• Sinéad Lydon, Michael Power, Jennifer McSharry, Molly Byrne, Caoimhe Madden, Janet Elaine Squires, and Paul O'Connor.
• 1Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland. 2Beaumont Hospital, Dublin, Ireland. 3Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland. 4School of Nursing, University of Ottawa, Ottawa, ON, Canada. 5The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
• Crit. Care Med. 2017 Nov 1; 45 (11): e1165-e1172.

ObjectivesTo synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described.Data SourcesSystematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened.Study SelectionEnglish language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included.Data ExtractionData were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist.Data SynthesisThirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (SD= 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (SD= 195.7; range, 4.3-1155.4%) from pre to post intervention.ConclusionsThis review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.

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