The Effectiveness of Interventions in Improving Hand Hygiene Compliance: A Meta-Analysis and Logic Model

Table 2

A logic model based on a socioecological approach delineating inputs, processes, and outcomes to improve hand hygiene compliance.

Situational analysis	Intervention target	Target audience	Change objectives	Theory	Methods	Activities	Short-term outcomes	Medium-term outcomes	Long-term outcomes
	Influence individuals	Healthcare workers (HCWs), patients	Hand hygiene compliance	(i) Theory of Planned Behavior (TPB); (ii) Freire’s model of adult education	(i) Discussion; (ii) Problem-based learning; (iii) Guided exploration	(i) Identifying the advantages and disadvantages of performing hand hygiene; (ii) Determining people whose approval is important for the person to do hand hygiene; (iii) Identifying barriers to performing hand hygiene; (iv) Identifying facilitators to performing hand hygiene; (v) Brainstorming root causes of poor hand hygiene adherence; (vi) Personalizing the issue and using role-plays to generate emotions	(i) Improved knowledge, perception, and attitudes about hand hygiene compliance	(i) Compliance with the WHO “5 moments of hand hygiene” responsibly; (ii) Sustained improvement in hand hygiene	(i) Reduced nosocomial infections
	Influence interpersonal level	Coworkers and supervisors	Supportive behavior; Emotional, informational, appraisal, and instrumental support	(i) Social norms theory	(i) The train-the-trainer method	(i) Participatory discussions between HCWs about hand hygiene compliance; (ii) Creation of new knowledge in a selected group of participants; (iii) Sharing knowledge with others	(i) Improved social norms about hand hygiene in workplace	(i) Social approval for hand hygiene compliance; (ii) HCWs imitate each other in performing hand hygiene; (iii) Sustained improvement in hand hygiene
	Influence organizational level	Decision-makers	Supportive environment: policies and regulations	Organizational change theory	(i) Planning; (ii) Monitoring; (iii) Reviewing; (iv) Rewarding	(i) Designing new and innovative policy for improving hand hygiene; (ii) Providing the essential materials and equipment for hand hygiene compliance; (iii) Continuous monitoring of hand hygiene compliance among staff and patients; (iv) Appropriate reaction to hand hygiene behavior at the right time and place; (v) Performance review with employee self-assessment; (vi) Encouragement of wards that have the highest hand hygiene and the lowest nosocomial infections	(i) Responsive policy for improving hand hygiene	(i) Sustained leadership; (ii) Continuous evaluation; (iii) Sufficient facilities; (iv) Sustained improvement in hand hygiene