Improving hand hygiene in community settings: a scoping review of current international guidelines
Authors: MacLeod Clara , Braun Laura , Caruso Bethany A. , Chase Claire , Chidziwisano Kondwani , Chipungu Jenala , Dreibelbis Robert , Ejemot-Nwadiaro Regina , Gordon Bruce , Mills Joanna Esteves , Cumming Oliver 
Published: September 2022

ABSTRACTBackgroundHand hygiene is an important measure to prevent disease transmission in community settings, such as households, public spaces, workplaces, and schools. There exist various international guidelines with recommendations on how to improve hand hygiene in these settings, but no review to date has been conducted to summarise these recommendations and assess to what extent they are consistent and evidence-based.MethodsTo identify international guidelines with recommendations on hand hygiene in community settings, categorised as either domestic, public, and institutional, we performed electronic and grey literature searches and contacted expert organisations and individuals. Recommendations extracted from included guidelines were mapped to four areas related to hand hygiene: i) effective hand hygiene; ii) minimum requirements; iii) behaviour change; and iv) government measures. We assessed if recommendations were supported by peer-reviewed literature and checked their consistency and concordance across settings.ResultsWe identified 51 guidelines published between 1999 and 2021 by multilateral agencies and international non-governmental organisations containing 923 recommendations. Handwashing with soap is consistently recommended as the preferred method for hand hygiene across all community settings. Most guidelines specifically recommend handwashing with plain soap and running water for at least 20 seconds; single-use paper towels for hand drying; and alcohol-based hand rub (ABHR) as a complement or alternative to handwashing. There are inconsistent and discordant recommendations for water quality for handwashing, affordable and effective alternatives to soap and ABHR, and the design of handwashing stations. Further, there are gaps in recommendations on soap and water quantity, behaviour change approaches, and government measures required for effective hand hygiene. Overall, less than 10% of recommendations are supported by evidence.ConclusionWhile current international guidelines consistently recommend handwashing with soap in domestic, public, and institutional settings, the lack of consistent, evidence-based recommendations may constrain global efforts to ensure effective hand hygiene across community settings.KEY MESSAGESWhat is already known on this topicHand hygiene has been found to be a cost-effective intervention that can reduce the risk of certain infectious diseases.Yet, the practice of hand hygiene, and access to the facilities which enable this, is often limited in community settings, such as households, public spaces, workplaces, and schools.There are various international guidelines with recommendations on hand hygiene in community settings, but it is unclear whether guidelines provide consistent and evidence-based recommendations.What this study addsThere are 51 guidelines with over 900 recommendations for hand hygiene in community settings published by multilateral agencies and international non-governmental organisations.Guidelines consistently recommend handwashing with soap, but there are several areas of inconsistency and discordance, as well as gaps in recommendations, related to minimum requirements, behaviour change, and government measures for effective hand hygiene in community settings.Very few recommendations are supported by peer-reviewed literature.How this study might affect research, practice, or policyThis scoping review highlights a gap in global normative guidance on hand hygiene in community settings.More research is needed to address the current areas of inconsistency and discordance, and gaps in recommendations.