A pragmatic randomised controlled trial of 6 step versus 3 step hand hygiene technique in acute hospital care

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  • Reilly, J et al (2016) Infection Control and Hospital Epidemiology article

    Rights statement: This is a final author version of the article originally published by Cambridge University Press in: Infection Control and Hospital Epidemiology (2016), 37 (6), pp.661-666. © 2016 by The Society for Healthcare Epidemiology of America.

    Accepted author manuscript, 358 KB, PDF-document


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Original languageEnglish
Pages (from-to)661-666
Number of pages6
JournalInfection Control and Hospital Epidemiology
Issue number06
Early online date7 Apr 2016
StatePublished - Jun 2016


This study evaluated the microbiological effectiveness of the World Health Organization’s (WHO) 6 step and the Center for Disease Control’s 3 step hand hygiene techniques using alcohol based handrub (ABHR). A parallel group randomized controlled trial (RCT). An acute care inner city teaching hospital.
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 technique (n=60). The 6 step technique was microbiologically more effective at reducing the median log10 bacterial count ((3.28 (95% CI 3.11, 3.38 cfu/ml) to 2.58 (95% CI 2.08, 2.93) cfu/ml)) than the 3 step ((3.08 (95% CI 2.977, 3.27) to 2.88 (95% CI 2.58, 3.15) cfu/ml)) (p=0.02), but did not increase the total hand coverage area (98.8% versus 99.0%, p=0.15) and required 15% (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.


  • hand hygiene, Healthcare associated infection, randomised controlled trial

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