An assessment of the impact of educational interventions on hand hygiene compliance

  • Carla Husband University of Bristol
  • Abbie McMillan University of Bristol
  • Lauren Sweeney University of Bristol



Open Access Logo



PICO question

In small animal veterinary professions, does implementation of an educational intervention, when compared to no intervention, improve hand hygiene compliance?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

Three papers were critically appraised. They were all prospective observational cohort studies

Strength of evidence


Outcomes reported

Two out of the three papers did not find educational implementation to have a statistically significant positive effect on hand hygiene compliance (HHC) in small animal veterinary professionals


The veterinary evidence reviewed does not provide strong justification for the use of education in the improvement of HHC in small animal practice. This contrasts with extensive human evidence which supports the use of educational interventions (Helder et al., 2010).  However, a limited veterinary knowledge base in the field of HH, combined with the flawed methodologies of the appraised literature, suggests that this finding is not representative of the effect education could have on HHC.

The conclusion drawn from the evidence assessed within this Knowledge Summary is that educational interventions are not significantly linked to an improvement in HHC within a small animal veterinary setting. When considering the volume of human evidence which supports education as a tool to improve HHC, the authors suggest this Knowledge Summary should be repeated in the future when additional veterinary evidence is available to reassess the conclusion drawn


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed

Author Biographies

Carla Husband, University of Bristol

Final year BSc Veterinary Nursing and Bioveterinary Science student at the University of Bristol

Abbie McMillan, University of Bristol

Final year BSc Veterinary Nursing and Bioveterinary Science student at the University of Bristol

Lauren Sweeney, University of Bristol

Final year BSc Veterinary Nursing and Bioveterinary Science student at the University of Bristol


Anderson, M., Sargeant, J. and Weese, J. (2014). Video observation of hand hygiene practices during routine companion animal appointments and the effect of a poster intervention on hand hygiene compliance. BMC Veterinary Research, 10(1), pp.106. DOI:

Chang, N., Reisinger, H., Jesson, A., Schweizer, M., Morgan, D., Forrest, G. and Perencevich, E. (2016). Feasibility of monitoring compliance to the My 5 Moments and Entry/Exit hand hygiene methods in US hospitals. American Journal of Infection Control, 44(8), pp.938–940. DOI:

Committee on the National Needs for Research in Veterinary Science, Board on Agriculture and Natural Resources, Division on Earth and Life Studies, and National Research Council (2005). The role of veterinary research in human society. Critical Needs for Research in Veterinary Science. National Academic Press. Washington, D.C. pp. 13–20. DOI:

Dubbert, P., Dolce, J., Richter, W., Miller, M. and Chapman, S. (1990). Increasing ICU Staff Handwashing: Effects of Education and Group Feedback. Infection Control & Hospital Epidemiology, 11(4), pp. 191–193. DOI:

Eckmanns, T., Bessert, J., Behnke, M., Gastmeier, P. and Rüden, H., (2006). Compliance With Antiseptic Hand Rub Use in Intensive Care Units The Hawthorne Effect. Infection Control & Hospital Epidemiology, 27(9), pp.931–934. DOI:

Helder, O., Brug, J., Looman, C., van Goudoever, J. and Kornelisse, R. (2010). The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison. International Journal of Nursing Studies, 47(10), pp.1245–1252. DOI:

Kurz, T., Gardner, B., Verplanken, B. and Abraham, C. (2014). Habitual behaviors or patterns of practice? Explaining and changing repetitive climate-relevant actions. Wiley Interdisciplinary Reviews: Climate Change, 6(1), pp.113–128. DOI:

Mann, A. (2017). The importance of hand hygiene. Veterinary Nursing Journal, 32(3), pp.82–85. DOI:

Morgan, D., Pineles, L., Shardell, M., Graham, M., Mohammadi, S., Forrest, G., Reisinger, H., Schweizer, M. and Perencevich, E. (2013). The Effect of Contact Precautions on Healthcare Worker Activity in Acute Care Hospitals. Infection Control & Hospital Epidemiology, 34(1), pp.69–73. DOI:

Mosley, C., Mosley, J., Bell, C., Aitchison, K., Rhind, S. and MacKay, J. (2019). Teaching best practice in hand hygiene: student use and performance with a gamified gesture recognition system. Veterinary Record, 185(14), pp.444. DOI:

Phan, H., Tran, H., Tran, H., Dinh, A., Ngo, H., Theorell-Haglow, J. and Gordon, C. (2018). An educational intervention to improve hand hygiene compliance in Vietnam. BMC Infectious Diseases, 18(1). DOI:

Randle, J., Clarke, M. and Storr, J. (2006). Hand hygiene compliance in healthcare workers. Journal of Hospital Infection, 64(3), pp.205–209. DOI:

Scherer, A., Reisinger, H., Goto, M., Goedken, C., Clore, G., Marra, A., Chasco, E., Evans, C., Rubin, M. and Perencevich, E. (2018). Testing a novel audit and feedback method for hand hygiene compliance: A multicenter quality improvement study. Infection Control & Hospital Epidemiology, 40(1), pp.89–94. DOI:

Shea, A. and Shaw, S. (2012). Evaluation of an educational campaign to increase hand hygiene at a small animal veterinary teaching hospital. Journal of the American Veterinary Medical Association, 240(1), pp.61–64. DOI:

Smith, J., Packman, Z. and Hofmeister, E. (2013). Multimodal evaluation of the effectiveness of a hand hygiene educational campaign at a small animal veterinary teaching hospital. Journal of the American Veterinary Medical Association, 243(7), pp.1042–1048. DOI:

World Health Organization (2009). My 5 Moments for Hand Hygiene.

World Health Organization (2019). WHO | Hand hygiene monitoring and feedback.

Yin, J., Reisinger, H., Weg, M., Schweizer, M., Jesson, A., Morgan, D., Forrest, G., Graham, M., Pineles, L. and Perencevich, E. (2014). Establishing Evidence-Based Criteria for Directly Observed Hand Hygiene Compliance Monitoring Programs: A Prospective, Multicenter Cohort Study. Infection Control & Hospital Epidemiology, 35(9), pp.1163–1168. DOI:

Vol. 5 No. 3 (2020): The third issue of 2020

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /