Did COVID-19 improve hand hygiene practices among healthcare workers?

Adherence to hand hygiene guidelines is an important measure for reducing hospital-acquired infections and preventing the transmission of pathogens in healthcare facilities (1). Similarly, high levels of hand hygiene have been pointed out as a vital strategy for preventing the spread of COVID-19 in hospitals (2). Nevertheless, maintaining high levels of hand hygiene compliance (HHC) among healthcare workers (HCWs) has been an ongoing challenge.  

A recent study by Sandbøl et al. (2022) published in the American Journal of Infection Control investigated how the HHC of HCWs changed before and during the COVID-19 pandemic. The study involved approximately 140 HCWs in three medical departments at the Danish Regional Hospital of West Jutland from April 2019 to August 2020. HHC was measured using an automated hand hygiene monitoring system, Sani Nudge (3).

The findings showed that HHC did not increase during the COVID-19 pandemic as otherwise expected.  In fact, the analyses revealed higher hand hygiene levels in two out of three departments before the COVID-19 pandemic (3). These findings are in line with the recent study by Stangerup et al. (2021) which found that the HHC of front-line HCWs decreases over time after their data-driven feedback meetings stopped; despite the pandemic (4).


What is the cause behind low hand hygiene compliance?

Potentially, increased workload and the usage of medical gloves instead of hand disinfection may be some contributing factors to lower hand hygiene compliance (3). Moreover, a pandemic may not inevitably improve HHC in hospital settings because other variables such as stress and self-protection may play a role (5, 6). Indeed, HHC was higher after patient contact compared with before patient contact, indicating an element of self-protection in the behaviour observed.

Interestingly, one of the wards increased their HHC significantly during some weeks which was related to an increase in cases of COVID-19 patients, and the Danish Working Environment Authority effected a working environment inspection (3). The findings in the ward support previous research indicating that adherence to hand hygiene increases with a fear of acquiring infection (self-protection) and with the risk of taking the infection home to one’s family.

All in all, this, as well as, other studies have demonstrated that management focus and continuous improvement initiatives appear to be critical in assuring adherence to hand hygiene guidelines.

Sani Nudge is committed to providing cutting-edge research that contributes to the adequate evaluation of the validity and advantages of electronic hand hygiene monitoring systems. To learn more about the latest research on hand hygiene and infection prevention and control visit our clinical research site.


1. WHO. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Interim guidance. 2020; Available from: https://www.who.int/publications/i/item/10665-331495.

2. WHO. WHO Guidelines on Hand Hygiene in Health Care. First global patient safety challenge clean care is safer care. 2009; Available from: https://www.who.int/publications/i/item/9789241597906.

3. Sandbøl SG, Glassou EN, Ellermann-Eriksen S, Haagerup A. Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic. American Journal of Infection Control. 2022;0(0). doi:10.1016/j.ajic.2022.03.014

4. Stangerup M, Hansen MB, Hansen R, et al. Hand hygiene compliance of healthcare workers before and during the COVID-19 pandemic: A long-term follow-up study. American Journal of Infection Control. Published online June 2021. doi:10.1016/j.ajic.2021.06.014

5. Borg MA, Benbachir M, Cookson BD, et al. Self-Protection as a Driver for Hand Hygiene Among Healthcare Workers. Infection Control & Hospital Epidemiology. 2009;30(6):578-580. doi:10.1086/59751

6. Korniewicz DM, El-Masri M. Exploring the factors associated with hand hygiene compliance of nurses during routine clinical practice. Applied Nursing Research. 2010;23(2):86-90. doi:10.1016/j.apnr.2008.06.002


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