A 6-step alcohol-based hand hygiene technique is significantly superior to the standard 3-step technique in reducing bacteria colony counts.
So says a randomized trial with 78 nurse and 42 doctor participants recently published online in the journal Infection Control and Hospital Epidemiology. The full text of the study is available here.
At 42.5 seconds, the 6-step process took significantly longer than the 35 second 3-step.
Multiple media outlets, including the New York Times, published stories about this study.
The study was done properly. But after reading it, I had an issue.
I conducted an informal, unscientific Twitter poll of emergency department nurses and doctors asking how many times per hour they used hand sanitizer or washed their hands at a sink. Of the 95 respondents, 43% performed hand hygiene 10 or more times per hour.
For the sake of simplicity, assume everyone switches to the 6-step technique. Factor in walking to a dispenser or sink and going on to the next task, at least 15 or more seconds will have transpired. Let's say that's about 1 minute total time for each hand hygiene event.
If a typical ED staff member performs hand hygiene 10 times per hour, that individual will spend 80 minutes on hand hygiene during a typical 8-hour shift.
The 19% of ED personnel who clean their hands 15 times per 8 hour shift will spend 120 minutes (2 hours) on hand hygiene.
In 2016, nearly all patient encounters involve wearing gloves. Is it practical for hospital workers to spend 17-25% of their shifts cleaning their hands? How will ever they find the time to check all the boxes in the electronic medical record?
In case you aren’t familiar with the 6-step technique, here’s how it’s done: