Even marginal improvements in hand hygiene are associated with significant reduction in hospital acquired infection rates. These authors evaluated the efficacy of a simplified hand hygiene protocol in relation to the WHO 6 steps protocol. The simplified 3 step approach the authors used consisted of first, covering all surfaces of the hands (based on own judgement), second rotational rubbing of fingertips in the palm of the alternate hand, and third, rotational rubbing of both thumbs. Both techniques are performed for 30 seconds using three ml of hand rub. This is a cluster-randomized trial the University Hospital Basel, Switzerland. Twelve wards were randomly assigned to either the 3-step technique or the conventional 6-step technique for use of hand rub. The primary endpoints were compliance with the assigned technique and reduction of bacterial counts on hands of healthcare workers. Overall, 2923 hand hygiene indications were observed and compliance was 70.7% (2066/2923). Compliance with technique and indications was 51.7% and 75.9% on wards assigned to the 3-step technique, as compared to 12.7% and 65.0% on wards assigned to the 6-step technique (p<0.001). The reduction factor of bacterial colony counts did not differ between both techniques (p=0.629).
Probably a simpler way of doing things, but further multi-center trials and demonstration of actual reduction in infection rates with this method is needed.