In a comprehensive new systematic review published in BMJ Global Health, researchers underscore the critical barriers and facilitators affecting hand hygiene behaviors in community settings worldwide. The study meticulously analyzes data across diverse environments—from private households to schools and public domains—revealing that the most significant impediment to effective handwashing is the lack of access to soap. This physical constraint poses a major obstacle in curbing the transmission of infectious agents through hand contact, which remains a fundamental vector for disease spread.
The review highlights that physical opportunity, particularly the availability and accessibility of soap, stands out as the foremost limitation preventing regular hand hygiene practices. Beyond this, psychological factors such as a lack of motivation and habit formation also contribute significantly to inconsistent handwashing behaviors. Habitual hand hygiene and heightened perceived health risks emerge as powerful enablers, fostering sustained and effective handwashing routines that are crucial for infection prevention and community health resilience.
However, the review points out a disconnect between interventions aimed at improving hand hygiene and the actual barriers or enablers identified through empirical research. Many programs fail to address the essential environmental components required for sustainable behavior change, such as reliable access to water, soap, and hygienic handwashing facilities. Without meeting these basic resource needs, strategies focusing solely on motivation-enhancement or knowledge dissemination may lack the foundational support necessary for lasting behavioral impact.
The authors caution that interventions which overlook the provision of critical hand hygiene infrastructure risk falling short of their goals. They emphasize that if communities do not already have adequate soap, water, and facilities embedded within their environment, efforts to promote handwashing through social pressure or educational campaigns alone are unlikely to succeed. This insight signals a pressing need for integrated approaches that combine infrastructural improvements with behavioral change techniques.
These findings contribute to a broader suite of five systematic reviews published concurrently, which collectively informed forthcoming World Health Organization (WHO) and UNICEF guidelines on hand hygiene in community contexts expected in October 2025. These guidelines respond to inconsistencies and insufficient evidence underpinning previous recommendations, with the goal of guiding governments and organizations toward evidence-based, practical, and scalable hand hygiene policies.
Notably, one of the reviewed analyses focused on the methods for pathogen removal and inactivation through handwashing. It revealed a significant research gap, with the vast majority of studies concentrating on bacteria reduction, while only a small fraction addressed viral pathogens, including enveloped viruses such as influenza, HIV, respiratory syncytial virus, and coronaviruses. Even less attention has been given to other categories of germs like fungi and protozoa, highlighting a critical need for diversified pathogen-specific evidence in hand hygiene research.
The investigation also flagged insufficient data on the efficacy of non-traditional soap substitutes widely used globally, such as sand and ash, as well as optimal techniques for drying hands—a factor known to influence microbial recontamination risk. Moreover, the impact of using microbially contaminated water for handwashing remains underexplored, despite its potential to undermine hygiene efforts, especially in resource-limited settings.
Given these identified gaps, the authors advocate for robust, targeted research to refine handwashing techniques and material recommendations. This is particularly urgent in light of pandemic viral illnesses and the stark resource constraints faced by many communities worldwide. Enhanced scientific understanding will enable formulation of clear, actionable guidelines that prioritize both efficacy and contextual feasibility.
Accompanying commentary from Joanna Esteves Mills of the WHO’s Water, Sanitation, Hygiene and Health Unit reinforces the broad benefits of effective hand hygiene beyond individual health. She emphasizes its role in reducing strain on healthcare systems by preventing infections that would otherwise require medical intervention. Importantly, widespread hand hygiene adoption can curtail antibiotic use, helping to mitigate the global threat of antimicrobial resistance—a leading cause of morbidity and mortality.
Despite widespread acknowledgment of hand hygiene’s importance, progress remains uneven. Between 2015 and 2024, although 1.6 billion people gained access to basic handwashing facilities, 1.7 billion still lacked soap and water at home, with 611 million having no facilities whatsoever. Achieving universal access by 2030, as outlined in Sustainable Development Goals, would necessitate accelerating progress rates several folds, especially in least developed and fragile countries—a formidable yet essential challenge.
The cumulative evidence from the systematic reviews distills into three foundational principles for effective hand hygiene promotion. First, guaranteeing access to soap, water, or alcohol-based sanitizers is an indispensable material precondition. Second, individuals must be educated on the why, when, and how of hand cleaning to foster informed practices. Third, the physical and social environment must be enabling—responsive to convenience, cultural norms, and motivational drivers—and supportive of sustained hygiene behavior.
Regrettably, the cycle of “panic and neglect” persists, wherein governments rapidly respond to infectious disease outbreaks with heightened hygiene measures but subsequently scale back investment and political will once immediate threats subside. Breaking this pattern requires embedding hand hygiene into broader health systems and development strategies with sustained political leadership and financial commitment.
Mills concludes that while hand hygiene interventions are relatively cost-effective, they are not universally low-cost, especially when infrastructural investments in reliable water supply are necessary. She urges policymakers to move away from emergency funding models and prioritize long-term budgeting within health systems to ensure continuous availability of hygiene essentials, thereby safeguarding health and community resilience against future infectious disease threats.
This landmark review and its associated studies not only deepen scientific understanding of hand hygiene determinants but also serve as a clarion call for integrated, resource-sensitive, and politically supported initiatives. In a world still grappling with recurrent epidemics and antimicrobial resistance challenges, elevating hand hygiene to a sustained global public health priority is a critical step toward healthier, more resilient societies.
Subject of Research: People
Article Title: Behavioural factors influencing hand hygiene practices across domestic, institutional and public community settings: a systematic review and qualitative meta-synthesis
News Publication Date: 16-Sep-2025
Web References:
WHO Global Handwashing Day
References:
DOI: 10.1136/bmjgh-2025-018927, BMJ Global Health
Keywords:
Hand washing, Hygiene, Behavioural factors, Infection control, Public health, Sustainable Development Goals
