Hand Hygiene

The CDC & the WHO Take on Hand Hygiene...  WHO wins?

Hand Hygiene - the 3 step method, or the 6 step method?


Recently in Becker’s Hospital review, there was a great article explaining that the verdict “was in” regarding whether the WHO’s (World Health Organization) 6-step or the CDC’s (Center for Disease Control) 3-step hand washing technique was better at removing bacteria. (2)


Becker’s cites the study done by the Society for Healthcare Epidemiology of America and published in SHEA online April 8, 2016. The study looked at 42 physicians and 78 nurses completing hand hygiene using an alcohol-based hand rub after delivering patient care and determined that the WHO’s six-step technique was better at reducing the median bacterial count from 3.28 to 2.58 versus 3.08 to 2.88 with the CDC’s 3-step technique. (1)

As I read this, I think some of the points of the article need clarified.

First, this is one study in one hospital with statistically few participants. I think we would all agree that this is interesting data, but more studies would be needed to confirm the validity of these results, overall.

Second, although Becker’s response is titled “hand washing,” it is actually not looking at hand washing, by definition, but looking at hand hygiene using sanitizer. This is important to note because both the CDC and WHO say that actually washing hands removes the MOST bacteria over hand hygiene with hand sanitizer.


Finally, the Becker’s review of the study notes that, “incidentally,” the 6-step process was complied with less (meaning the HCWs did not follow all the steps properly). I would contend that, this is one of the overwhelming issues facilities have with hand hygiene in general. It’s nice that the 6-step process removed more bacteria, but if HCWs aren’t complying with the technique, how beneficial is it? (2)

The incidental “compliance with technique” piece of the study brings the question: "how can we improve compliance with hand hygiene technique?"


Here are a few suggestions:

  • Training: Ensure HCWs not only attend regular, ongoing training, but that they demonstrate the technique.
  • Culture of accountability: I can remind you, you can remind me and we still like each other because we know it’s best for our health and our patients' health.
  • Personalizing the HAIs: These are people – daughters, fathers, brothers, mothers, etc. The patients are living, breathing humans not just a number of incidences of “infections.”
  • Use real time coaching and education while collecting data: Secret shopper techniques collect data but they allow HCWs to potentially spread infection because the “oopses” aren’t corrected before they cause potential harm to the patient.
  • Sharing the ongoing data trends: Is what we are doing working? If yes, keep reminding, educating, etc. If no, what do we need to change??


What is your hospital doing to ensure compliance with hand hygiene technique? Readiness Rounds offers a robust Hand Hygiene checklist, download a free sample.




(1) https://www.sciencedaily.com/releases/2016/04/160408132452.htm

(2) http://www.beckershospitalreview.com/quality/cdc-s-3-step-hand-washing-technique-vs-who-s-6-step-technique-which-is-most-effective.html

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