title: A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom.
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.
authors.affiliation: 1Institute for Applied Health Research,Glasgow Caledonian University,Glasgow,United Kingdom.
authors.forename: Jacqui S
authors.initials: JS
authors.lastname: Reilly
authors.affiliation: 2Department of Nursing & Community Health,Glasgow Caledonian University,Glasgow,United Kingdom.
authors.forename: Lesley
authors.initials: L
authors.lastname: Price
authors.affiliation: 3Department of Biological and Biomedical Sciences,Glasgow Caledonian University,Glasgow,United Kingdom.
authors.forename: Sue
authors.initials: S
authors.lastname: Lang
authors.affiliation: 4Department of Mathematics & Statistics,University of Strathclyde,Glasgow,United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Robertson
authors.affiliation: 5School of Nursing Sciences,University of East Anglia,Norwich,United Kingdom.
authors.forename: Francine
authors.initials: F
authors.lastname: Cheater
authors.affiliation: 3Department of Biological and Biomedical Sciences,Glasgow Caledonian University,Glasgow,United Kingdom.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Skinner
authors.affiliation: 6Department of Clinical Epidemiology,Tan Tock Seng Hospital,Singapore.
authors.forename: Angela
authors.initials: A
authors.lastname: Chow
mesh_terms: D058491:Bacterial Load; D006225:Hand / Q000382:microbiology; D063373:Hand Hygiene / Q000379:methods*; D006784:Hospitals, Teaching / Q000379:methods; D006801:Humans; D006113:United Kingdom