Are we doing enough on hand hygiene in social care?

New research reveals a stark gap between hand hygiene guidance and what happens in practice. For social care, where the people we support are among those most at risk from infection, providers should take the research, which was conducted in primarily hospital settings, as an opportunity to improve the quality of care to the people they support.

New research reveals a stark gap between hand hygiene guidance and what happens in practice. For social care, where the people we support are among those most at risk from infection, this should prompt a moment of honest reflection.

The numbers are hard to ignore A recent analysis pooling data from 17 studies found that hand hygiene compliance among hospital visitors in the UK stands at just four per cent the lowest rate of any country in the study. Japan recorded 94 per cent. Even among healthcare staff globally, compliance ranges between 40 and 70 per cent.

4%: Hand hygiene compliance rate among hospital visitors in the UK the lowest recorded in a 17-country meta-analysis. Japan recorded 94%.

These figures come from hospital settings, but there is little reason to assume social care looks significantly different. Care homes and domiciliary services are busy, high-contact environments. Staff, residents, visitors and external professionals move through shared spaces continuously. And the people receiving care are often highly vulnerable to infection older adults, those with underlying health conditions, people with dementia who may struggle to maintain hygiene independently.

Why social care is particularly exposed

Two pathogens are especially significant in social care settings: norovirus and Clostridioides difficile (C. diff). Both are among the most common causes of outbreaks in care homes. Both can be severe and, in some cases, fatal for older and frail residents. And both are known to spread primarily via hand contact.

The challenge in social care is not simply one of attitude or awareness. Care is delivered in fast-moving, unpredictable environments where staff frequently need to respond immediately to support a resident who is unsteady, to attend to an urgent personal care need, to intervene in a moment of distress. Perfect adherence to hand hygiene protocols at every single moment is genuinely difficult to achieve in practice. The WHO is clear that hand hygiene is a system issue, not just a behavioural one. Having the right products, in the right places, at the right moments matters as much as individual intention.

This means that culture, environment and infrastructure all play a role alongside individual behaviour. Are hand hygiene products readily accessible throughout the care setting, including in areas where staff frequently need them at short notice? Are visitors and external professionals a group where compliance appears particularly low being supported and prompted to clean their hands on arrival? Is hand hygiene embedded into induction, ongoing training, and everyday team culture, rather than treated as a box-ticking exercise?

It is also worth noting that some non-alcohol-based hand sanitisers are an effective alternative and are effective on both norovirus and C. diff but are not clearly stated in current IPC guidance for hand hygiene and provide a practical solution in settings where immediate access to handwashing facilities may not always be possible.

The Consultation is now open on the: Review of the DHSC Adult Social Care IPC resource. 20 April 2026 to 20 May 2026 which outlines social care IPC guidance and also includes hand hygiene. Care England will formally respond to the Department of Health and Social Care’s consultation on the updated Adult Social Care Infection Prevention and Control resource. As the leading representative body for independent adult social care providers in England, here is where Care England stand:

• The guidance is broadly consistent across other EU countries which also omit aspects in regard to hand hygiene
• The guidance rightly identifies that alcohol-based hand rubs which conform to EN1500 (bactericidal), are an effective solution in addition to hand-washing and have reduced the spread of certain infections. The consultation references product standards effective against both norovirus and C. diff for surfaces, and as an alternative to bleach which conform to EN14476 andEN13704, but stops short that some non-alcohol hand hygiene based products are also effective for up to 6 hours on hands and confirm to EN1500 EN14476 and EN13794.
• Environmental cleaning products are held to specific virucidal and sporicidal standards EN14476 and EN13704), yet hand hygiene products are not, despite hands being a primary route of transmission in social care
• Non-alcohol-based alternatives are not given the clear, practical direction they deserve, leaving providers to make complex product decisions without sufficient support, and leaving infection routes open to spread as a result of hand contact
• Guidance must reflect the real conditions of social care delivery, which is fast-moving, unpredictable, and high contact, if it is to suggest IPC guidance which reduces the risk of infection of viricidal and sporicidal activity (EN14476 andEN13704) and not just bactericidal (EN1500) if it wishes to reduce the circa 250+ deaths per annum in care services caused by both norovirus and c. diff.

Care England encourages care providers to review the IPC proposed guidance and to add their voice. Provider insight matters in shaping guidance that works in practice for social care.

A moment to reflect

Nothing in this article is intended to suggest that social care providers are not taking infection prevention seriously. The sector demonstrated enormous commitment and resilience throughout the COVID-19 pandemic. However, the data on compliance rates and the vulnerability of the people social care supports, means that hand hygiene deserves continued and active attention rather than assumption.

For Providers, it is worth asking honestly: when did you last review how hand hygiene is being practised in your service, not just whether policies exist? For frontline staff, it is worth reflecting on the moments in a shift where hand hygiene might be rushed or skipped, not through carelessness, but through the pressures of a demanding role and whether anything in the environment could make it easier.

Small habits, consistently maintained across a whole team, make a significant difference to the people in our care.

Solutions for surfaces and non-alcoholic hand sanitisation can be found here: Surface sanitiser and non-Alcohol based hand sanitiser: https://nilaqua.co.uk/pages/hands-surfaces Safer Spaces: https://smartdirectory.careengland.org.uk/supporter-member/1379/safer-space. We remain grateful to Safer Spaces for bringing the referenced article to our attention in support of their work to make social care a safer space and free from infection.