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Study advocates using hand rub with three steps for 15 seconds

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Applying hand rub with three steps for 15 seconds is as effective at reducing bacteria as the six steps for 30 seconds recommended by the World Health Organization, according to Swiss researchers.

They found the shortened 15-second application time and a simpler three-step technique for use of alcohol-based hand rub was as effective at reducing bacteria and could improve hygiene compliance.

“Shortening hand rubbing time and simplifying the technique for use of hand rub could be a safe alternative”

Sarah Tschudin-Sutter

They noted that hand hygiene was the single most effective thing healthcare staff can do to reduce the spread of infectious diseases.

However, they highlighted that there was previously limited evidence on which technique was most effective.

In its current guidelines, the WHO recommends a six-step “how to hand rub” technique for using alcohol-based hand rub.

But adherence to all six steps is low and previous studies have suggested a simplified three-step hand rub technique is superior to the six-step technique in terms of compliance and killing bacteria.

The current recommended application time for hand rubs is 30 seconds. However, according to the authors of the latest study, recent research by others has suggested that 15 seconds of hand rubbing could be just as effective at reducing bacteria.

In the new study, a randomised cross-over trial, researchers from University Hospital Basel investigated combining the simpler three-step technique with a shorter application time of 15 seconds.

It involved 20 healthy volunteers, aged 18 to 51 years, who were randomly assigned to one of four groups before swapping over so they had tried all four techniques.

These were the six-step hand hygiene technique for 30 seconds, the six-step technique for 15 seconds, the three-step hand hygiene technique for 30 seconds, and the three-step for 15 seconds.

The researchers said the results showed that a shorter application time of 15-second rubs was as effective at reducing bacterial counts on the hands of participants compared to the recommended 30-second hand rub.

This finding was irrespective of the hand hygiene technique (see table), according to the study authors.

 TechniqueMedian reduction factor (log bacterial counts) Interquartile range 

6 steps/30 seconds



6 steps/15 seconds



3 steps/30 seconds



3 steps/15 seconds



Lead author Professor Sarah Tschudin-Sutter said: “The time pressure and heavy workload experienced by healthcare workers reduces compliance with hand hygiene standards.”

She said: “Our findings suggest that shortening hand rubbing time and simplifying the technique for use of hand rub could be a safe alternative that is easier to fit into their busy routine, could enhance the overall quality of hand hygiene performance, and have a positive effect on adherence.

“Further studies are needed to validate the performance of the shorter application time in everyday clinical practice,” she added.

The findings were presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam in the Netherlands, which is on during 13-16 April.

  • See attached PDFs below for study abstract and poster
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