Bare below elbows: does this policy affect handwashing efficacy and reduce bacterial colonisation?

Area of Science:

• Microbiology
• Infection Control
• Clinical Practice

Background:

• UK Department of Health guidelines advocate for clinical staff to be 'bare below the elbows' (BBE).
• Limited scientific evidence currently supports the BBE policy.
• A hypothesis suggests that removing wrist clothing enhances handwashing efficacy.

Purpose of the Study:

• To investigate the impact of clinical staff dress code on bacterial colonization.
• To determine if being bare below the elbows (BBE) influences bacterial load before and after handwashing.
• To assess the effectiveness of handwashing in reducing bacterial counts in relation to clothing worn.

Main Methods:

• Sixty-six clinical staff participated, categorized as bare below the elbows (BBE) or not bare (NB).
• Bacterial imprints were taken from fingers, palms, wrists, and forearms onto agar plates before and after standardized handwashing.
• Colony counts were analyzed, and subcultures were performed to identify predominant bacteria.

Main Results:

• No significant difference in bacterial colonization was observed between BBE and NB groups before handwashing.
• Handwashing significantly reduced bacterial colony counts, particularly on fingers, palms, and dominant wrists.
• Post-handwashing, no significant difference in bacterial counts was found between the BBE and NB groups.

Conclusions:

• Handwashing significantly reduces bacterial colonies on clinical staff hands, irrespective of attire.
• The 'bare below the elbows' policy does not appear to impede the effectiveness of handwashing.
• Bacterial colonization on hands is highly variable, but hand hygiene remains a critical intervention.