Factors affecting hand hygiene adherence among critical care healthcare workers: A systematic review

Hand hygiene (HH) is the most effective and cost-efficient strategy to prevent healthcare-associated infections, yet compliance remains suboptimal, particularly in intensive care units (ICUs) and emergency departments (EDs). This study aimed to analyse the main factors influencing HH compliance among healthcare workers in critical care settings. A systematic review of studies investigating barriers to HH adherence in ICUs and EDs was conducted according to PRISMA guidelines. Thirty studies published between 1994 and 2024 were included, mostly quantitative, with sample sizes ranging from 25 to 600 healthcare workers. The review identified major structural and organizational barriers, such as limited availability of materials, time constraints, suboptimal sink placement, high workload, and overcrowding. Personal factors, including skin irritation and glove use, as well as coworkers' attitudes, were also associated with reduced compliance. Persistent contextual barriers hinder HH adherence, underscoring the need for continuous education alongside organizational, logistical, and architectural support.