ArticleBMC infectious diseases2013
A large-scale assessment of hand hygiene quality and the effectiveness of the "WHO 6-steps".
Article in BMC infectious diseases, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
41 citing papers in PubMed, 3 syntheses or guidelines pooled it, 92 citations in OpenAlex.
- Effects of the Implementation of Intelligent Technology for Hand Hygiene in Hospitals: Systematic Review and Meta-analysis.Journal of medical Internet research · 2023Pooled it
- Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology.Journal of medical Internet research · 2021Pooled it
- Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review.Infection control and hospital epidemiology · 2016Pooled it
- Hand Hygiene Accuracy of Students and Staff at a Dutch Dental School.European journal of dental education : official journal of the Association for Dental Education in Europe · 2026Article
- Scanner-Measured Hand Hygiene Performance After Automated Visual Feedback-Supported Training: A Multicenter Quality Improvement Project in Italian Hospitals.Nursing reports (Pavia, Italy) · 2026Article
- ATP Bioluminescence Feedback Is Associated with Reduced Residual Hand Contamination Among Healthcare Workers: A Single-Center Before-and-After Study.Healthcare (Basel, Switzerland) · 2026Article
- Evaluation of Hand Hygiene Technique in Uzbekistan: First Experience from Semmelweis Scanner-Based Digital Assessment in Educational Institutions.Healthcare (Basel, Switzerland) · 2026Article
- Examining the impact of alerting visual stimuli on the effectiveness of practising surgical scrub technique in medical education.BMC medical education · 2025Article
- Enhancing hand hygiene compliance in healthcare environmental services staff: a systematic approach to indicator development.Antimicrobial resistance and infection control · 2025Article
- Artificial Intelligence and Hand Hygiene Accuracy: A New Era in Infection Control for Dental Practices.Clinical and experimental dental research · 2025Article
- Evaluating the Effectiveness of the WHO 6-Step Hand Hygiene Technique: Impact of Step Omission and Duration on Microbial Reduction.Risk management and healthcare policy · 2025Article
- Methods for assessing efficacy of cleaning and disinfection in livestock farms: a narrative review.Frontiers in veterinary science · 2025Review
- Knowledge of hand hygiene and evaluation of hand washing technique among nurses at the University of Nigeria Teaching Hospital.BMC nursing · 2024Article
- Evaluation of a Video-Based Concept for Hand Hygiene Education of Parents in a Neonatal Intensive Care Unit.Healthcare (Basel, Switzerland) · 2024Article
- Development and Implementation of an Ultraviolet-Dye-Based Qualification Procedure for Hand Washing and Disinfection to Improve Quality Assurance of Pharmacy Preparations and Compounding, Especially in Cleanrooms: A Pilot Study.Pharmacy (Basel, Switzerland) · 2024Article
- Preventing Healthcare-Associated Infections: Hand Disinfection Monitoring Using an Automated System in an Italian Neurological Hospital.Healthcare (Basel, Switzerland) · 2023Article
- Factors associated with hand washing effectiveness: an institution-based observational study.Antimicrobial resistance and infection control · 2023Observational
- The Association between Hand Disinfection Techniques and Their Barriers, as Well as the "Bare below the Elbows" Concept, among Healthcare Professionals-A Study Based on a Polish Population.International journal of environmental research and public health · 2022Article
- Establishing a Learning Model for Correct Hand Hygiene Technique in a NICU.Journal of clinical medicine · 2022Article
- Use of ultraviolet light in graduate medical education to assess confidence among residents and fellows in handwashing instruction.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHand hygiene compliance is generally assessed by observation of adherence to the "WHO five moments" using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectively assess hand rub coverage of staff using a novel imaging technology and to look for patterns and trends in missed areas after the use of WHO's 6 Step technique.
methodsA hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic.
resultsDespite the assessment taking place immediately after the training, only 72% of staff achieved satisfactory coverage. Failure to adequately clean the dorsal and palmar aspects of the hand occurred in 24% and 18% of the instances, respectively. Fingertips were missed by 3.5% of subjects. The analysis based on 4642 records showed that nurses performed best (77% pass), and women performed better than men (75% vs. 62%, p<0.001). Further risk indicators have been identified regarding age and occupation.
conclusionOngoing education and training has a vital role in improving hand hygiene compliance and technique of clinical staff. Identification of typical sites of failure can help to develop improved training.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.