Facilitators and Barriers to Hand Hygiene Compliance Among Health Care Providers in Hospital Settings: A Qualitative Systematic Review

Healthcare-associated infections pose a significant challenge to patient safety, and hand hygiene plays a vital role. This review intended to identify the barriers and facilitators to hand hygiene compliance among doctors, nurses, and students directly involved in patient care in hospitals. A comprehensive search was conducted in PubMed, CINAHL, Scopus, Web of Science, ClinicalKey, and ProQuest. The Patricia J Lucas 4-step approach to thematically analyze the data was adopted. A total of eight themes encompassing both facilitators and barriers, such as professional and moral identity: from "do no harm" to moral distress, protection of self and family: selective risk focus, workload, time pressure and competing priorities: pragmatism under strain, social modeling and norms: positive exemplars versus negative contagion, feedback, hierarchy and interdisciplinary climate, knowledge, training and misconceptions: from ritual to resistance, gloving, shortcuts and subjective risk: workarounds to an unrealistic ideal, and infrastructure, products and the material environment, were identified and mapped across the levels of the Social Ecological Model. Healthcare personnel's facilitators and barriers to utilizing hand hygiene practices should be considered when developing strategies to reduce infections.