PWAT-D-24-00190

Current international tools and guidance for the implementation of hand hygiene recommendations in community settings: a scoping review

PLOS Water

Dear Dr. MacLeod,

Thank you for submitting your manuscript to PLOS Water. After careful consideration, we feel that it has merit but does not fully meet PLOS Water's publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please see the comments from the reviewers - one suggested 'minor' and the other 'major' revision, but I believe their comments are similar (and fall into more of a 'moderate' category) - that more justificaiton is needed as to how this study fills a gap in the literature and differs from your previous study, particularly through changes to the Discussion section. Please think this through carefully and address (as well as the more minor comments)

Please submit your revised manuscript by Jun 23 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at water@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pwat/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Dani J Barrington

Academic Editor

PLOS Water

Journal Requirements:

Additional Editor Comments (if provided):

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Water’s publication criteria?>

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?-->?>

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Dear Authors,

The manuscript entitled “Current international tools and guidance for the implementation of hand hygiene recommendations in community settings: a scoping review” provides a systematic review of guides, handbooks, and manuals related to hand hygiene for their implementation recommendations and tools sorted by a six-step conceptual framework. The systematic review can provide importance guidance to implementors of hand hygiene and the WHO who are developing more guidance for hand hygiene in community settings. The study identifies important gaps in international hand hygiene recommendations with the need for more tools (only 21 found and many not hand hygiene specific, but general WASH) and need for more implementation guidance in identifying key leadership, allocation and resource planning, data analysis, enabling environment, stakeholder review of baseline data, and scaling up under the various steps.

The manuscript matches the mission and scope of PLOS Water that brings together researchers in hydrology, water resources, and WASH. The research is ethically and methodologically rigorous as it uses the PRISMA systematic review standard and reports detailed information in the supplemental information.

I’d like to see greater clarification of the literature gap that this study is filling compared to past studies by the author. I have some major, followed by minor comments.

MAJOR COMMENTS:

1. Please provide more detail on how this current study is different than the author’s recent published scoping review on hand hygiene (reference #12): “MacLeod C, Braun L, Caruso BA, Chase C, Chidziwisano K, Chipungu J, et al. Recommendations for hand hygiene in community settings: a scoping review of current international guidelines. BMJ Open. 2023;13(6):e068887.”

2. Line 177- Please add details on how the first 10 pages of Google were reviewed and included or not included. This is a step that has less reviewers/verification than others which may have introduced bias/error.

3. Please add in the conclusion or more strongly in discussion/limitations to review regional or country guidance. I know this isn’t international guidance, but there maybe some important lessons learned from these documents for international guidance.

MINOR COMMENTS:

1. Line 125- Possible repetition of the word guideline when you may mean “guide” in the first instance.

2. Line 171- What are meant by “MeSH” terms. Please define acronym.

3. I’d suggest adding a recommendation to review the manuals/handbooks/guides that you found if the implementation guidance incorporated cross-cutting themes or not.

4. Line 212- Capitalize “Figure” for figure 1 like the rest.

5. Line 252 and others- It is good to spell out the number if it appears at the beginning of a sentence.

6. Line 262- Would the document that targets “both the institutional and public setting” also be counted in public setting?

7. Line 278-280- A fragment, put in sentence format.

8. Figure 4- Consider making the outline in black if you are keeping tools in the same, light color. It makes it look like they run together. May want to adjust the angle of the text in some boxes more (e.g., key leadership, allocation and resources, .

9. Lines 290-296- It would be great to summarize some examples of key implementation guidance like you did for the tools, etc.). Some text overlaps borders like in Support and Approval and almost stakeholder review.

10. Table 2- Add percents to the third column values like you did for Table 1.

Reviewer #2: Thanks for developing the paper on this important issue. Overall, the manuscript looks good to me. However, I have a few questions which might require clarification only, and a few suggestions for improvement below:

Methods

It would be great if you could add exclusion and inclusion criteria in the methods section. Now, these are missing in the methods.

Did you include hotels and these types of accommodations in institutional/workplace settings? Were there any guidelines on this?

Discussion

The discussion section might require a major revision - the overall importance and implication of these key findings and how these findings are similar or in contrast with other studies might needed. The current discussion section probably did not address these two properly. Some other specific suggestions are:

The first sentence of the discussion seems to be a duplication of results.

In the 2nd paragraph of the discussion- could you please highlight the discrepancy instead of the six-step approach? This approach was already described earlier.

3rd paragraph of the discussion seems to be a duplicate of the results; please check.

Limitation

Limitations need to be articulated how did you overcome these limitations, or how can we interpret these results with even those limitations? The current version only describes limitations.

Fourth limitation was: we excluded tools and guidance documents published by governments,

which can also be used for implementing hand hygiene in specific regional or national contexts. Could you please justify this? Why excluded? And how are the results still valid and acceptable after excluding this?

Other comments:

Line 123: How did you decide that those were in line with global guidelines? I wanted to know what procedures you followed to select articles which were in line with global guidelines.

Line 186: You mentioned that “(4) published by an international non governmental organisation (NGO), multilateral agency or public health agency”. Why only International organization? Usually, for guidelines and tools, governments play a significant role, why have you excluded the government?

Line 188: You screened documents published from 1 January 1990 and 15 November 2024. Why this timeframe? Any justification for this particular timeframe?

Line 195: This sentence is not clear “Implementation guidance documents and tools that have a more recent edition available and country- or region-specific implementation tools were excluded as they do not support the global implementation of recommendations for hand hygiene.” Two types of documents excluded: ‘recent edition of a document’ and ‘country- or region-specific implementation tools’. Why? Any reason?

The second question is: how do locally adopted tools or guidelines not support the global implementation of recommendations for hand hygiene?

Line 198: Please mention the Endnote version.

Line 199: ‘title and document objective were screened for eligibility by one reviewer (CM)’. How did you/team ensure that she did not exclude any document by mistake?

Line 247: It seems that Figure 2 legends and explanation texts are mixed together. Please check.

Line 252: 46% or forty-six percent? Please make sure you spell out numbers or % if they are at the beginning of the sentence.

Supplementary documents

S7 should go to the main document

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: Yes:  Mahbub-Ul Alam

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Current international tools and guidance for the implementation of hand hygiene recommendations in community settings: a scoping review

PWAT-D-24-00190R1

Dear Dr. MacLeod,

We're pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you'll receive an e-mail detailing the required amendments. When these have been addressed, you'll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Dani J Barrington

Academic Editor

PLOS Water

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

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publication criteria?>

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?-->?>

Reviewer #2: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)??>

The PLOS Data policy

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?<br/><br/>PLOS Water does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->?>

Reviewer #2: Yes

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Reviewer #2: Thanks for addressing all comments. This version of the manuscript is ready for publication.

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what does this mean? ). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #2: Yes: Mahbub-Ul Alam

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