Healthcare Consumer Hand Hygiene White Paper

Background The prevalence and impact of healthcare-associated infections (HAIs) is significant. While hand hygiene is well documented as the single most effective method to prevent HAIs, research and prevention has focused on the healthcare provider's hand hygiene. Studies validate the importance of the healthcare consumer's hand hygiene, finding consumers’ hands become a reservoir and means of transmission if not adequately cleansed. Although consumer hand hygiene is an obvious safety concern across healthcare settings, it is frequently overlooked and not routinely measured. Barriers to consumer hand hygiene include inaccessible supplies, irritating agents, lack of knowledge, forgetfulness, or lack of administrative leadership/support. Our evidence-based protocol for healthcare consumer hand hygiene addresses the roles and responsibilities of all within the healthcare community. Methods We appraised the scientific literature using Dang and Dearholt's (2018) five levels of evidence with Level 1 being the most stringent. We included fifty-four studies spanning 17 years (2002-2019); thirty-one studies published during the last 5 years in professional peer reviewed journals and twenty-three seminal studies more than 5 years old. There were 3 Level I studies, 26 Level 2 studies, 9 Level 3 studies, 15 Level 4 studies, and 1 Level 5 study. Studies differed in focus, design, methods, and included several countries, healthcare systems, and settings (hospitals, long-term care facilities, and the community), with hospitals being the most frequent setting. Results The evidence demonstrates a multi-modal approach to healthcare consumer hand hygiene is most effective. Key elements include leadership to implement and maintain high levels of adherence, education, consumer preference, and verbal and nonverbal reminders. Following implementation of a healthcare consumer hand hygiene protocol, increased rates of healthcare provider hand hygiene adherence and decreased rates of HAI were noted in the literature. Conclusions A healthcare consumer hand hygiene protocol may decrease HAIs, improve outcomes, and promote healthcare consumer engagement and satisfaction.