Two hand-hygiene techniques are promoted internationally: the World Health Organization’s six-step and the Centers for Disease Control and Prevention’s three-step techniques; both of which may be considered to have suboptimum levels of empirical evidence for use with alcohol based handrub (ABHR). The aim of the study by Price, et al. (2015) was to to compare the effectiveness of the two techniques in clinical practice.
A prospective parallel group randomized controlled trial (RCT) was conducted with 1:1 allocation of six-step versus the three-step ABHR hand hygiene technique in a clinical setting. The primary outcome was residual microbiological load. Secondary outcomes were hand surface coverage and duration. The participants were medical and nursing participants (n=120) in a large teaching hospital. The six-step technique was statistically more effective at reducing the bacterial count 1900cfu/ml (95% CI 1300, 2400cfu/ml) to 380cfu/ml (95% CI 150, 860 cfu/ml) than the three-step 1200cfu/ml (95% CI 940, 1850cfu/ml) to 750cfu/ml (95% CI 380, 1400cfu/ml) (p=0.016) but even with direct observation by two researchers and use of an instruction card demonstrating the technique, compliance with the 6 step technique was only 65 percent, compared to 100 percent compliance with the three-step technique. Further those participants with 100 percent compliance with six-step technique had a significantly greater log reduction in bacterial load with no additional time or difference in coverage compared to those with 65 percent compliance with six-step technique (p=0.01).
The researchers say that to their knowledge this is the first published RCT to demonstrate the six-step technique is superior to the three-step technique in reducing the residual bacterial load after hand hygiene using alcohol-based handrub in clinical practice. What remains unknown is whether the residual bacterial load after the three-step technique is low enough to reduce risk of transmission from the hands and whether the six-step technique can be adapted to enhance compliance in order to maximize reduction in residual bacterial load and reduce duration.
This paper is part of the supplement Antimicrobial Resistance and Infection Control: Abstracts from the 3rd International Conference on Prevention and Infection Control (ICPIC 2015). For additional ICPIC hand hygiene abstracts, CLICK HERE.
Reference: Price L, Reilly J, Lang S, Robertson C, Cheater F and Chow A. Hand hygiene techniques: still a requirement for evidence for practice? Antimicrobial Resistance and Infection Control 2015, 4(Suppl 1):O49 doi:10.1186/2047-2994-4-S1-O49