Abstract
Background
This review, commissioned by the World Health Organization (WHO), examined the effectiveness of the WHO 6-step hand hygiene (HH) technique in reducing microbial load on hands and covering hand surfaces, and compared its effectiveness to other techniques.
Methods
Medline, CINAHL, ProQuest, Web of Science, Mednar, and Google Scholar were searched for primary studies, published in English (1978-February 2021), evaluating the microbiological effectiveness or hand surface coverage of HH techniques in healthcare workers. Reviewers independently performed quality assessment using Cochrane tools. The protocol for the narrative review was registered (PROSPERO 2021: CRD42021236138).
Results
Nine studies were included. Evidence demonstrated that the WHO technique reduced microbial load on hands. One study found the WHO technique more effective than the 3-step technique (P = .02), while another found no difference between these 2 techniques (P = .08). An adapted 3-step technique was more effective than the WHO technique in laboratory settings (P = .021), but not in clinical practice (P = .629). One study demonstrated that an adapted 6-step technique was more effective than the WHO technique (P = .001). Evidence was heterogeneous in application time, product, and volume. All studies were high risk of bias.
Conclusions
Eight studies found that the WHO 6-step technique reduced microbial load on healthcare workers’ hands; but the studies were heterogeneous and further research is required to identify the most effective, yet feasible technique.
This review, commissioned by the World Health Organization (WHO), examined the effectiveness of the WHO 6-step hand hygiene (HH) technique in reducing microbial load on hands and covering hand surfaces, and compared its effectiveness to other techniques.
Methods
Medline, CINAHL, ProQuest, Web of Science, Mednar, and Google Scholar were searched for primary studies, published in English (1978-February 2021), evaluating the microbiological effectiveness or hand surface coverage of HH techniques in healthcare workers. Reviewers independently performed quality assessment using Cochrane tools. The protocol for the narrative review was registered (PROSPERO 2021: CRD42021236138).
Results
Nine studies were included. Evidence demonstrated that the WHO technique reduced microbial load on hands. One study found the WHO technique more effective than the 3-step technique (P = .02), while another found no difference between these 2 techniques (P = .08). An adapted 3-step technique was more effective than the WHO technique in laboratory settings (P = .021), but not in clinical practice (P = .629). One study demonstrated that an adapted 6-step technique was more effective than the WHO technique (P = .001). Evidence was heterogeneous in application time, product, and volume. All studies were high risk of bias.
Conclusions
Eight studies found that the WHO 6-step technique reduced microbial load on healthcare workers’ hands; but the studies were heterogeneous and further research is required to identify the most effective, yet feasible technique.
| Original language | English |
|---|---|
| Pages (from-to) | 1079-1090 |
| Number of pages | 12 |
| Journal | American Journal of Infection Control |
| Volume | 50 |
| Issue number | 10 |
| Early online date | 21 Sept 2022 |
| DOIs | |
| Publication status | Published - Oct 2022 |
| Externally published | Yes |
Bibliographical note
We would like to thank the WHO Technical Expert Group for their constructive comments when this work was presented at the WHO Technical Expert Meeting on Hand Hygiene Technique. We would also like to acknowledge the Scottish Healthcare Associated Infection Prevention Institute (SHAIPI) research consortium who financially supported a post of the staff member (LG) who has contributed to this review.
Access to Document
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