The WHO method for hand hygiene is very well embedded as the ‘gold standard’ for hand hygiene technique. But is it feasible to perform every time in the busy clinical environment? A new study in Clinical Infectious Diseases seems to suggest that a shorter, simpler hand hygiene method be just as effective and more feasible in the real world.
The WHO method for hand hygiene has six steps, is very thorough, and sure makes a good dance…
But if you’ve ever spent any time on a ward, the WHO hand hygiene method is nowhere in sight (ok, it’s not quite that bad, but you take the point – the reality is that healthcare workers create their own truncated hand hygiene method). This group of researchers in Switzerland and Austria have previously published a simpler three-step hand hygiene method for applying alcohol gel, which was shown to be as effective as the six-step method in terms of bacterial reduction in an experimental setting (Figure 1). So enter this study – a clever randomised trial evaluating the performance of the three-step method in a clinical setting.
Figure 1: WHO six-step hand hygiene method vs. the proposed three-step method
12 wards were randomised to the six-step or three-step method for two months. Observation of almost 3k hand hygiene observations found that compliance with both technique and indication was significantly higher on the wards using the three-step method (Figure 2). Healthcare workers in participating wards were approached randomly to have their hands sampled before and after hand hygiene. There was no significant difference in the reduction factor of bacterial contamination on staff hands comparing wards using the six-step with the three-step method.
Figure 2: Compliance with hand hygiene technique and indication on wards using the six- or three-step hand hygiene method
Perhaps the most striking finding of this study is that the 12% compliance with technique using the six-step method can be improved to a more satisfactory (although far-from-perfect) 51%, seemingly without reducing the efficacy of the process. So, it may be time for us to step down from a six-step to a three-step method for hand hygiene!