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J Nurs Scholarsh. 2017 Mar;49(2):143-152. doi: 10.1111/jnu.12274. Epub 2017 Jan 23.

A Systematic Review on the Effectiveness of Interventions to Improve Hand Hygiene Compliance of Nurses in the Hospital Setting.

Author information

Masters Candidate, Ingram School of Nursing, McGill University, McGill University Health Centre, Montreal, QC, Canada.
Assistant to the Director, Quality, Patient Safety, and Performance McGill University Health Centre, Montreal, QC, Canada.
Associate Professor, Ingram School of Nursing, McGill University, McGill University Health Centre, Montreal, QC, Canada.



The purpose of the present systematic review is to identify the interventions that improve hand hygiene compliance (HHC) specifically among nurses.


A systematic review was performed guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to evaluate the short and long-term effects of interventions to promote hand hygiene practices among nurses in the hospital setting. A search of the Cumulative Index to Nursing and Allied Health Literature, Medline Global Health, and Embase was conducted in addition to studies identified by the most recent systematic review. Six studies met inclusion criteria: three randomized controlled trials (RCTs), one controlled before and after studies (CBAs), and two interrupted times series (ITS).


One RCT reported effectiveness and 6-month sustainability of the effect related to multimodal-directed and multimodal with team leadership-directed strategies. The other two RCTs found positive effect of education and feedback on compliance; however, compliance rates declined after 1 month. Education was also found to improve HHC up to 3 months postintervention. An electronic reminder and feedback system evaluated by an ITS improved HHC and detected variation in HHC through the day.


This review showed that single and combined interventions do improve hand hygiene practices among nurses; however, there is a need for more methodologically robust studies to define the most effective and sustainable interventions.


Although hand hygiene is the most effective measure to prevent healthcare-associated infections, compliance with hand hygiene remains low. Nurses are among the healthcare providers who spend the most time in direct patient contact. Therefore, there is a need for research to identify the interventions that improve HHC in this group.


Hand hygiene compliance; hospital setting; nurses; systematic review

[Indexed for MEDLINE]

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