Two techniques for doctors and nurses undertaking direct patient care have been reported for hand-hygiene use using alcohol-based hand rub in international guidance; the six-step guidance by the World Health Organization (WHO) and three-step by the US’ Centers for Disease Control and Prevention. Neither of these techniques have previously had an evidence base to support their effectiveness.

Hand hygiene is the single most important intervention to reduce avoidable illness and prevent infections.

Healthcare associated infections can be an unintended consequence of healthcare delivery. They are caused by a range of organisms, which are frequently resistant to antibiotics, but are often preventable.

This new study, published in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, provides the first evidence that the six-step technique is more effective in reducing residual bacterial load on the hands than the three-step hand hygiene technique.

The research team, led by GCU’s Professor Jacqui Reilly, has recommended that authors of international guidance documents should consider this evidence, as should healthcare organisations using the Centers for Disease Control and Prevention’s three-step technique in practice currently.

Professor Jacqui Reilly said: “Hand-hygiene is the cornerstone of infection prevention and control and yet little evidence exists to support the best technique. This study provides the first evidence of applied research from a randomised controlled trial (RCT) that the six-step technique is superior to the three-step technique in reducing the residual bacterial load after alcohol-based hand run hand-hygiene. The reduction was not related to coverage, type of organism or staff group. Further well-designed, applied RCTs are needed to evidence much of what is ritual in infection prevention and control practice.”

Nursing students at GCU recently put the six-step hand-hygiene technique into practice, and set a new Guinness World Record for the most participants in a hand sanitising relay, in partnership with Glasgow City of Science and Health Protection Scotland.



Glasgow Caledonian University