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Author: Park et al. (2014) Source: Am J Infect Control. 2014; 42(5):559-61.


Park et al. (2014)

Assessment of the appropriateness of hand surface coverage for healthcare workers according to World Health Organization hand hygiene guidelines

The success of hand disinfection is predicated on the application of enough hand disinfectant, adherence to the exposure time and complete coverage of all hand areas. The hand hygiene guidelines of the World Health Organization (WHO) include a detailed description of the rub-in technique comprising a specific sequence of 6 steps to ensure good coverage. The Korean study examined whether caregivers actually perform WHO’s rub-in steps in clinical practice.

Methods: The study was conducted at the Asan Medical Center in Seoul, Korea, a tertiary-care hospital with 2 700 beds. During a 3-month period, 2 174 hand disinfection procedures were monitored in terms of whether 5 predefined steps for applying the hand disinfectant were actually carried out. The sequence was based on the 6 steps of the WHO recommendations. However, for this study, steps 2 and 4 of the WHO method were combined in one step. Hands were considered well covered with disinfectant when all five steps had been performed. At the same time, the study participants’ compliance was measured against 4 960 hand hygiene indications by observing whether hand hygiene was performed in accordance with WHO’s 5 Moments for Hand Hygiene.

Only 7.4 % of participants carried out all 5 steps of the rub-in method. The performance of the 5 steps got worse within the sequence: step 1 (palm to palm) was carried out by 99.9 % of the participants; step 2 (palm over dorsum with interlaced fingers) by 91.3 %; step 3 (palm to palm with fingers interlaced) by 55.7 %; step 4 (rotational rubbing of thumb clasped in palm) by 15.2 % and step 5 (rotational rubbing, backwards and forwards, with clasped fingers in palm) by 8.5 % only. However, with an average of 86.7 % hand hygiene compliance was high.

With a predefined rub-in technique pursuant to WHO recommendations, 92 % of the participants delivered poor hand hygiene performance. However, indications for hand disinfection were recognised correctly by almost 90 % of the participants. Insufficient coverage is an avoidable risk of infection, which should be prevented by practical training and improved rub-in methods.

Am J Infect Control. 2014; 42(5):559-61.

Further study on hand disinfection coverage quality and rub-in method

Information on the responsible rub-in technique