Becker's Clinical Quality & Infection Control

20 HAND HYGIENE CDC's 3-Step Hand-Washing Technique or WHO's 6-Step Technique: Which is Most Effective? By Shannon Barnet B atman versus Superman. e World Health Organization's six-step hand hygiene technique versus the CDC's three-step method. Which is superior? While the debate around the superheroes may never be truly settled, new research has declared a winner in the hand hygiene battle. A study led by Jacqui Reilly, PhD, professor of infection prevention and control at Glasgow Caledonian University in Scotland, found WHO's six-step hand hygiene technique was better than the CDC's three-step method in re- ducing bacteria on healthcare workers' hands. e findings were published in the journal In- fection Control & Hospital Epidemiology. Dr. Reilly and her team conducted a random- ized controlled trial in an urban, acute care teaching hospital, observing 42 physicians and 78 nurses completing hand-washing using an alcohol-based hand rub aer deliv- ering patient care. e six-step technique was determined to be microbiologically more effective for reducing the median bacterial count (3.28 to 2.58) com- pared to the three-step method (3.08 to 2.88). at said, WHO's method took 25 percent longer to complete (42.50 seconds vs. 35 seconds). "One of the interesting incidental find- ings was that compliance with the six-step technique was lacking. Only 65 percent of providers completed the entire hand hygiene process despite participants having instruc- tions on the technique in front of them and having their technique observed," said Dr. Reilly. "is warrants further investigation for this particular technique and how compliance rates can be improved." n Is it Possible to Truly Observe Compliance to WHO's 5 Moments of Hand Hygiene? By Shannon Barnet T he effectiveness of the World Health Organization's My 5 Moments for Hand Hygiene method is well-document- ed, but a study published in the American Journal of Infection Control calls into question the feasibility of observing compliance with WHO's M5M. The study was created to compare the ease of observation of M5M compared to the ease of observing hand hygiene compliance upon room entry and exit. During the multicenter trial, direct observations were made outside patient rooms for privacy protection and to minimize the Hawthorne effect, which suggests hand hygiene compliance improves when subjects believe they are being watched. The authors of the study found, under covert direct observa- tion, the entry/exit method opportunities were observed at all times, but M5M episodes were only observable 32.3 percent of the time. Furthermore, the ability to observe M5M episodes was even lower in certain wards (roughly 28 percent). Ultimately, while the M5M method may better approximate hand hygiene effectiveness, the feasibility of directly observ- ing hand hygiene compliance using M5M is limited in U.S. hospitals. "Physical barriers represent the most significant obstacle in the implementation of M5M methodology," concluded the study authors. "When deciding on a specific observation method, infection prevention programs need to take into account the physical infrastructure of their hospital to maxi- mize the utility of their hand hygiene compliance monitoring efforts." n Quality Improvement, Hand Hygiene Initiatives Needed in Outpatient Settings, Study Finds By Shannon Barnet M ore outpatient attention is needed on quality improvement initiatives for infection prevention, hand hygiene and injection safety in outpatient settings, according to a study published in the April edi- tion of the American Journal of Infection Control. The authors of the study examined infection preven- tion policies and practices at 15 outpatient sites across New Mexico during a medical student outpatient rotation. Although the sites had implemented an average of 92.8 percent of recommended quality improvement policies and practices, there were still areas for improvement. For instance, of the 163 injection safety opportunities observed, clinicians only disinfected the medication vial rubber septums with alcohol 78.4 percent of the time before piercing a patient. Additionally, 330 hand hygiene observations revealed clinicians used alcohol-based handrub 33.9 percent of the time, soap and water 29.1 percent of the time and no hand hygiene measures 37 percent of the time. "These findings support the need for ongoing infection prevention quality improvement initiatives in outpatient settings and underscore the importance of assessing both self-report and observed behavior of infection pre- vention compliance," concluded the study authors. n

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