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Handwashing: Are You Doing it Right? WHO Disagrees

APR 22, 2016 | SARAH ANWAR

The Study

The recent trial studied the effectiveness of the CDC's three-step method vs WHO's six-step method using an alcohol-based handrub (ABHR) to “compare the microbiologic effectiveness of the techniques on hand coverage and reduction of bacterial contamination on the hands of healthcare workers.” The authors studied a group of 42 doctors and 78 nurses who worked in different medical and surgical specialties, including an intensive care unit. The study was conducted on weekdays from February 1, 2014 to March 31, 2014.

The authors placed the participants into two groups: one group was instructed to follow the six-step method; the other group was instructed to follow the three-step method. At the end of the study, the authors found that 65% of the participants in the six-step group followed the full six-step handwashing method, while 100% of the participants in the three-step group followed the three-step method.

The authors measured the median log10 bacterial count before and after hand washing for those who fully complied with the respective techniques. The initial bacterial count was 3.28 CFU/mL (95% CI, 3.11–3.38 CFU/mL). After the three-step method, a drop in bacterial count ranged from 3.08 CFU/mL (95% CI, 2.97–3.27 CFU/mL) to 2.88 CFU/mL (2.58–3.15 CFU/mL). However, the six-step method showed a significant drop from the initial (pre-hygiene) bacterial count to 2.58 CFU/mL (2.08–2.93 CFU/mL).

The study found that although WHO's six-step handwashing method did not cover more surface-area, and took 42.5 seconds, 7.5 seconds longer to perform than the three-step method, it was superior to the three-step method in reducing bacterial count on an individual's hands. 

A full pictorial representation of WHO's six-step method is available here. According to WHO, “washing your hands properly takes about as long as singing "Happy Birthday" twice.”
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