Geneva, 12 May 2023: On 5 May - World Hand Hygiene Day – the World Health Organization (WHO) released its first-ever research agenda on hand hygiene in health care. The WHO research for hand hygiene in health care 2023–2030: summary provides guidance on the highest priorities for research to gather further evidence on best approaches to improve hand hygiene practices during health care delivery, as well as to accelerate innovative solutions.
During the two-years long consultative process with a large group of experts from around the world, 192 research priorities were identified, of which 178 achieved the consensus. The summary released on 5 May lists 21 highest research priorities in six key areas, including impact of communication on health workers' behaviour, institutional safety climate, and impact of hand hygiene on health care-associated infections (HAIs) and antimicrobial resistance (AMR). A full document covering all research priorities in the six identified domains will be issued at a later stage.
Evidence from countries shows that, despite being vital for safe health delivery, hand hygiene practices at the point of care remain suboptimal worldwide. Average hand hygiene compliance without specific improvement interventions remains at around 40%, while in critical care, such as intensive care units, average compliance levels are around 60%. Significant disparities between high- and lower-income countries exist. Clearly, a better understanding of factors influencing hand hygiene behaviour is needed, as is prioritization of research areas where gaps still exist.
The purpose of the agenda is to also generate data and evidence to enable national and health-facility-level policy and decision makers to scale up and accelerate hand hygiene improvement by choosing most effective and cost-effective strategies and interventions and reduce the risk of HAIs and and AMR in health care.
HAIs are among the most frequent adverse events occurring in the context of health service delivery and represent a significant threat to health of the people around the globe. They harm patients, health workers and strain health budgets. According to WHO's 2022 report, out of every 100 patients in acute-care hospitals, seven patients in high-income countries and 15 patients in low- and middle-income countries will acquire at least one HAI during their hospital stay.
There is compelling evidence that IPC interventions, including hand hygiene practices, can achieve 35 to 70% reduction in the rates of HAIs. In addition to being significantly beneficial in preventing infections, IPC programmes are the "best buy" for decision makers, resulting in at least seven-fold return for each 1 US$ invested. Improving hand hygiene in health care settings represents an excellent return on investment: it could save up to US$ 16.5 in health care expenditure for every 1 US$ spent.
Advancing the quality of evidence on hand hygiene improvement strategies through the research agenda will ultimately result in more efficient and cost-effective IPC programmes, improved quality and safety of care, and better patient outcomes.
Many of the infections acquired in health care settings can be prevented and avoided by hand hygiene in health care facilities, and yet, half of health care facilities worldwide lack basic hygiene services with water and soap or alcohol-based hand rub where patients receive care, and at toilets. Around 3.85 billion people use these facilities, putting them at greater risk of infection, including 688 million people who receive care at facilities with no hygiene services at all.
Clean hands keep patients and health workers safe and there are solutions even where infrastructure and resources are limited. Investing in water, sanitation hygiene (WASH) services in health care facilities would incur only modest funding – only 3% of current government health spending in least-developed countries. The investments would bring large gains that extend beyond preventing infections to an increased uptake of services, increased staff morale, and improved efficiency in delivering health services.
Effective IPC measures and WASH services in health care facilities are the foundation of quality care. Primary care settings - the first point of entry into the health system for many people – require special attention and innovative approaches, not the least as recent data demonstrated that IPC is significantly less implemented in primary care than in hospitals. The global survey from 2019 revealed the urgent need to strengthen and scale up IPC intervention in primary care: no facility met all WHO minimum requirements for IPC in low-income countries, while in high-income ones, only 26% did.
To support countries' efforts to improve IPC in primary health care settings – an area of focus for the WHO Infection Prevention and Control Hub (IPC Hub) over the past several years – the IPC Hub launched on 5 May a host of new resources, including a new webpage on basic IPC and primary care, a new IPC assessment tool for primary care facilities and a practical and intuitive infographic and inventory document on the prevention of surgical site infection for primary care settings.
