{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:02:44Z","timestamp":1785812564582,"version":"3.56.0"},"posted":{"date-parts":[[2026,7,31]]},"group-title":"Public and Global Health","reference-count":79,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Hand hygiene is a core component of infection prevention and control, yet evidence on the effectiveness of hand hygiene interventions in health-care facilities in low-income and middle-income countries has not been comprehensively synthesized alongside implementation barriers and enablers. We assessed the effectiveness of hand hygiene interventions in these settings and examined implementation conditions shaping success.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a systematic review drawing on a University of North Carolina evidence map of environmental health services in low-income and middle-income country health-care facilities, which searched PubMed, Scopus, and Global Health and was supplemented by hand-searching. Hand-hygiene-specific records were restricted to peer-reviewed English-language studies published between Jan 1, 2015, and Nov 28, 2025; backward citation chasing identified additional eligible records. Random-effects meta-analysis was done for studies with extractable pre-intervention and post-intervention hand hygiene compliance data. Other outcomes were synthesized using effect-direction methods. Barriers and enablers were synthesized thematically. The protocol was registered with PROSPERO, CRD420251252831.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>We screened 656 records and included 57 studies from 32 low-income and middle-income countries. Fifteen studies contributed to meta-analysis. Hand hygiene interventions were associated with higher post-intervention than pre-intervention compliance (pooled risk ratio 1\u00b745, 95% CI 1\u00b720\u20131\u00b774), with substantial heterogeneity (I\u00b2=98%). Most studies used non-randomized designs. Multimodal WHO-style strategies and system-change interventions focused on alcohol-based hand rub availability, placement, or related infrastructure were the most common intervention categories. Effect-direction synthesis suggested favorable effects for compliance and system-related outcomes, whereas evidence for reductions in health-care-associated infections was less consistent. Common barriers included supply shortages, weak audit and data systems, staffing and workload pressures, and WASH infrastructure constraints; common enablers included training, monitoring and feedback, leadership support, reliable supplies, and implementation support.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Hand hygiene interventions can improve observed compliance in low-income and middle-income country health-care facilities, but sustained gains depend on system supports that make hand hygiene feasible at the point of care. Programs should pair training and behavior-change strategies with reliable supplies, functional WASH infrastructure, audit-and-feedback routines, leadership accountability, and protected implementation time.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.28.26359185","type":"posted-content","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T16:45:20Z","timestamp":1785516320000},"source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of Hand Hygiene Interventions in Healthcare Facilities in Low- and Middle-Income Countries (LMICs): A Systematic Review"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9716-6917","authenticated-orcid":false,"given":"Fred","family":"Tusabe","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, North Carolina 27599, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Cronk","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, North Carolina 27599, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9905-3775","authenticated-orcid":false,"given":"Fred","family":"Twinomugisha","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackline","family":"Ninsiima","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darcy","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, North Carolina 27599, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9887-6219","authenticated-orcid":false,"given":"Lucy K","family":"Tantum","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, North Carolina 27599, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Kobba","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reuben","family":"Kiggundu","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dathan","family":"Byonanebye","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"School of Public Health, Makerere University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith Nanyondo","family":"Semanda","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Kakooza","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026080307550605000_2026.07.28.26359185v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61458-4"},{"key":"2026080307550605000_2026.07.28.26359185v1.2","doi-asserted-by":"publisher","DOI":"10.1177\/10105395251338002"},{"key":"2026080307550605000_2026.07.28.26359185v1.3","unstructured":"UNICEF, WHO. 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