ArticleThe Lancet. Infectious diseases2022
Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019.
Article in The Lancet. Infectious diseases, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers.
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Who cites it
49 citing papers in PubMed.
- World Health Organization Multimodal Improvement Strategy for Hand Hygiene: A Stepped-Wedge Cluster Randomized Trial.JAMA network open · 2026Trial
- Baseline Characteristics of a Cluster Randomized Controlled Trial Targeting Hand Hygiene in Primary Healthcare in Burkina Faso and Mali.International journal of public health · 2025Trial
- Application of the behaviour-centred design to understand facilitators and deterrents of hand hygiene among healthcare providers: findings from a formative phase of a cluster randomised trial in the Kampala Metropolitan area.BMC health services research · 2024Trial
- Hand Hygiene Education Components Among First-Year Nursing Students: A Cluster Randomized Clinical Trial.JAMA network open · 2024Trial
- Effect of animation-based edutainment compared with pamphlet-based education on hand hygiene and HAI prevention among surgical patients: a quasi-experimental study.Infection prevention in practice · 2026Article
- Mapping policy gaps and governance challenges in Kenya's hand hygiene environment: a health policy triangle analysis.Health policy and planning · 2026Article
- Infection prevention and control measures during the COVID-19 pandemic in sub-Saharan Africa: a multinational cross-sectional study.BMJ open · 2026Article
- Patient Safety Implications of Opportunistic Pathogens and Healthcare-Associated Infections in COVID-19 Patients: A Narrative Review.Healthcare (Basel, Switzerland) · 2026Review
- Hand hygiene knowledge and practices among patients in selected health facilities of Mukono and Kagadi districts in Uganda: A cross-sectional study.IJID regions · 2026Article
- Omissions in nurses' infection prevention and control practices and their contributing factors: a CFIR-based sequential explanatory mixed-methods study.BMC nursing · 2026Article
- Hand hygiene compliance among healthcare workers at a tertiary maternity hospital in Sierra Leone: a cross-sectional study.Antimicrobial resistance and infection control · 2026Article
- Effects of clinical training on compliance with standard precautions among nursing students: a quasi-experimental study.BMC medical education · 2026Article
- High Bed Occupancy Rates in Internal Medicine Departments Are Associated with Lower Hand Hygiene Compliance.Medicina (Kaunas, Lithuania) · 2026Article
- Changes in Alcohol-Based Handrub Usage Among Hospital Staff Four Years After the COVID-19 Pandemic: A Single-Centre Observational Time-Series Study.Healthcare (Basel, Switzerland) · 2026Article
- Evaluation of hand hygiene implementation in hospitals in the post-war Tigray region of Ethiopia, using the WHO Hand Hygiene Self-Assessment Framework.Infection prevention in practice · 2025Article
- Implementation of infection prevention and control components in Italian hospitals based on a nationwide survey on behalf of INSIEME project.Scientific reports · 2025Observational
- Water, sanitation and infection control practices in rural health facilities of Jodhpur District, India: an intervention through supportive supervision.BMC health services research · 2025Article
- WHO research agenda on the role of the institutional safety climate for hand hygiene improvement: a Delphi consensus-building study.BMJ quality & safety · 2025Article
- Determinants of non-compliance with hand hygiene using a covert direct observation methodology.Infection prevention in practice · 2025Article
- A multimedia tool for infection prevention and control practices in the intensive care unit: a participatory interventional before-after study.Infection prevention in practice · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundHand hygiene is at the core of effective infection prevention and control (IPC) programmes. 10 years after the development of the WHO Multimodal Hand Hygiene Improvement Strategy, we aimed to ascertain the level of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey.
methodsFrom Jan 16 to Dec 31, 2019, IPC professionals were invited through email and campaigns to complete the online Hand Hygiene Self-Assessment Framework (HHSAF). A geospatial clustering algorithm selected unique health-care facilities responses and post-stratification weighting was applied to improve representativeness. Weighted median HHSAF scores and IQR were reported. Drivers of the HHSAF score were determined through a generalised estimation equation.
findings3206 unique responses from 90 countries (46% WHO Member States) were included. The HHSAF score indicated an intermediate hand hygiene implementation level (350 points, IQR 248-430), which was positively associated with country income level and health-care facility funding structure. System Change had the highest score (85 points, IQR 55-100), whereby alcohol-based hand rub at the point of care has become standard practice in many health-care facilities, especially in high-income countries. Institutional Safety Climate had the lowest score (55 points, IQR 35-75). From 2015 to 2019, the median HHSAF score in health-care facilities participating in both HHSAF surveys (n=190) stagnated.
interpretationMost health-care facilities had an intermediate level of hand hygiene implementation or higher, for which health-care facility funding and country income level were important drivers. Availability of resources, leadership, and organisational support are key elements to further improve quality of care and provide access to safe care for all.
fundingWHO, Geneva University Hospitals and Faculty of Medicine, and WHO Collaborating Center on Patient Safety, Geneva, Switzerland.
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