Current international tools and guidance for the implementation of hand hygiene recommendations in community settings: a scoping review

Background Hand hygiene is an important measure to prevent disease transmission. This scoping review identifies and summarises current tools and guidance for the implementation of hand hygiene recommendations in community settings. Methods We conducted a scoping review following the Arksey and O’Malley framework. To identify relevant documents, we searched: 1) a grey literature database, 2) Google search engine, and 3) the websites of international organisations in August 2023. We included tools and implementation guidance relevant to hand hygiene in community settings, categorised as domestic, public, or institutional, and published in English by international organisations between January 1990 and August 2023. Tools and implementation guidance were mapped to an existing conceptual framework adapted for this review that includes a six-step implementation approach. Results We included a total of 35 documents, comprising 30 implementation guidance documents and 5 stand-alone tools. Among these 35 documents, we identified 207 implementation recommendations and a total of 21 tools for the six implementation steps. The 21 tools include 5 stand-alone tools and 16 tools embedded within guidance documents. Most implementation guidance was mapped to steps 1 (prepare for action), 2 (analyse the situation), 3 (develop an action plan), and 5 (monitor, evaluate, and course correct) of the conceptual framework, with limited guidance for step 4 (executing the action plan) and step 6 (cross-cutting themes). Over half of identified tools are for step 2 (analyse the situation) and primarily for undertaking a situation analysis. Only two documents provided guidance or a tool across the six steps. Conclusion Implementation guidance is available, yet inconsistently spread across the different implementation steps. There is also a limited number of tools to support implementation. Future work should focus on developing comprehensive practical tools for the implementation of hand hygiene recommendations in community settings, in line with international guidelines. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was funded by the World Health Organization and the United Kingdom Foreign, Commonwealth and Development Office. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][1]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors [1]: http://ClinicalTrials.gov