Lecture critique – Hygiène des mains en 3 ou 6 étapes : quelle plus-value ?

Titre de l'article sujet de la Lecture critique

Sarah Tschudin-Sutter¹, Daniel Sepulcri¹, Marc Dangel¹, Anja Ulrich², Reno Frei³, Andreas F Widmer¹

Simplifying the world health organization protocol: 3 steps versus 6 steps for performance of hand hygiene in a cluster-randomized trial

Clinical Infectious Diseases 2018; ciy948. DOI: 10.1093/cid/ciy948.

^{1- Division of Infectious Diseases and Hospital Epidemiology
2- Department of Internal Medicine
3- Division of Clinical Microbiology
University Hospital Basel – Basel – Switzerland.}

Background. In an experimental setting, a simplified, 3-step hand hygiene technique for applying alcohol-based hand rub was non inferior in terms of reduction of bacterial counts, as compared to the conventional World Health Organization 6-step technique. We therefore compared compliance and microbiological efficacy between both hand hygiene techniques in routine clinical practice. Methods. We performed a cluster-randomized trial from October–November 2015 at the University Hospital Basel, Switzerland: a tertiary, academic care center (ISRCTN45923734). We randomly assigned 12 wards to either the 3-step technique or the conventional 6-step technique of hand rubbing. The primary endpoints were compliance with the assigned technique and reduction of bacterial counts on the hands of health-care workers. Results. Overall, 2923 hand hygiene indications were observed, and compliance was 70.7% (2066/2923). Compliance with technique and indications was 51.7% (595/1151) and 75.9% (1151/1516) on wards assigned to the 3-step technique, respectively, as compared to 12.7% (116/915) and 65.0% (915/1 407) on wards assigned to the 6-step technique (p<0.001). The reduction factor (RF) of bacterial colony counts did not differ between techniques (median RF 0.97 log10colony-forming units [CFU] [interquartile range 0.39–1.59] for the 3-step technique vs median RF 1.04 log10 CFU [interquartile range 0.49–1.52] for the 6-step technique; p=0.629). Conclusions. In a clinical setting, the simpler hand hygiene technique, consisting of 3 steps, resulted in higher compliance with both hand hygiene indications and technique, as compared to the 6 steps. As the results of the microbiological analyses exclude inferiority, the conventional 6 steps could be safely replaced by a simpler hand hygiene technique.