Optimizing Hand Hygiene Protocols in Emergency Settings: A Systematic Review and Meta-Analysis of Agent, Technique, and Procedural Dura-tion
Archives of Academic Emergency Medicine,
Vol. 14 No. 1 (2026),
1 October 2025
,
Page e62
https://doi.org/10.22037/aaem.v14i1.3160
Abstract
Introduction: Hand hygiene is essential for infection prevention, but in busy clinical settings such as emergency departments (EDs), recommended protocols are often performed incompletely. This study aimed to review agent effectiveness, technique complexity, and procedural duration, trying to optimize the hand hygiene protocol in the ED setting. Methods: We conducted a systematic review and meta-analysis (PROSPERO CRD420261303149; PRISMA 2020) comparing alcohol-based hand rub (ABHR)-inclusive strategies with washing or antiseptic comparators, the simplified 3-step technique with the World Health Organization (WHO) 6-step technique, and shortened with standard or longer application durations. PubMed, Cochrane CENTRAL, and Scopus were searched for studies published from 2016 to January 2026. Eligible studies enrolled healthcare workers, students, caregivers, or volunteers and reported quantitative microbiological outcomes. Risk of bias was assessed with RoB 2 and Joanna Briggs Institute tools, certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and effects were pooled using random-effects models of Hedges’ g. Results: Twenty-five studies were included. ABHR-inclusive strategies showed a non-significant trend toward lower microbial burden than washing or antiseptic comparators (g = −0.62, 95% confidence interval (CI): −1.32 to 0.09; I² = 88.8%); excluding one study comparing alcohol gel with 2% chlorhexidine foam strengthened the effect (g = −0.91, 95% CI: −1.42 to −0.40; I² = 67.9%). The simplified 3-step and WHO 6-step techniques showed negligible differences (g = −0.01, 95% CI: −0.46 to 0.44; I² = 87.4%). Shortened durations showed a small, non-significant effect favoring longer durations (g = −0.40, 95% CI: −0.87 to 0.08; I² = 50.9%). Certainty of evidence was very low to low, and the included studies were conducted in intensive care units, operating rooms, and laboratory simulations rather than emergency settings. Conclusion: Selected protocol modifications may achieve comparable microbiological performance and could be attractive where contact time limits compliance, as in resuscitation, triage, and trauma care, but pragmatic non-inferiority trials, including in emergency settings, are needed before guideline modification.
- Hand Hygiene
- Hand Disinfection
- Infection Control
- Meta-Analysis
- Emergency Medicine
How to Cite
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