Hand hygiene techniques: still a requirement for evidence for practice?

L. Price, J. Reilly, S. Lang, C. Robertson, F. Cheater, A. Chow

Research output: Contribution to conferencePosterpeer-review


Introduction: Two hand hygiene techniques are promoted internationally:the World Health Organisation’s 6 step and the Centre for Disease Control’s 3 step techniques; both of which may be considered to have suboptimum levels of empirical evidence for use with alcohol based hand rub (ABHR).
Objectives: The aim of the study was to to compare the effectiveness of the two techniques in clinical practice.
Methods: A prospective parallel group randomised controlled trial(RCT) was conducted with 1:1 allocation of 6 step versus the 3 step ABHR hand hygiene technique in a clinical setting. The primary outcome was residual microbiological load. Secondary outcomes were hand surface coverage and duration. The participants were medical and nursing participants (n=120) in a large teaching hospital.
Results: The 6 step technique was statistically more effective at reducing the bacterial count 1900cfu/ml (95% CI 1300,2400cfu/ml) to 380cfu/ml (95% CI 150, 860 cfu/ml) than the 3 step 1200cfu/ml (95% CI 940, 1850cfu/ml) to 750cfu/ml (95% CI 380, 1400cfu/ml) (p=0.016) but even with direct observation by two researchers and use of an instruction card demonstrating the technique, compliance with the 6 step technique was only 65%, compared to 100%compliance with 3 step technique. Further those participants with 100% compliance with 6 step technique had a significantly greater log reduction in bacterial load with no additional time or difference in coverage compared to those with 65% compliance with 6 step technique (p=0.01).
Conclusion: To our knowledge this is the first published RCT todemonstrate the 6 step technique is superior to the 3 steptechnique in reducing the residual bacterial load afterhand hygiene using alcohol based hand rub in clinicalpractice. What remains unknown is whether the residualbacterial load after the 3 step technique is low enough toreduce risk of transmission from the hands and whetherthe 6 step technique can be adapted to enhance compliancein order to maximise reduction in residual bacterialload and reduce duration
Original languageEnglish
Number of pages1
Publication statusPublished - 16 Jun 2015


  • hand hygiene
  • World Health Organisation
  • Centre for Disease Control
  • techniques
  • alcohol based hand rub
  • ABHR
  • bacterial count


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