Hand contamination before and after different hand hygiene techniques: a randomized clinical trial

Area of Science:

• Infection Control
• Microbiology
• Healthcare Epidemiology

Background:

• Hand hygiene (HH) is crucial in clinical settings to prevent healthcare-associated infections.
• The comparative efficacy of alcohol-based handrubs (ABH) versus various handwashing (HW) techniques requires further elucidation.
• Factors contributing to high microbial contamination on healthcare workers' hands need identification.

Purpose of the Study:

• To compare the efficacy of alcohol-based handrubs (ABH) against different handwashing (HW) protocols for hand hygiene (HH).
• To identify factors associated with significant hand contamination in healthcare professionals.
• To evaluate the reduction in bacterial counts following various HH interventions.

Main Methods:

• Forty-three healthcare workers (HCW) performed six HH techniques: non-antiseptic HW (10s, 30s), antiseptic HW (10s, 30s, 60s), and ABH.
• Bacterial cultures were obtained from fingertips before and after each HH technique.
• Log(10)-transformed bacterial count reductions were calculated and compared across methods.

Main Results:

• Alcohol-based handrubs (ABH) and antiseptic handwashing (AS) yielded significantly greater bacterial reductions than non-antiseptic handwashing (US).
• Log(10) bacterial count reductions were 0.74 (US10), 0.51 (US30), 1.13 (AS10), 1.14 (AS30), 1.21 (AS60), and 1.40 (ABH).
• Pathogenic bacteria were present in 4.3% of pre-HH cultures, with two cases remaining positive post-US HW.

Conclusions:

• Alcohol-based handrubs (ABH) are the most effective method for reducing bacterial load on hands in clinical settings.
• Antiseptic handwashing (AS) is superior to non-antiseptic handwashing (US) for effective hand hygiene.
• Medical ward, physician role, and not wearing gloves were associated with higher pre-HH contamination.