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Compliance With Hand-Washing Guidelines Among Visitors From the Community to Acute Care Settings: A Scoping Review

Background: Health care–associated infections are widely acknowledged to be an important public health issue. Hand hygiene guidelines for health care workers are common, but remain uncommon for visitors. Purpose: The purpose of this systematic review is to examine the methodological quality of articles indicating the adherence and efficacy of hand hygiene compliance of community visitors to the acute care setting. Data Sources: Academic Search Complete, CINAHL, Cochrane Library, Medline, and PubMedß. Study Selection: A systematic literature search was conducted for articles describing hand-washing efficacy among visitors in an acute care setting using the following Medical Subject Headings (MeSH) terms: “clinical trial,” “evaluation studies,” “randomized controlled trial,” “cross infection/epidemiology,” “cross infection/prevention & control,” “hand disinfection/standards,” “intervention studies,” “guideline adherence/statistics & numerical data,” “risk factors,” “skin care/standards,” and “time factors.” Primary or secondary research studies that were published in peer-reviewed journals, written in English, and involving hospital visitor hand hygiene compliance were included. The Downs and Black (D&B) checklist was used to document the methodological quality. The Cochrane Collaborative checklist was used to assess the risk of bias. Data Synthesis: Mean D&B scores were 17/27. Baseline hand hygiene compliance for visitors was 0.5% to 11% at the hospital main entrance, 9% to 35% for general and surgical units, 11% for isolation rooms, 39% in pediatric wards, 3.95% to 49.1% at bedside, and 7% to 94% for intensive care units. Posted signs, de-germer dispensers, and pandemic influenza status all increased hand hygiene compliance over baseline observations. Limitations: Studies were generally low quality and at high risk for bias. In addition, data could not be pooled. This was attributed to the unavailability of prospective controlled trials. Substantial heterogeneity was found in the number and types of dependent variable measures. Conclusions: Visitor compliance with hand hygiene guidelines is highly variable but may be amenable to public health interventions. Higher quality studies focused on health outcomes are necessary to generate best practice recommendations related to hand hygiene.