issues that may be leading to an underestimate of reported hand hygiene rates. Another potential issue is the lack of an established definition for a successful hand hygiene event, which limits the ability to accurately measure hand hygiene adherence. For these two reasons, we cannot confidently accept the results of previous hand hygiene studies at face value, and conclusions that are drawn from the existing body of literature about the effectiveness of hand hygiene interventions are potentially flawed. Finally, we propose an alternative method of measuring and reporting hand hygiene.