Objective: To identify global research priorities for improving hand hygiene in healthcare settings and develop a 2023-2030 research agenda to guide funding, coordinate research, promote investment, and inform policy for enhanced healthcare quality and safety.

Design: Expert consensus study using a modified Delphi process.

Participants: A 105-member panel of international hand hygiene experts including the World Health Organization (WHO) Technical Advisory Group of Experts on Hand Hygiene in Healthcare representing all WHO regions and World Bank income levels.

Methods: The research priorities were identified through a multiphase approach including a meta-review to establish knowledge gaps and inform initial priorities, followed by expert consultations using a modified Delphi process. 192 preliminary priorities were included in a two-round Delphi survey. Experts rated each priority in the first round, and then reviewed and adjusted responses based on the panel's aggregated, anonymous responses in the second round. Ratings were collected on a five-point Likert scale. Consensus was defined as a combined "strongly agree" and "agree" frequency of at least 70%.

Results: Consensus was achieved for 178 of 192 priorities (92.7%), categorized into six domains: system change; training and education; evaluation and feedback; reminders and communications; institutional safety climate; and hand hygiene improvement impact on healthcare-associated infections and antimicrobial resistance. Of these, 121 priorities reached >80% consensus. The Delphi process, maintained a 92% response rate over two rounds.

Conclusions: A structured consensus process yielded a research agenda to address gaps in hand hygiene improvement, supporting enhanced healthcare quality and safety globally.