A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom

作者：Reilly Jacqui S^*; Price Lesley; Lang Sue; Robertson Chris; Cheater Francine; Skinner Kirsty; Chow Angela

来源：Infection Control and Hospital Epidemiology, 2016, 37(6): 661-666.

DOI：10.1017/ice.2016.51

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 log(10) 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.

• 出版日期2016-6