New research indicates that a six-step hand-hygiene technique recommended by the World Health Organization is more effective in reducing bacteria on healthcare workers’ hands than a three-step method advocated by the Centers for Disease Control and Prevention (CDC).

However, the newer method also takes more time and resulted in lower compliance rates among workers, researchers found. The study was published in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

“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,” said Jacqui Reilly, PhD, lead author of the study and professor of infection prevention and control at Glasgow Caledonian University in Scotland. “This study provides a foundation for effective best practices to implement on the frontlines of healthcare.”

The study took place in an urban, acute-care teaching hospital, where researchers observed 42 physicians and 78 nurses use an alcohol-based hand rub after delivering patient care. The six-step method did a better job reducing the median bacterial count on workers’ hands than the three step-method, but it also took about 25% longer—42 seconds compared to 35 seconds for the three-step method. That may explain the lower compliance rates recorded among workers using the six-step method, the researchers say.

“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. This warrants further investigation for this particular technique and how compliance rates can be improved,” Reilly said.

The article, “A pragmatic randomised controlled trial of 6 step versus 3 step Hand Hygiene technique in acute hospital care,” is available on the journal website.

Photo credit: © Yandong Liu |