Quality of Hand Hygiene Performance: A Systematic Literature Review

Julia Messina G Ferreira; Vinicius S Marra; Jose Roberto Generoso Jr; Carlos H Tudino; Mariana Kim Hsieh; Isabele Pardo; Pietra Sovero Campagnoli; Luiz Eduardo Ceccon; Patricia Deffune Celeghini; Beatriz Bonini Zancopé; Mariah Pires Possebon; Lucca Miguel Duda Tavares; Beatriz Corrêa Dos Santos Seabra; Eli N Perencevich; Michihiko Goto; Michael B Edmond; Alexandre R Marra

doi:10.1016/j.ajic.2025.08.025

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Quality of Hand Hygiene Performance: A Systematic Literature Review

Journal article

Peer reviewed

Quality of Hand Hygiene Performance: A Systematic Literature Review

Julia Messina G Ferreira, Vinicius S Marra, Jose Roberto Generoso Jr, Carlos H Tudino, Mariana Kim Hsieh, Isabele Pardo, Pietra Sovero Campagnoli, Luiz Eduardo Ceccon, Patricia Deffune Celeghini, Beatriz Bonini Zancopé, …

American journal of infection control, Vol.54(2), pp.192-209

02/2026

DOI: 10.1016/j.ajic.2025.08.025

PMID: 40907706

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Abstract

Hand hygiene (HH) is essential for infection prevention in healthcare, but the quality of its performance, meaning how well it is done, receives much less attention than compliance. This review examines how HH technique is assessed and can be improved among healthcare providers. Following PRISMA guidelines, six databases were searched through May 15, 2025. Studies assessing HH performance quality in healthcare were included. Quality indicators included technique completeness, product volume, and duration. Study selection, data extraction, and risk of bias assessments were performed independently by two reviewers. Forty studies met inclusion criteria. Despite compliance rates, ranging from 23.5% to 93.2%, proper technique was often lacking. Few HH events followed all recommended steps, and frequently missed areas included fingertips, thumbs, and wrists. Alcohol-based hand rubs (ABHR) outperformed soap and water in quality and coverage. Interventions such as real-time feedback, UV markers, and augmented reality tools improved technique temporarily, though sustained improvement was rare. Educational interventions showed mixed long-term results. HH performance quality remains suboptimal even with high compliance. Future efforts should prioritize technique-focused training, innovative feedback, and simplified protocols to enhance hand hygiene quality in clinical practice.

Direct observation

Quality performance

Alcohol-based hand rubs

Guideline Adherence

Compliance

Hand hygiene

Details

Title: Subtitle: Quality of Hand Hygiene Performance: A Systematic Literature Review
Creators: Julia Messina G Ferreira - Hospital Israelita Albert Einstein
Vinicius S Marra - University of Iowa
Jose Roberto Generoso Jr
Carlos H Tudino - Hospital Israelita Albert Einstein
Mariana Kim Hsieh - University of Iowa
Isabele Pardo - Hospital Israelita Albert Einstein
Pietra Sovero Campagnoli - Hospital Israelita Albert Einstein
Luiz Eduardo Ceccon - Hospital Israelita Albert Einstein
Patricia Deffune Celeghini - Hospital Israelita Albert Einstein
Beatriz Bonini Zancopé - Hospital Israelita Albert Einstein
Mariah Pires Possebon - Hospital Israelita Albert Einstein
Lucca Miguel Duda Tavares - Hospital Israelita Albert Einstein
Beatriz Corrêa Dos Santos Seabra - Faculdade de Ciências Médicas de Santos, São Paulo, SP, Brazil
Eli N Perencevich - University of Iowa
Michihiko Goto - University of Iowa
Michael B Edmond - West Virginia University
Alexandre R Marra - University of Iowa
Resource Type: Journal article
Publication Details: American journal of infection control, Vol.54(2), pp.192-209
DOI: 10.1016/j.ajic.2025.08.025
PMID: 40907706
NLM abbreviation: Am J Infect Control
ISSN: 0196-6553
eISSN: 1527-3296
Publisher: MOSBY-ELSEVIER
Language: English
Electronic publication date: 09/02/2025
Date published: 02/2026
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984958294202771

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