Is a three-step hand rub technique as effective as the WHO six-step version?

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The WHO six-step “how to hand rub” technique can be simplified to a 3-step procedure based on the reduction of bacterial counts on HCW’s hands achieved under experimental conditions” Tschudin-Sutter et al (2017).

Abstract:

Objectives: The World Health Organization (WHO) issued guidelines on hand hygiene recommending a six-step “how to hand rub” technique for applying alcohol-based hand rub. However, adherence to all six steps is poor. We assessed a simplified three-step technique and compared it to the conventional WHO six-step technique in terms of bacterial counts’ reduction on healthcare workers’ (HCW) hands.

Methods: Thirty-two participants were randomly assigned to clean their hands following the six-step “how to hand rub” technique (WHO-reference group) or a simplified three-step technique (intervention group). Assignments were reversed after one day. The degree of bacterial killing was assessed following the European Norm (EN 1500) for testing hand hygiene products. Hands were contaminated with E. coli and the mean logarithmic reduction in bacterial counts was compared between both techniques.

Results: Bacterial density before hand hygiene performance did not differ between the WHO-reference group (median 6.37 log10 CFU, interquartile range [IQR] 6.19-6.54) and the intervention group (median 6.34 log10 CFU, IQR 6.17-6.60, p=0.513). After hand hygiene, the logarithmic reduction factor was higher in the intervention group (median 4.45, IQR 4.04-5.15) as compared to the WHO-reference group (median 3.91, IQR 3.69-4.62, p=0.021).

Conclusions: The WHO six-step “how to hand rub” technique can be simplified to a 3-step procedure based on the reduction of bacterial counts on HCW’s hands achieved under experimental conditions. The proposed technique is easier to perform and could improve adherence to the execution of hand hygiene action.

Reference:

Tschudin-Sutter, S., Rotter, M.L., Frei, R., Nogarth, D., Häusermann, P., Stranden, A., Didier, P. and Widmer, A.F. (2017) Simplifying the WHO “how to hand rub” technique: three steps are as effective as six – results from an experimental randomized cross-over trial. Clinical Microbiology and Infection. January 3rd. [epub ahead of print].

DOI: http://dx.doi.org/10.1016/j.cmi.2016.12.030

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