April 15, 2016
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WHO’s six-step hand hygiene technique superior to CDC’s three-step technique

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Recent findings published in Infection Control and Hospital Epidemiology showed that the WHO-recommended six-step hand hygiene technique was more effective than the CDC’s three-step technique in reducing bacteria on health care workers’ hands.

“Hand hygiene is regarded as the most important intervention to reduce health care-associated infections, but there is limited evidence on which technique is most effective,” Jacqui S. Reilly, PhD, professor of infection prevention and control at Glasgow Caledonian University in Scotland, said in a press release. “This study provides a foundation for effective best practices to implement on the frontlines of health care.”

WHO’s six-step technique involves applying a palmful of alcohol-based handrub (ABHR) in a cupped hand, covering all surfaces and rubbing six different aspects of the hands and wrist, the researchers wrote. The CDC’s three-step technique involves applying ABHR to the palm of one hand and rubbing hands together, covering all surfaces, and continuing the rub until hands are dry. This is the first study to compare these two techniques using ABHR.

The researchers conducted a randomized controlled trial of 120 doctors and nurses at an urban acute care teaching hospital in Glasgow.

The researchers found that the six-step technique was microbiologically more effective at reducing the median log10 bacterial count. WHO’s approach reduced the count from 3.28 colony-forming units (CFU)/mL (95% CI, 3.11-3.38) to 2.58 CFU/mL (95% CI, 2.08-2.93), while the CDC’s technique reduced the count from 3.08 CFU/mL (95% CI, 2.97-3.27) to 2.88 CFU/mL (95% CI, 2.58-3.15). The six-step technique, however, required 15% more time to implement (P = .002).

For the six-step technique, the backs of hands were more frequently missed, while the backs of index and middle fingers of the right hand were less frequently missed when compared with the three-step technique.

“One of the interesting incidental findings was that compliance with the six-step technique was lacking,” Reilly said. “Only 65% of providers completed the entire hand hygiene process despite participants having instructions on the technique in front of them and having their technique observed. This warrants further investigation for this particular technique and how compliance rates can be improved.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.