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

Hand hygiene is an important public health 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. 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 November 2024. We included tools and implementation guidance relevant to hand hygiene in community settings, categorised as domestic, public, or institutional, and published in English by multilateral agencies and international organisations between January 1990 and November 2024. Tools and implementation guidance were mapped to an existing conceptual framework adapted for this review that includes a six-step implementation approach. We included 37 documents, comprising 33 implementation guidance documents and 4 stand-alone tools. Among these 37 documents, we identified 210 implementation recommendations and 24 unique tools for the six implementation steps. The 24 tools include 4 stand-alone tools and 20 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. Implementation guidance for hand hygiene in community settings is available yet inconsistently spread across the six implementation steps. There is also a limited number of tools available to support implementation. Future work should focus on developing comprehensive practical tools for the implementation of hand hygiene recommendations in community settings to support international guidelines.