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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).
References
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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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