{
  "abstract": "Introduction This systematic review aimed to identify and evaluate the implementation of government measures that support equitable and sustained hand hygiene practices in community settings.Methods We systematically searched 12 databases, including PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary for peer-reviewed and grey literature published through late March 2023. Additional sources were identified through expert consultations and manual reference list checks of related reviews. Studies employing quantitative, qualitative or mixed-methods designs were eligible. Study quality was assessed using the Mixed Method Appraisal Tool. Government measures were categorised according to the Sanitation and Water for All Building Blocks framework: sector policy strategy; institutional arrangements; sector financing; planning, monitoring, review; and capacity development. Hand hygiene outcomes were classified as access, behaviour change or enabling environment and impact as positive, null or not evaluated.Results Thirty-one studies (24 journal articles and 7 grey literature) from 19 countries—mostly middle income (71%)—were included. Most focused on household (58%), schools (19%) or both (13%). A total of 75 government measures were identified, with sector policy strategy and capacity development being the most common (each 31%), followed by institutional arrangements (17%), planning, monitoring, review (13%) and sector financing (8%). Positive impacts were linked to 45 measures across all five Building Blocks in 17 studies.Conclusion This systematic review highlights diverse government measures supporting hand hygiene in community settings, with sector policy strategy and capacity development being the most frequently reported. While many government measures showed positive impacts, gaps remain in financing, implementation and sustainability beyond households and schools. Strengthening governance, increasing investment and expanding research on cost-effectiveness and implementation barriers are essential to improve hygiene initiatives and ensure equitable access.PROSPERO registration number CRD42023429145.",
  "authors": [
    {
      "affiliations": [
        "Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Jedidiah S Snyder"
    },
    {
      "affiliations": [
        "Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Erika Canda"
    },
    {
      "affiliations": [
        "Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Jordan Honeycutt"
    },
    {
      "affiliations": [
        "Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Lilly A O’Brien"
    },
    {
      "affiliations": [
        "Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Hannah K Rogers"
    },
    {
      "affiliations": [
        "Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK",
        "Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland"
      ],
      "name": "Oliver Cumming"
    },
    {
      "affiliations": [
        "Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland"
      ],
      "name": "Joanna Esteves Mills"
    },
    {
      "affiliations": [
        "Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland"
      ],
      "name": "Bruce Gordon"
    },
    {
      "affiliations": [
        "Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Marlene K Wolfe"
    },
    {
      "affiliations": [
        "Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Bethany A Caruso"
    },
    {
      "affiliations": [
        "Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Matthew C Freeman"
    }
  ],
  "title": "Effectiveness of measures taken by governments to support hand hygiene in community settings: a systematic review",
  "uid": "eb662af3-c6ca-5df9-ac21-53101598fd2d"
}