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

  • Jacqui S. Reilly (a1), Lesley Price (a2), Sue Lang (a3), Chris Robertson (a4), Francine Cheater (a5), Kirsty Skinner (a3) and Angela Chow (a6)...
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 log10 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.

Infect Control Hosp Epidemiol 2016;37:661–666

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Copyright
Corresponding author
Address correspondence to Jacqui S. Reilly, PhD, Institute for Applied Health Research, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G40BA, Scotland, United Kingdom (Jacqui.reilly@gcu.ac.uk).
Linked references
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

6. A Chow , OA Arah , SP Chan , et al. Alcohol handrubbing and chlorhexidine handwashing protocols for routine hospital practice: a randomized clinical trial of protocol efficacy and time effectiveness. Am J Infect Control 2012;40:800805.

7. G Kampf , C Ostermeyer , P Heeg , D Paulson . Evaluation of two methods of determining the efficacies of two alcohol-based hand rubs for surgical hand antisepsis. Appl Environ Microbiol 2006;72:38563861.

13. AF Widmer , S Tschudin-Sutter . Letter to the editor regarding “efficacy of alcohol gel for removal of methicillin-resistant Staphylococcus aureus from hands of colonized patients”. Infect Control Hosp Epidemiol 2015;36:854.

16. EL Larson , AE Aiello , J Bastyr , et al. Assessment of two hand hygiene regimens for intensive care unit personnel. Crit Care Med 2001;29:944951.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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