hand hygiene in healthcare
WHO published results of a world wide Infection control survey.

WHO shares largest study of hand hygiene in healthcare

Scientists working with the World Health Organization (WHO) have undertaken the largest-scale study of the worldwide state of infection prevention in clinics and hospitals.

In a unprecedent, cross-national survey, the WHO sought to understand the global reality of infection prevention in healthcare. This ambitious study included 4,440 participating facilities in over 80 countries. Hand hygiene was a key component of this.

The team of researchers led by Sara Tomczyk from the Robert Koch Institute in Berlin and Anthony Twyman from the WHO’s Infection Prevention Department investigated the extent to which the participating hospitals implement infection prevention. The renowned journal The Lancet Infectious Diseases published the results in its February 2022 issue.

The good news at the outset is that when all 4,440 facilities are considered, implementation is generally at an advanced level (with a median score of 605 out of 800).

However, on closer inspection, there are strong differences between the so-called low-income countries with lower infection control standards compared to the countries classified as high-income.

The building blocks of infection prevention

In tackling a topic with such a daunting scope, how did the study authors collect their findings? In order to obtain as detailed a picture as possible of hand hygiene and other factors, the scientists divided an extensive questionnaire into eight topic blocks relating to infection prevention. A maximum of 100 points were available in each section, resulting in a total score of 800. The topic blocks were:

  1. Infection prevention control (IPC) programme
  2. IPC guidelines
  3. IPC education
  4. surveillance of nosocomial infections
  5. multimodal strategies
  6. monitoring, audit and feedback
  7. workload, staffing, and bed occupancy
  8. built environment

In the third block, “IPC education” health care facilities could earn points, for example, if they conducted regular hand hygiene training sessions in the various departments and evaluated them. The sixth topic included the extent to which hygiene behaviour is measured and reported back to the hospital staff. This point in particular shows a high discrepancy between the low-income countries and the rest of the nations that participated in the WHO survey.

Incidentally, the complete questionnaire, entitled “The Infection Prevention and Control (IPC) Assessment Framework (IPCAF),” can be accessed free of charge on the World Health Organization website.

Where is there still room for improvement?

Education and workload, staffing and bed occupancy scored comparatively poorly in the global survey. These two core components for infection prevention achieved a weighted median score of 70 points. 

A chart comparing the results between countries group by wealth.

Another key finding identified by the international research team is that only 15.2 percent of healthcare facilities surveyed met the WHO’s minimum requirements in all eight categories. In this area, there also exists a serious discrepancy between high-income nations and the post-colonial South.

The authors ultimately conclude their study by saying “that the challenges in the rise of antibiotic-resistant bacteria and the incidence of nosocomial infections must be addressed through further advances in infection prevention.”


[1] Tomczyk, Sara & Twyman, Anthony & Kraker, Marlieke & Rehse, Ana & Tartari, Ermira & Toledo, João & Cassini, Alessandro & Pittet, Didier & Allegranzi, Benedetta. (2022). The first WHO global survey on infection prevention and control in health-care facilities. The Lancet Infectious Diseases. 10.1016/S1473-3099(21)00809-4.


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