Factors affecting hand hygiene adherence among critical care healthcare workers: A systematic review

Brunone S, Dellisanti B, Capitani V, Rosso A, Zarro M, Bashlakova K, Ceparano M, Renzi E et al.

Journal of infection and public health, 2026

Abstract

Hand hygiene (HH) is the most effective and cost-efficient strategy to prevent healthcare-associated infections, yet compliance remains suboptimal, particularly in intensive care units (ICUs) and emergency departments (EDs). This study aimed to analyse the main factors influencing HH compliance among healthcare workers in critical care settings. A systematic review of studies investigating barriers to HH adherence in ICUs and EDs was conducted according to PRISMA guidelines. Thirty studies published between 1994 and 2024 were included, mostly quantitative, with sample sizes ranging from 25 to 600 healthcare workers. The review identified major structural and organizational barriers, such as limited availability of materials, time constraints, suboptimal sink placement, high workload, and overcrowding. Personal factors, including skin irritation and glove use, as well as coworkers' attitudes, were also associated with reduced compliance. Persistent contextual barriers hinder HH adherence, underscoring the need for continuous education alongside organizational, logistical, and architectural support.

How strong is the evidence?

Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.

How the five levels of evidence work. The level is assigned automatically from the abstract and can be wrong, so check the paper.

Read the paper

• DOI
• PubMed
• Publisher page

Related studies

• The Matrisome: In Silico Definition and In Vivo Characterization by Proteomics of Normal and Tumor Extracellular Matrices Molecular & Cellular Proteomics, 2011
• The Escherichia coli MG1655 in silico metabolic genotype: Its definition, characteristics, and capabilities Proceedings of the National Academy of Sciences, 2000
• In silico pharmacology for drug discovery: methods for virtual ligand screening and profiling British Journal of Pharmacology, 2007
• In silico prediction of splice-altering single nucleotide variants in the human genome Nucleic Acids Research, 2014
• In silico clinical trials: how computer simulation will transform the biomedical industry International Journal of Clinical Trials, 2016
• In silico optimization of a guava antimicrobial peptide enables combinatorial exploration for peptide design Nature Communications, 2018

Go deeper in Evidence Hub

Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.

Open this study Sign up free