Hand hygiene among cleaning staff in acute care hospitals: a scoping review

The aim of this study was to examine attitudes and behaviors related to hand hygiene among hospital cleaning staff and to identify promoting and inhibiting factors influencing hand hygiene behavior. In addition, existing worldwide target group-specific interventions for this occupational group were mapped.

A comprehensive literature search was conducted for publications from 2009 to 2025 in MEDLINE (via PubMed^®), the Cochrane Library, CINAHL (via EBSCO), Embase, and Scopus. Additional research was carried out in WHO IRIS, BASE, and Science.gov, and internationally applicable guidelines were identified using the TRIP Database. Included were studies from worldwide somatic acute care hospitals examining hand hygiene compliance, knowledge, attitudes, practices, influencing factors, or interventions among cleaning staff. Texts limited to other hygiene domains, airborne infections, non-acute-care settings, or study populations consisting of mixed occupational groups and not limited to cleaning staff exclusively were excluded. Literature screening was performed in two stages (title/abstract and full-text screening), and data extraction was conducted by one reviewer using a standardized extraction table.

In total, 33 sources met the inclusion criteria, comprising five guidelines, 25 full-text studies, and three conference abstracts, which formed the primary basis of this review. The conference abstracts identified during the research for which corresponding full texts were not provided were documented for the sake of completeness, but not included in the main analysis and qualitative synthesis, as relevant information may not be available due to the lack of full texts. The base of evidence was heterogeneous and predominantly descriptive, addressing knowledge, attitudes, practices, as well as promoting and inhibiting factors. Identified interventions related to infection prevention and control and hand hygiene among cleaning staff were based on the provision of target group-oriented training materials, simulation-based training, and multimodal approaches and training programs.

The findings indicate overall limited and predominantly descriptive evidence regarding hand hygiene among hospital cleaning staff. This underscores the need for methodologically diverse research as well as the development of target group-specific interventions and guidelines to strengthen infection prevention, particularly hand hygiene, in acute care hospital settings.