Hand hygiene after the COVID-19 pandemic: Is it still at a high level?

Hand hygiene (HH) is crucial for preventing healthcare-associated infections (HAIs), with compliance notably increasing during the COVID-19 pandemic. Whether this adherence can be sustained remains uncertain. We sought to assess changes in HH compliance following the pandemic and explore its correlation with HAIs.

A longitudinal study was launched to assess HH compliance and HAIs across two phases. Phase 1 spanned from October 2021 to January 2023, a period of normalized prevention and control of COVID-19, while phase 2 extended from February 2023 to July 2024, following the downgrade in the management of COVID-19. Observers recorded HH practices. HAIs were identified through using semi-automated, continuous surveillance software. Pearson correlation coefficient (rs) was used to evaluate the relationship between HAIs and HH.

A total of 2,233 HH opportunities were observed with 966 during Phase 1 and 1,267 in Phase 2. Compliance with HH significantly declined from 90.27% (95% CI: 85.34% to 95.4%) in Phase 1 to 82.56% (95% CI: 80.35% to 84.61%) in Phase 2 (P < 0.001). Concurrently, the incidence of HAI rose notably from 16.79‰ (95% CI: 16.20‰ to 17.39‰) to 18.71‰ (95% CI: 18.20‰ to 19.24‰) (P < 0.001). However, despite these concurrent trends, monthly analysis found no statistically significant correlation between HH compliance and HAI incidence (rs = -0.296; P = 0.0897).

As the pandemic threat waned, maintaining high HH compliance became challenging, indicating it's time to implement additional strategies. Moreover, the correlation between HH and HAI requires further study to uncover.