The Impact of a Hand Hygiene Education Program in Long-Term Care Facilities in Korea

Korea's rapid population aging has increased demand for long-term care facilities (LTCFs). Because LTCFs are vulnerable to infectious disease outbreaks, consistent hand hygiene (HH) practices among caregivers are essential. We evaluated an LTCF-tailored HH education program with measurement of caregiver compliance.

HH compliance rate (HHCR) was defined as the proportion of performed HH actions among the observed WHO five moments. In 2025, 17 LTCFs participated; 13 received HH education. Nine LTCFs also participated in 2024 (three received education in 2024, all nine in 2025). Facility-level effects of 2025 education were assessed using generalized linear mixed-effects models, and caregiver-level HH monitoring was analysed separately.

Education was associated with a greater improvement in HHCR from the first to second half monitoring periods in 2025 (interaction adjusted odds ratio, 8.83; 95% confidence interval [CI], 2.25-34.61; P=0.004). In the two-year enrolled facilities (n=9), 2025 HHCR differed by 2024 education status and monitoring periods (three-way interaction, P=0.008). Within 2024, facilities receiving education in 2024 showed greater HHCR improvement (odds ratio, 58.72; 95% CI, 5.42-635.87; P=0.002). In caregiver-level analyses for second half of 2025, HHCR was higher among educated caregivers than among non-educated (median, 80.0% vs. 12.0%; P=0.002). The weakest HH moment was before touching; education was associated with higher compliance before touching, before a clean procedure, and after body fluid exposure risk.

In the multi-district study of 17 LTCFs, an in-person HH education program was associated with improved caregiver compliance. These findings support expanding and sustaining HH education across Korean LTCFs.