Hand hygiene compliance among hospital visitors: A systematic review and meta-analysis of observational studies.

Background: Hand hygiene is a crucial measure for preventing the spread of healthcare-associated infections. While healthcare workers receive emphasis, hospital visitor hand hygiene compliance is limited.

Aim: To investigate hand hygiene compliance among hospital visitors.

Methods: A comprehensive search of four databases (PubMed, Embase, Scopus, ScienceDirect) and a hand search were performed from inception to October 2023. Observational studies in hospital settings were included if estimates for adult hospital visitors' observation were reported. Joanna Briggs Institute critical appraisal checklist was used to assess the risk of bias in the included studies. Meta-analysis was conducted using STATA software version 17 to estimate a weighted pooled compliance rate with a 95% confidence interval.

Results: 17 studies were included in this study. The pooled hand hygiene compliance among hospital visitors was 37% (95% CI: 25 - 49). Subgroup analysis revealed that in low-middle-income countries, covert observation, ICU and various ward studies, longer observation durations, measuring hand hygiene at entrance and exit points, and smaller sample sizes were all associated with higher visitor hand hygiene compliance rates.

Discussion: The visitor hand hygiene compliance rate was notably low, much lower than that reported for doctors and nurses. This significant difference highlights the urgent need for focused attention and interventions to improve visitor hand hygiene practices.