Lilly A O'Brien, Kennedy Files, Jedidiah S Snyder, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Matthew C Freeman, Bethany A Caruso, Marlene K Wolfe
{"title":"Minimum material requirements for hand hygiene in community settings: a systematic review.","authors":"Lilly A O'Brien, Kennedy Files, Jedidiah S Snyder, Hannah K Rogers, Oliver Cumming, Joanna Esteves Mills, Bruce Gordon, Matthew C Freeman, Bethany A Caruso, Marlene K Wolfe","doi":"10.1136/bmjgh-2025-018926","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This systematic review assessed the minimum requirements necessary to create an enabling environment for sustained hand hygiene practices: quantity of water and soap, and number, spacing, location, and design of hand hygiene facilities.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary, and consulted experts. Eligible studies were published through 29 March 2023, observational, in non-healthcare community settings, and reported on at least one of the five categories: (1) quantity of water, (2) quantity of soap, (3) location of hand hygiene materials, (4) number of users or spacing of facilities and (5) considerations for equitable access. Two reviewers independently extracted data from each study and assessed risk of bias using the Mixed Method Appraisal Tool.</p><p><strong>Results: </strong>This review identified 37 studies that met inclusion criteria from 27 countries, representing 4 of the 6 WHO regions (Africa, South-East Asia, the Americas and Europe). Household settings were the most represented (59% of studies), followed by institutional or school settings (41%) and public establishments (27%). Of the 37 studies, 12 (32%) assessed the relationship between a material requirement and hand hygiene practices. Despite extensive global research on hand hygiene, we found a lack of evidence linking material requirements with handwashing practices in community settings.</p><p><strong>Conclusions: </strong>This review was limited to observational studies, and more data could be derived from experimental studies. Important evidence gaps include the quantity of water and soap needed, the influence of facility location and design on hand hygiene practice, and material needs providing equitable access. Further research is needed to strengthen the evidence base for hand hygiene recommendations and supplement the expert opinion on which many recommendations are currently based.</p><p><strong>Prospero registration number: </strong>CRD42023429145.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 7","pages":""},"PeriodicalIF":6.1000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443185/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Global Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjgh-2025-018926","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Background: This systematic review assessed the minimum requirements necessary to create an enabling environment for sustained hand hygiene practices: quantity of water and soap, and number, spacing, location, and design of hand hygiene facilities.
Methods: We searched PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary, and consulted experts. Eligible studies were published through 29 March 2023, observational, in non-healthcare community settings, and reported on at least one of the five categories: (1) quantity of water, (2) quantity of soap, (3) location of hand hygiene materials, (4) number of users or spacing of facilities and (5) considerations for equitable access. Two reviewers independently extracted data from each study and assessed risk of bias using the Mixed Method Appraisal Tool.
Results: This review identified 37 studies that met inclusion criteria from 27 countries, representing 4 of the 6 WHO regions (Africa, South-East Asia, the Americas and Europe). Household settings were the most represented (59% of studies), followed by institutional or school settings (41%) and public establishments (27%). Of the 37 studies, 12 (32%) assessed the relationship between a material requirement and hand hygiene practices. Despite extensive global research on hand hygiene, we found a lack of evidence linking material requirements with handwashing practices in community settings.
Conclusions: This review was limited to observational studies, and more data could be derived from experimental studies. Important evidence gaps include the quantity of water and soap needed, the influence of facility location and design on hand hygiene practice, and material needs providing equitable access. Further research is needed to strengthen the evidence base for hand hygiene recommendations and supplement the expert opinion on which many recommendations are currently based.
背景：本系统综述评估了为持续的手卫生习惯创造有利环境所需的最低要求：水和肥皂的数量，以及手卫生设施的数量、间隔、位置和设计。方法：检索PubMed、Web of Science、EMBASE、CINAHL、Global Health、Cochrane Library、Global Index Medicus、Scopus、PAIS Index、WHO IRIS、UN Digital Library和World Bank Library，并咨询专家。在2023年3月29日之前，在非卫生保健社区环境中发表了符合条件的观察性研究，并报告了以下五个类别中的至少一个：(1)水的数量，(2)肥皂的数量，(3)手卫生材料的位置，(4)使用者人数或设施间隔，以及(5)公平获取的考虑。两名审稿人分别从每项研究中提取数据，并使用混合方法评估工具评估偏倚风险。结果：本综述确定了来自27个国家的37项符合纳入标准的研究，代表了世卫组织6个区域中的4个（非洲、东南亚、美洲和欧洲）。家庭环境最具代表性（59%的研究），其次是机构或学校环境（41%）和公共机构（27%）。在37项研究中，12项（32%）评估了物质需求与手卫生习惯之间的关系。尽管全球对手卫生进行了广泛的研究，但我们发现缺乏将物质要求与社区环境中的洗手习惯联系起来的证据。结论：本综述仅限于观察性研究，更多的数据可以从实验研究中获得。重要的证据缺口包括所需水和肥皂的数量、设施位置和设计对手部卫生习惯的影响，以及提供公平获取的物质需求。需要进一步的研究来加强手卫生建议的证据基础，并补充目前许多建议所依据的专家意见。普洛斯彼罗注册号：CRD42023429145。
期刊介绍：
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.
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