By Dr Lucyna Gozdzielewska
Each year, on the 5th of May we celebrate World Hand Hygiene Day, which is led by the World Health Organization, as part of the SAVE LIVES: Clean Your Hands Campaign to promote good hand hygiene practices in healthcare and prevent healthcare-associated infections.
This year’s campaign focuses on the importance of promoting hand hygiene knowledge and strengthening hand hygiene training.
To support this initiative, we invited students and staff in our University to practice the correct hand hygiene technique using fluorescent gel and inspect their hands under ultraviolet light to evaluate their performance.
This event also gave us an opportunity to share our knowledge about hand hygiene with others by highlighting some of the key findings from our hand hygiene research:
- Hand hygiene using the World Health Organization’s 6-step technique effectively reduces microorganisms on hands.
Our updated systematic review, commissioned by the World Health Organization, examined the effectiveness of the WHO 6-step hand hygiene technique and showed the 6-step technique is effective in reducing the bacterial load on hands. Available evidence included a clinical trial conducted by the SHIP team in 2016 in a Scottish hospital, which compared the 6-step technique to a simpler, 3-step approach, and found that the 6-step technique was better.
However, other technique variations have been proposed to date, and it remains unclear which of these techniques is the best, which highlights the need for further research to investigate this.
- The amount of alcohol-based hand rub and duration of hand rubbing matter!
Another systematic review conducted by the SHIP research group examined factors influencing the effectiveness of hand hygiene. We considered factors such as the amount of alcohol-based hand rub applied, application time, the size of hands and rubbing friction. Our findings showed that the larger amount of alcohol-based hand rub was used, the longer it took to dry on hands and the greater reduction in bacterial load was observed. However, it was not possible to identify the most optimal amount of alcohol-based hand rub that should be used or the duration of hand rubbing. Therefore, until more evidence is available, current World Health Organization’s recommendations should be followed. These recommendations include using a “palmful of the product, sufficient to cover all hand surfaces” and handrubbing for 20-30 seconds with alcohol-based hand rub, or washing hands with soap and water for 40-60 seconds.
- Good hand hygiene practices: not only in hospitals
In 2022, we published yet another systematic review examining the effectiveness of hand hygiene for preventing community transmission of respiratory viruses that have previously caused epidemics and pandemics, that is novel coronaviruses and influenza. Although the quality of the reviewed evidence was relatively weak, the findings suggest that encouraging hand hygiene could be beneficial for preventing the acquisition or transmission of SARS-CoV-1, SARS-CoV-2 and influenza viruses. However, it also highlighted the need for further work to define when and how often hand hygiene should be performed in the community to offer the best protective effect.
- Technology can help us learn the correct hand hygiene technique
In 2018, we conducted a research study testing the mobile AR hand hygiene training app. In particular, we investigated how many app training sessions it takes to develop proficiency in performing the World Health Organization’s 6-step technique. We recruited 47 university students and staff members and asked them to practice the 6-step technique once a day for 4 weeks using a mobile app. Each practice session lasted only 2 minutes. We found that 38 of the 47 participants were able to correctly perform the 6 steps by the end of week 4, and on average, it took 24 training sessions to develop this proficiency. These findings suggest that short, regular practice using technology is an effective pedagogical approach that can help learners develop their hand hygiene skills independently.
- Hand hygiene can be improved, even in resource-limited settings
Implementation of hand hygiene guidelines and improving hand hygiene compliance is often challenging, especially in resource-limited settings because of insufficient training, and lack of hand hygiene resources and facilities. However, our recent research study shows that hand hygiene interventions can be successfully adapted to local settings and result in a significant improvement in hand hygiene compliance, despite limited resources.
In 2020-2021, we worked with colleagues from Infection Control Africa Network (ICAN) and a researcher from Banso Baptist Hospital in Cameroon, to conduct a research study evaluating the implementation of alcohol-based hand rub at the point of care intervention, supported by local production of alcohol-based hand rub, provision of hand hygiene training, monitoring of hand hygiene compliance and feedback provision, and appointment of hand hygiene champions. The results of our study showed that healthcare workers’ hand hygiene compliance improved from 33.3% to 87.2% after the intervention implementation.
To find out more about the SHIP team, head on to the GCU website, read the rest of our blogs and follow us on Twitter @SHIPGCU