Background: Hand hygiene competence is one of the critical outcomes in nursing education. Ensuring nursing students recognize the what, when and how of hand hygiene is critical in the light of the increasing rates of healthcare-associated infections. Aim: To systematically appraise and synthesize articles on hand hygiene knowledge and compliance among nursing students. Methods: This is a systematic review of scientific articles published from 2006 to 2016. The primary databases used were as follows: PubMed, Embase, Cumulative Index to Nursing & Allied Health Literature, Proquest and PsychINFO. Key search terms utilized were as follows: ‘handwashing’, ‘hand hygiene’, ‘compliance’, ‘knowledge’, ‘practice’ and ‘nursing students’. Findings: Nineteen studies met the review criteria. The findings revealed a low-to-moderate knowledge of and compliance with hand hygiene among nursing students. In addition, there were significantly higher rates of hand hygiene compliance in nursing students when compared to medical students. Relatively few studies attempted to identify predictors of hand hygiene knowledge and compliance. Conclusion: This review demonstrated suboptimal knowledge and compliance to hand hygiene among student nurses. In addition, this review also highlighted the paucity of studies that examined individual and organizational factors, which influence nursing students hand hygiene knowledge and compliance. Implications for nursing and policy: The findings of this review emphasized the role of nurse educators in enhancing hand hygiene competence in nursing students. Implementation of empirically tested strategies such as utilizing multidimensional interventions, scenario-based hand hygiene simulation activities and hand hygiene education programmes that would enhance nursing students’ hand hygiene knowledge and compliance is an asset. Hospital and nursing administrators should ensure continuous support and monitoring to guarantee that hand hygiene programmes are institutionalized in every healthcare setting by every healthcare worker.
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