Reactive rather than preventive? Five-year patterns of hand hygiene compliance

Background

Healthcare-associated infections (HAIs) remain a major preventable cause of morbidity and mortality in hospitalised patients. Hand hygiene (HH) is the most effective preventive measure, yet compliance among healthcare workers (HCWs) remains suboptimal. This study aimed to assess HH compliance over a five-year period and to explore temporal trends and associated factors.

Methods

An annual HH monitoring programme based on standardized direct observation of the WHO “5 moments” has been conducted since 2021 in a large teaching hospital in Rome. Trained HCWs collected data across all wards. Temporal trends (2021–2025) and predictors of compliance were analysed using multivariable logistic regression models. Structured feedback was provided to each ward after each annual monitoring cycle.

Results

A total of 31968 HH opportunities were observed. Compliance showed a fluctuating trend, decreasing from 71.0% in 2021 to 66.3% in 2024, followed by an increase to 78.0% in 2025 (aOR 1.51; 95% CI 1.02–2.26). Compliance was consistently higher after body fluid exposure (up to 94.8%; aOR 9.06; 95% CI 7.0-11.7) and after patient contact (up to 89.1%; aOR 4.42; 95% CI 3.67-5.31), while the lowest rates were observed before patient contact (down to 51.2%). Female HCWs (aOR 1.25; 95% CI 1.14-1.36) and internal staff showed higher compliance, whereas external staff (aOR 0.61; 95% CI 0.51-0.73) and support workers had lower adherence.

Conclusions

Despite recent improvements, HH compliance remains suboptimal, particularly in preventive indications. The consistent pattern across five years suggests a predominantly reactive behaviour among HCWs rather than preventive adherence. Targeted interventions addressing high-risk moments and external staff are needed to achieve sustained improvements.

Key messages

• Healthcare workers show consistently higher compliance after exposure than before patient contact, indicating a reactive approach to hand hygiene.

• Targeted interventions focusing on high-risk moments and specific professional groups are needed to achieve sustained improvements in hand hygiene compliance.