This Blog was written by Claire Kilpatrick & Lucy Gozdzielewska
Happy Global Handwashing Day!
Did you know that Global Handwashing Day was first stimulated by a “disgustologist”– Dr Val Curtis of the London School of Hygiene and Tropical Medicine? The Global Handwashing Day started being commemorated in 2009, and is held annually on 15 October
A Nursing Times article authored by Lucy Gozdzielewska and Claire Kilpatrick of the SHIP team, published in August 2025, brings us right up to date. It provided a comprehensive overview of evidence-based hand hygiene practices in healthcare, focusing specifically on the application of alcohol-based hand rubs (ABHR) as a critical public health intervention to prevent healthcare-associated infections (HAI). It highlights that compliance involves both performing hand hygiene at the World Health Organization’s (WHO) “Five Moments” and using the correct technique and volume of product. The paper discussed the WHO-recommended six-step technique (also known as Ayliffe technique), noting its effectiveness in reducing bacterial load despite low compliance rates observed in clinical practice, possibly due to its complexity. Furthermore, the paper examined key factors affecting hand-rubbing quality, including the volume of ABHR applied (recommending a palmful) and the duration of rubbing (recommending at least 20 seconds, or until hands are dry). Finally, it underscored the pivotal role of nurses in implementing, championing, and influencing the future research agenda for improved hand hygiene and patient safety.
We have known for many years that adherence to hand hygiene recommendations are often low, across all countries of the world.
Many years ago, visualisation of the impact of poor hand hygiene was demonstrated by the powerful work of Dr Lemonia Ftkia in Chesterfield Hospitals. Dr Ftkia spread UV powder around the ward area and tracked where hands took that powder. As noted in the photograph (Figure 1), it ended up under the bandage at the IV-line site of an elderly patient. Shocking!
Being able to see where potentially harmful germs spread when hands are not clean, particularly in relation to the WHO 5 Moments recommendations, can re-stimulate those in healthcare to think again about patient’s and health worker’s safety at the most critical times.
The aforementioned WHO research agenda provides a renewed focus on what we need to know moving forward to address the prevailing gaps and covers areas that have been outlined since 2009 by WHO as the multimodal improvement strategy – system change, training and education, evaluation and feedback, reminders and communication, as well as the impact of hand hygiene improvement on HAI and antimicrobial resistance. Some of the priorities are outlined in the recent Nursing Times article: identifying the most effective and feasible hand-rubbing technique, determining the optimal hand-rubbing duration, and better understanding of how ABHR volumes could be standardised or customised for the individual to achieve the best results.
However, it’s not just healthcare where further action needs to be taken.
On the occasion of Global Handwashing Day, WHO will launch a new guideline on hand hygiene in communities, which compliments those available guidelines for healthcare, which were published in 2009. The new guideline work was driven by the COVID-19 pandemic and under the auspices of the Hand Hygiene For All initiative led by WHO and UNICEF. The COVID-19 pandemic highlighted the importance of hand hygiene as a public health intervention and political commitments promised to improve access to hand hygiene facilities globally. The recently launched BMJ articles associated with these new guidelines stressed that “We have the evidence but governments must now build the systems to deliver on hand hygiene.”
A systematic review on the effectiveness of hand hygiene for preventing transmission of novel coronavirus or influenza infections in the community, published in 2022, showed that hand hygiene can help reduce the spread of COVID-19, SARS, and influenza, but the evidence comes from studies that were generally small or of weak quality. The review highlighted the need for more research to determine how often and when hand hygiene should be done and to develop better ways to encourage good hand hygiene habits. Even in healthcare, where workers are trained in hand hygiene, guidelines are clear, and compliance is monitored, hand hygiene compliance is often poor. With the general public likely devoid of consistent training, reminders and simple direction or guidelines, promoting hand hygiene in communities presents an even greater challenge.
All of this demonstrates that improving hand hygiene is complex and multifaceted. To protect those in healthcare, other workplaces, and in communities from prevailing diseases, more needs to be done. This includes high-quality research to identify the most effective hand hygiene techniques, product volumes and durations, studies to determine how often and when hand hygiene should be performed, and work to develop better ways to encourage consistent hand hygiene habits in both healthcare and other settings. As the new guidelines outline, efforts should also focus on improving access to hand hygiene facilities. By addressing the prevailing gaps, we can strengthen the impact of hand hygiene as a critical public health measure and move closer to a world where hand hygiene is practiced consistently and effectively by everyone.
To learn more about public engagement and science communication please visit UK Research and Innovation’s website (UKRI).
To find out more about the SHIP team head on to the GCU website, read some more of our blogs, follow us on Twitter, and connect with us on LinkedIn.