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*, Lesley Price, Sue Lang, Chris Robertson, Francine Cheater, Kirsty Skinner, Angela Chow

*Corresponding author for this work

Research output: Contribution to journalArticle

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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.
Original languageEnglish
Pages (from-to)661-666
Number of pages6
JournalInfection Control and Hospital Epidemiology
Volume37
Issue number6
Early online date7 Apr 2016
DOIs
Publication statusPublished - Jun 2016

Keywords

  • hand hygiene
  • Healthcare associated infection
  • randomised controlled trial

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