Modified WHO hand-washing technique can help remove C. diff

Reuters Health Information: Modified WHO hand-washing technique can help remove C. diff

Modified WHO hand-washing technique can help remove C. diff

Last Updated: 2017-06-05

By Will Boggs MD

NEW YORK (Reuters Health) - A modified version of the World Health Organization (WHO)-recommended hand-washing technique improved the removal of Clostridium difficile from hands compared with an unstructured approach in a new study, while the WHO method did not.

The WHO hand-washing technique has been shown to remove various bacteria, including Escherichia coli, but its efficacy to remove C. difficile spores is unknown.

Dr. Yves Longtin from Jewish General Hospital Sir Mortimer B. Davis, in Montreal, Canada, and colleagues compared the efficacy of three approaches in removing C. difficile from hands: the WHO-recommended approach (described at; a modified "WHO shortened repeated (WHO-SR)" technique, where participants performed the entire WHO technique over 30 seconds rather than 60 seconds, but repeated the technique twice in a row; and an unstructured technique that allowed participants to wash their hands as they would at home without any specific requirements.

The prospective crossover study included 10 participants (six men and four women). The median effectiveness (as measured in log10 reductions in plaque-forming units, compared with no hand-washing) was 1.30 with the unstructured technique, 1.71 with the WHO-recommended approach and 1.70 with the WHO-SR approach.

As reported May 16 online in the American Journal of Infection Control, in head-to-head comparisons, the WHO-SR technique was significantly better than the unstructured technique (p=0.01), the WHO-recommended technique was non-significantly superior to the unstructured technique (p=0.13), and there was a trend for the WHO-SR technique to be superior to the WHO technique (p=0.09).

"In conclusion," the researchers write, "performing a structured handwashing technique was superior to an unstructured technique to remove C. difficile, and the WHO-recommended technique was moderately effective against C. difficile. Whether its efficacy could be improved remains to be determined."

Dr. Sudha Jayaraman from VCU Health System, Richmond, Virginia, who has investigated the impact of infection control strategies on rates of resistant hospital-acquired pathogens, told Reuters Health by email, "You will get better results if you have something that's more structured because we're human, so these results are not entirely surprising. Any technique that is encouraged should be fast, easy, and simple in order to have the greatest number of people following it.”

“I think physicians should really take away that this (washing hands) is an intervention that is almost as important as many of the interventions they make or recommend for their patients,” she said. “It's a culture change to emphasize hand hygiene. There is not a robust mechanism to transmit this information to medical students or trainees through the current educational systems, and so it needs to be emphasized over and over again in the healthcare environment.”

“There are other issues that this paper does not address,” said Dr. Jayaraman, who was not involved in the new work. “One - there is significant environmental contamination and no matter how much hand hygiene is done, just that alone is not enough to prevent transmission of bacteria to patients. It is important to address the significant microbiological burden in the hospital environment. So we really also need to be asking how hospitals clean the environment especially after patients with resistant infections are taken care of.”

“Both hand hygiene and environmental decontamination need to go together to address transmission of bacteria,” she concluded. “Of course this goes along with antibiotic stewardship to limit the development of these infections and decontamination of patients with resistant infections to prevent dispersion into the environment and onto healthcare workers.”

Dr. Longtin did not respond to a request for comments.


Am J Infect Control 2017.

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