6-Step More Effective than 3-Step Hand Hygiene Technique

MedicalResearch.com Interview with:

Professor Jacqui Reilly PhD Institute for Applied Health Research Glasgow Caledonian University Glasgow

Dr. Jacqui Reilly

Professor Jacqui Reilly PhD
Institute for Applied Health Research
Glasgow Caledonian University

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Reilly: Hand hygiene is the single most important intervention to reduce avoidable illness and prevent infections. Two techniques have been reported for hand hygiene use with alcohol-based hand rub (ABHR) in international guidance:  6 step by the WHO and 3 step by the Center for Disease Control. Neither of these techniques have an evidence base to support their effectiveness.

The study provides the first evidence in a RCT that the 6 step technique is superior in reducing residual bacterial load on the hands. The reduction was not related to coverage, type of organism or staff group. The 6 step technique was microbiologically more effective at reducing the median log10 bacterial count (3.28  to 2.58)than the 3 step (3.08  to 2.88), (p=0.02), but did not increase the total hand coverage area (98.8% versus 99.0%, p=0.15) and required 25% (95% CI: 6%-24%) more time (42.50 seconds  vs 35.0 seconds, p=0.002). Total hand coverage was not related to the reduction in bacterial count.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Reilly: This is the first evidence on the effectiveness of these techniques demonstrating that 6 step is superior to 3 step technique.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Reilly: Our results demonstrate that, contrary to the findings from the latest systematic review, the 6 step technique with alcohol-based hand rub was more effective than the 3 step hand hygiene technique, in terms of residual bacterial load.  Also contrary to earlier observational studies on hand washing, larger coverage area of the hand was not related to a larger reduction in bacterial loads. This may be because the 6 step technique took a longer time due to the greater number of steps required compared to the 3 step technique.

One of the interesting incidental findings was that compliance with the 6 step technique was only 65%, despite participants having instructions on the technique in front of them and having their technique observed. This warrants further investigation in order that hand hygiene can be further optimised.  

MedicalResearch.com: Is there anything else you would like to add?

Dr. Reilly: Authors of international guidance documents should consider this evidence. Further studies are needed, given the limited evidence base for such an important measure in preventing infection in healthcare.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Jacqui S. Reilly, Lesley Price, Sue Lang, Chris Robertson, Francine Cheater, Kirsty Skinner, Angela Chow.A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom. Infection Control & Hospital Epidemiology, 2016; 1 DOI: 1017/ice.2016.51

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Last Updated on April 12, 2016 by Marie Benz MD FAAD