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Science in the News

More Rigorous Hand Hygiene Routine May be Needed

April 21, 2016

Hand hygiene is a critical component in infection control. Research out of Scotland demonstrates that in terms of reducing bacterial load, a six-step hand hygiene regimen using alcohol-based hand rubs outperforms the currently promoted three-step method.

The three-step technique, used by many healthcare professionals, involves applying the rub to the palm of one hand, rubbing the hands together—covering all surfaces—and continuing to rub until hands are dry.1 The six-step method, recommended by the World Health Organization, using the same amount of rub, likewise encourages providers to cover all surfaces, but specifies a more detailed technique that may be useful in achieving this coverage.2 For example, WHO’s approach specifically describes methods intended to cover the area between the fingers and fingertips.

Not surprisingly, the six-step method took longer to complete than the quicker three-step method—an average of 42.5 seconds compared to 35 seconds.

It should be noted that soap and water remain the standard approach for hand hygiene if the hands are soiled; alcohol-based hand rubs are adequate if hands are not visibly soiled. The ADA Professional Product Review offers a complete discussion on hand hygiene as well as a video demonstrating proper hand hygiene using soap and water.3


  1. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep 2002;51:1–45.
  2. World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: a Summary. 2009; page 13.  Accessed April 21, 2016.
  3. ADA Council on Scientific Affairs. Back to Basics: Hand Hygiene for the Dental Team. ADA Professional Product Review 2015;10(2):4-7.

Prepared by: Center for Scientific Information, ADA Science Institute

About Science in the News

Science in the News is a service by the American Dental Association (ADA) to its members to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.