A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom

Abstract

objective. To evaluate the microbiologic effectiveness of the World Health Organization's 6-step and the Centers for Disease Control and Prevention's 3-step hand hygiene techniques using alcohol-based handrub.design. A parallel group randomized controlled trial.setting. An acute care inner-city teaching hospital (Glasgow).participants. Doctors (n = 42) and nurses (n = 78) undertaking direct patient care.intervention. Random 1:1 allocation of the 6-step (n = 60) or the 3-step (n = 60) technique.results. The 6-step technique was microbiologically more effective at reducing the median log 10 bacterial count. The 6-step technique reduced the count from 3.28 CFU/mL (95% CI, 3.11-3.38 CFU/mL) to 2.58 CFU/mL (2.08-2.93 CFU/mL), whereas the 3-step reduced it from 3.08 CFU/mL (2.977-3.27 CFU/mL) to 2.88 CFU/mL (−2.58 to 3.15 CFU/mL) (P = .02). However, the 6-step technique did not increase the total hand coverage area (98.8% vs 99.0%, P = .15) and required 15% (95% CI, 6%-24%) more time (42.50 seconds vs 35.0 seconds, P = .002). Total hand coverage was not related to the reduction in bacterial count.conclusions. Two techniques for hand hygiene using alcohol-based handrub are promoted in international guidance, the 6-step by the World Health Organization and 3-step by the Centers for Disease Control and Prevention. The study provides the first evidence in a randomized controlled trial that the 6-step technique is superior, thus these international guidance documents should consider this evidence, as should healthcare organizations using the 3-step technique in practice. 2016;37:661-666 Hand hygiene is argued to be the most important intervention in preventing healthcare-associated infection. Infect Control Hosp Epidemiol1 Despite this, a recent systematic review 2 identified that there is limited evidence to support hand hygiene techniques, and compliance with hand hygiene remains suboptimal. There is little point in getting the opportunity, or the "5 Moments," 1 correct for hand hygiene if a technique effective in reducing the bacterial load on the hand thereafter is not evident.There are 2 main techniques in international guidance on hand hygiene: the first of these is the World Health Organization 6-step technique, 1 which involves applying a palmful of alcohol-based handrub (ABHR) in a cupped hand, covering all surfaces, and rubbing 6 different aspects of the hands. This technique has a limited evidence base for use in clinical practice because it was developed as a standardized technique to test hand hygiene products in a laboratory setting.3 Furthermore, this technique has no evidence of microbiologic effectiveness in clinical settings with ABHR. The second technique is the 3-step technique. This technique involves first, applying ABHR to the palm of one hand and rubbing hands together; second, covering all surfaces; third, continuing to rub until hands are dry. 4 There is some observational evidence base 5 and 1 randomized controlled trial (RCT) to support this technique on the basis of shorter duration, althoug...

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“…A helyes kézhigiéné kivitelezésére több nemzetközi irányelv ismert [17]. A leginkább elterjedt ezek közül a WHO által kidolgozott "hatlépéses protokoll", amely során a fertőtlenítőszert a kézen hat különálló, egymást követő mozdulattal kell eloszlatni.…”

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Subjective Qualitative Hand Hygiene Compliance Observation: A Feasibility Trial

“…4 Another limitation is the small number of participants and the experimental setting of this proof-of-principle study. However, we believe that based on our results, the addition of dichotomous subjective quality assessment using the parameters time and skin coverage during live observation by experienced infection control staff is feasible and could be a valuable addition to conventional hand hygiene observation.…”