title: A review of hand-washing techniques in primary care and community settings.
abstract: OBJECTIVE
  This review seeks to identify the most effective hand-washing and hand-cleansing practice that could be used in primary care.
  
  
  BACKGROUND
  Healthcare associated infection is a major problem in the UK causing 5000 deaths every year. Current guidelines indicate expert opinion is the level of evidence for hand washing as an activity to reduce infection.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Publications on hand-washing, hand-cleansing studies, policy and practice-based documents were sought by searching several databases. Terms used included hand washing, hand cleansing, hand hygiene, hand decontamination, infection control and primary care.
  
  
  RESULTS
  Few articles described the hand-washing technique in detail and some publications simply referred to either the European and British Standards or the Centre for Disease Control statement on hand washing. Major discrepancies in hand position and water flow direction were found. Several methodological problems were also identified and few studies were undertaken in primary care.
  
  
  CONCLUSIONS
  This review has found a lack of evidence for hand-washing techniques being undertaken in practice today. Findings from hand-washing technique studies were inconclusive and methodological issues exist resulting in sparse reliable evidence. There is an urgent need to undertake methodologically sound studies of hand-washing techniques for use in the ever expanding scope of primary care practice.
  
  
  CONCLUSIONS
  Evidence for hand-washing and hand-cleansing techniques will inform healthcare professional practice, and contribute to the overall management of infection control in primary care.
authors.affiliation: Centre for Evidence-Based Medicine, Department of Primary Health Care, University of Oxford, Oxford, UK. sheree.smith@imperial.nhs.uk
authors.forename: Sheree M S
authors.initials: SM
authors.lastname: Smith
mesh_terms: D003152:Community Health Nursing / Q000379:methods* / Q000592:standards; D003153:Community Health Services; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards; D006801:Humans; D009732:Nursing Care / Q000379:methods* / Q000592:standards; D009741:Nursing Staff, Hospital / Q000592:standards*; D011320:Primary Health Care; D006113:United Kingdom