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Six-step hand-washing technique ‘most effective’


A six-step hand-washing technique advocated by the World Health Organization has been found to be the most effective for reducing bacteria.

Scottish researchers compared the WHO’s technique with a three-step method suggested by the US Centers for Disease Control and Prevention.

“This study provides a foundation for effective best practices to implement on the frontlines of healthcare”

Jacqui Reilly

The findings demonstrated that the six-step technique was superior to the three-step method in reducing bacteria on the hands of healthcare workers in a Glasgow teaching hospital.

The researchers observed 42 doctors and 78 nurses completing hand-washing using an alcohol-based hand rub, after providing patient care.

The six-step technique was determined to be microbiologically more effective for reducing the median bacterial count.

It reduced the bacterial count from 3.28 CFU/mL to 2.58 CFU/mL. This was compared to the three-step method, which reduced the count from 3.08 CFU/mL to 2.88 CFU/mL.

However, using the six-step method required 25% more time to complete – 42.50 seconds versus 35 seconds).

The researchers recommend that international guidance should consider their evidence when making official recommendations on best practices in hand hygiene.

“The study provides the first evidence in a randomised controlled trial that the six-step technique is superior, thus these international guidance documents should consider this evidence, as should healthcare organisations using the three-step technique in practice,” they said in the journal Infection Control and Hospital Epidemiology.

Glasgow Caledonian University

Six-step hand-washing technique ‘most effective’

Jacqui Reilly

Lead study author Jacqui Reilly, professor of infection prevention and control at Glasgow Caledonian University, said: “Hand hygiene is regarded as the most important intervention to reduce healthcare-associated infections, but there is limited evidence on which technique is most effective.”

She suggested that her findings provided a “foundation for effective best practices to implement on the frontlines of healthcare”.

She added: “One of the interesting incidental findings was that compliance with the six-step technique was lacking.

“Only 65% of providers completed the entire hand hygiene process despite participants having instructions on the technique in front of them and having their technique observed,” she said. “This warrants further investigation.”

 6-Step: Applying a palmful of alcohol-based handrub (ABHR) in a cupped hand, covering all surfaces, and rubbing six different aspects of the hands

3-Step: Applying ABHR to the palm of one hand and rubbing hands together; second, covering all surfaces; third, continuing to rub until hands are dry


Readers' comments (6)

  • michael stone

    I was 'being attacked' recently, for pointing out that although it clearly makes sense to use the method for CPR which has got the best evidence supporting its clinical effectiveness, the evidence around CPR is hard to collect.

    If the evidence about which method of hand-washing is best, is still being looked into, then I rest my case re CPR !

    Although I might have over-claimed here - it is possible, that I wasn't being attacked in connection with what I wrote about CPR, and was in fact being attacked just for being me.

    As for the hand washing:

    It reduced the bacterial count from 3.28 CFU/mL to 2.58 CFU/mL. This was compared to the three-step method, which reduced the count from 3.08 CFU/mL to 2.88 CFU/mL.

    I'm not sure what CFU stands for, but it looks as if neither method is all that successful at removing the bugs: however, the better of the two methods would presumably significantly reduce infections, because the potential number of infections is very large.

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  • More nonsense from MS. obsessive compulsive commenting is no different from any other rituals associated with OCD such as more commonly described repeated hand washing or cleaning. Therapies are available.

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  • I didn't even know there was a three step hand washing method? perhaps before my time :0)

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  • this sounds suspiciously like common sense......rare in the NHS

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  • I realise it is impossible to remove all bacteria from the hands, and the aim is to remove those that are loosely applied to our skin, and thus easily passed to our patients. However making the procedure even longer and more complicated may be counterproductive and discourage the cleansing that is already undertaken. Obviously it depends what is being done, but during general care often the fingers and particularly the fingertips are usually the first point of contact, I would therefore hate to see those being neglected whilst concentrating on a new procedure.

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