A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers

Lesley Price, Lynn Melone, Nichola McLarnon, Donald Bunyan, Claire Kilpatrick, Paul Flowers, Jacqueline Reilly

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)
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Background: Effective hand hygiene prevents healthcare-associated infections. This systematic review evaluates the evidence for the World Health Organization's (WHO) technique in reducing the microbial load on the hands of healthcare workers (HCWs). Methods: This study was conducted in accordance with Joanna Briggs Protocol 531. Index and free-text terms for technique, HCW, and microbial load were searched in CINAHL, Medline, Web of Science, Mednar, Proquest, and Google Scholar. Inclusion criteria were articles in English that evaluated the WHO 6-step hand hygiene technique for healthcare staff. Two reviewers independently performed quality assessment and data extraction. Results: All 7 studies found that the WHO technique reduced bacterial load on HCW hands, but the strongest evidence came from 3 randomized controlled trials, which reported conflicting evidence. One study found no difference in the effectiveness of the WHO 6-step technique compared to the Centers for Disease Control and Prevention's 3-step technique (P =.08); another study found the WHO 6-step technique to be more effective (P =.02); and the third study found that a modified 3-step technique was more effective than the 6-step technique (P =.021). Conclusions: This review provides evidence of the effectiveness of the WHO technique but does not identify the most effective hand hygiene technique. Questions to be addressed by further research are identified. Meanwhile, current practices should continue.

Original languageEnglish
Pages (from-to)814-823
Number of pages10
JournalAmerican Journal of Infection Control
Issue number7
Early online date27 Mar 2018
Publication statusPublished - 1 Jul 2018


  • hand hygiene
  • microbial load
  • systematic review
  • technique

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