Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

doi:10.1016/j.ajic.2021.11.030

Review

. 2022 May;50(5):563-571.

doi: 10.1016/j.ajic.2021.11.030. Epub 2021 Dec 7.

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

Ying Wang¹, Jinru Yang², Fu Qiao³, Bilong Feng⁴, Fen Hu⁵, Zi-Ang Xi⁶, Wenwen Wu⁷, Zi-Ling Ni⁸, Li Liu⁹, Yufeng Yuan¹⁰

Affiliations

¹ Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China; Institute of Hospital Management, Wuhan University, Wuhan, Hubei, P. R. China.
² Cancer Center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
³ Infection Prevention and Control Department, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
⁴ Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.
⁵ Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China; Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, P. R. China.
⁶ School of Architecture, Tsinghua University, Beijing, P. R. China.
⁷ School of Public Health and Management, Hubei University of Medicine, Shiyan, China.
⁸ School of Medicine, Hangzhou Normal University, Hangzhou, China.
⁹ School of Architecture, Tsinghua University, Beijing, P. R. China. Electronic address: liuli_archi@tsinghua.edu.cn.
¹⁰ Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China. Electronic address: yuanyf1971@whu.edu.cn.

PMID: 34883162
PMCID: PMC8648372
DOI: 10.1016/j.ajic.2021.11.030

Review

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

Ying Wang et al. Am J Infect Control. 2022 May.

. 2022 May;50(5):563-571.

doi: 10.1016/j.ajic.2021.11.030. Epub 2021 Dec 7.

Authors

Ying Wang¹, Jinru Yang², Fu Qiao³, Bilong Feng⁴, Fen Hu⁵, Zi-Ang Xi⁶, Wenwen Wu⁷, Zi-Ling Ni⁸, Li Liu⁹, Yufeng Yuan¹⁰

Affiliations

¹ Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China; Institute of Hospital Management, Wuhan University, Wuhan, Hubei, P. R. China.
² Cancer Center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
³ Infection Prevention and Control Department, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
⁴ Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.
⁵ Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China; Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, P. R. China.
⁶ School of Architecture, Tsinghua University, Beijing, P. R. China.
⁷ School of Public Health and Management, Hubei University of Medicine, Shiyan, China.
⁸ School of Medicine, Hangzhou Normal University, Hangzhou, China.
⁹ School of Architecture, Tsinghua University, Beijing, P. R. China. Electronic address: liuli_archi@tsinghua.edu.cn.
¹⁰ Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China. Electronic address: yuanyf1971@whu.edu.cn.

PMID: 34883162
PMCID: PMC8648372
DOI: 10.1016/j.ajic.2021.11.030

Abstract

Background: Hand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures.

Aim: To systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic.

Methods: The PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I² statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed.

Findings: Seven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%).

Conclusions: During the COVID-19 pandemic, the compliance of health care providers' HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for "before contact with patients" should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.

Keywords: COVID-19; Hand hygiene compliance; Hand hygiene improvement; Health care-associated infection control; Review.

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Figures

**Fig 1**
Flow chart of study identification.

**Fig 2**
Forest plot of HHC of health care providers during COVID-19 pandemic.

**Fig 3**
Forest plot of HHC of health care providers among different occupations during COVID-19 pandemic.

**Fig 4**
Forest plot of HHC of health care providers among different washing opportunities during COVID-19 pandemic.

**Fig 5**
Forest plot of HHC rate of health care providers among different observation methods during COVID-19 pandemic.

See this image and copyright information in PMC

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References

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[1] Clancy C, Delungahawatta T, Dunne CP. Hand hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect. 2021;111:6–26. S0195-6701:00102-X. - PMC - PubMed

[2] Clancy C, Delungahawatta T, Dunne CP. Hand hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect. 2021;111:6–26. S0195-6701:00102-X. - PMC - PubMed

[3] Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–241. - PubMed

[4] Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–241. - PubMed

[5] Liu X, Cui D, Li H, et al. Direct medical burden of antimicrobial-resistant healthcare-associated infections: empirical evidence from China. J Hosp Infect. 2020;105:295–305. - PubMed

[6] Liu X, Cui D, Li H, et al. Direct medical burden of antimicrobial-resistant healthcare-associated infections: empirical evidence from China. J Hosp Infect. 2020;105:295–305. - PubMed

[7] Tchouaket Nguemeleu E, Beogo I, Sia D, et al. Economic analysis of healthcare-associated infection prevention and control interventions in medical and surgical units: systematic review using a discounting approach. J Hosp Infect. 2020;106:134–154. - PMC - PubMed

[8] Tchouaket Nguemeleu E, Beogo I, Sia D, et al. Economic analysis of healthcare-associated infection prevention and control interventions in medical and surgical units: systematic review using a discounting approach. J Hosp Infect. 2020;106:134–154. - PMC - PubMed

[9] Sickbert-Bennett EE, DiBiase LM, Willis TM, et al. Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerg Infect Dis. 2016;22:1628–1630. - PMC - PubMed

[10] Sickbert-Bennett EE, DiBiase LM, Willis TM, et al. Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerg Infect Dis. 2016;22:1628–1630. - PMC - PubMed

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Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

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Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

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