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Clin Infect Dis. 2018 Nov 3. doi: 10.1093/cid/ciy948. [Epub ahead of print]

Simplifying the WHO protocol: Three steps versus six steps for performance of hand hygiene - a cluster-randomized trial.

Author information

1
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
2
Department of Internal Medicine, University Hospital Basel, Basel Switzerland.
3
Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland.

Abstract

Background:

In an experimental setting, a simplified 3-step hand hygiene technique for applying alcohol-based hand rub was non-inferior in terms of reduction of bacterial counts as compared to the conventional WHO-6-step technique. We therefore compared compliance and microbiological efficacy between both hand hygiene techniques in routine clinical practice.

Methods:

We performed a cluster-randomized trial from 10/2015-11/2015 at the University Hospital Basel, Switzerland - a tertiary academic care center (ISRCTN45923734). Twelve wards were randomly assigned to either the 3-step technique or the conventional 6-step technique for use of hand rub. The primary endpoints were compliance with the assigned technique and reduction of bacterial counts on hands of healthcare workers.

Results:

Overall, 2923 hand hygiene indications were observed and compliance was 70.7% (2066/2923). Compliance with technique and indications was 51.7% (595/1151) and 75.9% (1151/1516) on wards assigned to the 3-step technique, as compared to 12.7% (116/915) and 65.0% (915/1407) on wards assigned to the 6-step technique (p<0.001). The reduction factor (RF) of bacterial colony counts did not differ between both techniques (median RF 0.97 log10 CFU, IQR 0.39-1.59 for the 3-step technique vs. median RF 1.04 log10 CFU, IQR 0.49-1.52 for the 6-step technique, p=0.629).

Conclusions:

The simpler hand hygiene technique consisting of three steps resulted in higher compliance with both hand hygiene indications and technique as compared to the six steps in a clinical setting. As the results of the microbiological analyses exclude inferiority, the conventional six steps could be safely replaced by a simpler hand hygiene technique.

PMID:
30395180
DOI:
10.1093/cid/ciy948

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