A THEORETICAL FRAMEWORK FOR IMPROVING HAND HYGIENE COMPLIANCE: A SYSTEMATIC REVIEW

Abstract

Evidence before the COVID-19 outbreak indicated that healthcare workers' hand hygiene compliance had been low. Although hand hygiene compliance improved during the COVID-19 pandemic, it is necessary to plan a tailored and targeted hand hygiene promotion strategy to maintain these changes. Therefore, this review aimed to assess experimental theory-based studies on hand hygiene improvement to identify the best theory and constructs with higher effectiveness. The study design is a systematic review. The search strategy was developed, and Medline (PubMed), ProQuest, Web of Knowledge, Scopus, Cochrane Trials, and Science Direct databases were searched up to May 26, 2020, without time restrictions. Review Manager 5.1 software was used to determine the risk of bias. Irrelevant articles, non-original articles, non-interventional studies, and those that lacked a theoretical framework were excluded. A total of eight articles were entered into the final analysis, including three randomized clinical trials and five quasi-experimental studies. In the selected studies, different theories were reported at intrapersonal, interpersonal, and organizational levels. Moreover, some studies evaluated multifaceted interventions involving various levels of influence. Finally, we suggested an integrated multi-level approach to promote hand hygiene (IMAPH) with a comprehensive theoretical framework for designing the interventions.