Recommendations for hand hygiene in community settings: a scoping review of current international guidelines

• Type of Material: Article
• Authors: Clara MacLeod, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases; Laura Braun, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases; Bethany A Caruso, Emory University; Claire Chase, World Bank Group, Washington; Kondwani Chidziwisano, Malawi University of Business and Applied Sciences; Jenala Chipungu, Center for Infectious Disease Research in Zambia; Robert Dreibelbis, London School of Hygiene and Tropical Medicine; Regina Ejemot-Nwadiaro, University of Calabar, Nigeria; Bruce Gordon, WHO, Geneva, Switzerland; Joanna Esteves Mills, WHO, Geneva, Switzerland; Oliver Cumming, London School of Hygiene and Tropical Medicine
• Language: English
• Date: 2023-06-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © 2023 BMJ Publishing Group Ltd
• License: Creative Commons Attribution 3.0 IGO License
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjopen-2022-068887
• Title of Journal or Parent Work: BMJ OPEN
• Volume: 13
• Issue: 6
• Start Page: e068887
• End Page: e068887
• Grant/Funding Information: This research was funded by the WHO and the UK Foreign, Commonwealth and Development Office.
• Keywords: public health; Science & Technology; Life Sciences & Biomedicine; EFFICACY; HANDWASHING PRACTICES; RISK; WATER; General & Internal Medicine; PROMOTION; BEHAVIOR; DRYING METHODS; COVID-19; DIARRHEA; Medicine, General & Internal
• Research Categories: Health Sciences, Public Health; Health Sciences, Hygiene; Health Sciences, Medicine and Surgery

Abstract

Background Hand hygiene is an important measure to prevent disease transmission. Objective To summarise current international guideline recommendations for hand hygiene in community settings and to assess to what extent they are consistent and evidence based. Eligibility criteria We included international guidelines with one or more recommendations on hand hygiene in community settings - categorised as domestic, public or institutional - published by international organisations, in English or French, between 1 January 1990 and 15 November 2021. Data sources To identify relevant guidelines, we searched the WHO Institutional Repository for Information Sharing Database, Google, websites of international organisations, and contacted expert organisations and individuals. Charting methods Recommendations were mapped to four areas related to hand hygiene: (1) effective hand hygiene; (2) minimum requirements; (3) behaviour change and (4) government measures. Recommendations were assessed for consistency, concordance and whether supported by evidence. Results We identified 51 guidelines containing 923 recommendations published between 1999 and 2021 by multilateral agencies and international non-governmental organisations. Handwashing with soap is consistently recommended as the preferred method for hand hygiene across all community settings. Most guidelines specifically recommend handwashing with plain soap and running water for at least 20 s; single-use paper towels for hand drying; and alcohol-based hand rub (ABHR) as a complement or alternative to handwashing. There are inconsistent and discordant recommendations for water quality for handwashing, affordable and effective alternatives to soap and ABHR, and the design of handwashing stations. There are gaps in recommendations on soap and water quantity, behaviour change approaches and government measures required for effective hand hygiene. Less than 10% of recommendations are supported by any cited evidence. Conclusion While current international guidelines consistently recommend handwashing with soap across community settings, there remain gaps in recommendations where clear evidence-based guidance might support more effective policy and investment.