Evidence map›Paper›PMID 40957688›Full record

SynthesisBMJ global health2025

Minimum material requirements for hand hygiene in community settings: a systematic review.

Lilly A O'Brien, Kennedy Files, Jedidiah S Snyder, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Matthew C Freeman, Bethany A Caruso, Marlene K Wolfe

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Lilly A O'BrienGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.ORCID 0009-0004-1987-3706
Kennedy FilesGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.ORCID 0009-0001-0837-1186
Jedidiah S SnyderGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.ORCID 0000-0002-7688-4450
Hannah K RogersWoodruff Health Sciences Center Library, Emory University, Atlanta, Georgia, USA.ORCID 0000-0002-9515-1439
Oliver CummingDepartment of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.ORCID 0000-0002-5074-8709
Joanna Esteves MillsWater, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland.
Bruce GordonWater, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland.ORCID 0000-0001-8760-9377
Matthew C FreemanGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.ORCID 0000-0002-1517-2572
Bethany A CarusoHubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.ORCID 0000-0001-9738-9857
Marlene K WolfeGangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA marlene.wolfe@emory.edu.ORCID 0000-0002-6476-0450

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundThis systematic review assessed the minimum requirements necessary to create an enabling environment for sustained hand hygiene practices: quantity of water and soap, and number, spacing, location, and design of hand hygiene facilities.

methodsWe searched PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary, and consulted experts. Eligible studies were published through 29 March 2023, observational, in non-healthcare community settings, and reported on at least one of the five categories: (1) quantity of water, (2) quantity of soap, (3) location of hand hygiene materials, (4) number of users or spacing of facilities and (5) considerations for equitable access. Two reviewers independently extracted data from each study and assessed risk of bias using the Mixed Method Appraisal Tool.

resultsThis review identified 37 studies that met inclusion criteria from 27 countries, representing 4 of the 6 WHO regions (Africa, South-East Asia, the Americas and Europe). Household settings were the most represented (59% of studies), followed by institutional or school settings (41%) and public establishments (27%). Of the 37 studies, 12 (32%) assessed the relationship between a material requirement and hand hygiene practices. Despite extensive global research on hand hygiene, we found a lack of evidence linking material requirements with handwashing practices in community settings.

conclusionsThis review was limited to observational studies, and more data could be derived from experimental studies. Important evidence gaps include the quantity of water and soap needed, the influence of facility location and design on hand hygiene practice, and material needs providing equitable access. Further research is needed to strengthen the evidence base for hand hygiene recommendations and supplement the expert opinion on which many recommendations are currently based. PROSPERO REGISTRATION NUMBER: CRD42023429145.

Indexed as

Hand HygieneHand DisinfectionHumansSoapsSoapsHygienePrevention strategiesPublic Health

Identifiers

PMID40957688
PMCPMC12443185

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.