7.

Cues compared with no cue or different cue for promotion of hand hygiene
Patient or population: Healthcare workers Settings: Acute care hospitals Intervention: Signs or scent as cue Comparison: No cue or different signs
Outcomes	Impact	No of Participants (studies)	Certainty of the evidence (GRADE)
Observed hand hygiene compliance	1 RCT reported an increase in hand hygiene of 8.51 percentage points for the patient consequences sign compared to a slight decrease of 0.29 percentage points for the personal consequences sign. 1 RCT reported increases in hand hygiene compliance of 31.9 and 6.7 percentage points for the scent cue and sign of stern male eyes respectively, and a decrease of 5 percentage points for the sign with female eyes. One NRCT reported an increase of 7 percentage points in hand hygiene compliance with the light cue on day 2 compared to 9 percentage points with no light cue, whereas on day 3 compared to day 1 there was no difference with the light cue and an increase of 16 percentage points with no light cue	2 RCTs, 1 NRCT 3 hospitals	⊕⊕⊝⊝ low1
Infection rates	Not reported	‐	‐
Colonisation rates	Not reported	‐	‐
GRADE Working Group grades of evidence High certainty: Further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: We are very uncertain about the estimate. Abbreviations: NRCT: non‐randomised (controlled) trial; RCT: randomised (controlled) trial

¹Evidence downgraded from high to low due to non‐randomised evidence (one of three studies); risk of bias (all studies have two or more sources of high risk of bias), and inconsistency in effect sizes between studies.