Intended for healthcare professionals


Improving hand hygiene in hospitals—more is better

BMJ 2015; 351 doi: (Published 28 July 2015) Cite this as: BMJ 2015;351:h3931
  1. Matthew P Muller, medical director, infection prevention and control
  1. 1St Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
  1. Correspondence to: mullerm{at}

The WHO-5 bundle is a good place to start, but might work better with optional extras

Hand hygiene, performed appropriately by healthcare workers, protects patients and providers from infections acquired in hospital; ultimately, good hand hygiene saves lives. Despite this, adherence to hand hygiene guidelines is unacceptably poor.1 Hospitals worldwide need to tackle this critical patient safety issue. Many hospitals have tried to improve hand hygiene. Few have been unable to achieve sustained improvements.

In a linked paper, Luangasanatip and colleagues (doi:10.1136/bmj.h3728) sought to identify interventions that improve compliance with good hand hygiene in hospital and to establish their relative efficacy through a systematic review and network meta-analysis.2 They excluded study designs at high risk of bias (such as uncontrolled before-after studies). The authors conducted a thorough literature review that identified studies published in 1980-2014.

Their review included 41 studies that met eligibility criteria, 31 of which were published after 2009, including five of the six included randomised controlled trials. Most of the evaluated interventions were “multi-modal” or “bundled” interventions that included several different components; only six studies …

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