load on hands . However , this was a laboratory-based study limited by the lack of randomization .

Instead of being able to point to a definitive finding , Price , et al . ( 2022 ) acknowledge that , “ From the whole body of evidence , there is consistency in that all techniques reduce the microbial load on the hands ; however , it is difficult to differentiate between the efficacy of different hand hygiene techniques . Furthermore , with the exception of the ‘ self-responsible application ’ technique for which no specific instructions were provided , all techniques identified in our review involved covering all surfaces of the hands , which may have confounded the comparisons . In addition , relevant confounding factors , such as product used , time taken to perform hand hygiene , volume of hand hygiene product and accuracy in performance of the technique have not always been controlled for and may have influenced the results . Therefore , inconsistencies in evidence could result from the influence of these potential confounders .”

Parenthetically , in their previous review , Price and Melone ( 2018 ) had concluded that there was evidence of the effectiveness of the WHO technique , but it does not identify the most effective hand hygiene technique overall . The researchers had previously identified seven studies indicating that the WHO technique reduced bacterial load on healthcare personnel ’ s hands , but the strongest evidence came from three randomized controlled trials which reported conflicting evidence . One study found no difference in the effectiveness of the WHO 6-step technique compared to the CDC 3-step technique ; another study found the WHO 6-step technique to be more effective ; and the third study found that a modified 3-step technique was more effective than the 6-step technique .

As the ICPIC taskforce observes , “ There is inconclusive evidence regarding the most effective hand hygiene technique in real-world clinical settings . Effectiveness in this context incorporates elements of both microbiological efficacy and implementation .”

As experts continue to debate the number of steps in proper hand hygiene technique and the opportunities for performing hand hygiene , challenges in monitoring landed on the ICPIC taskforce ’ s list of gaps that must be addressed to move the needle on HAI prevention .

Just as the Five Moments have been cemented as the hand hygiene framework of popular choice , direct hand hygiene observations conducted by trained observers has been designated as the “ gold standard ” for estimating hand hygiene compliance for all Five Moments . But , as the ICPIC taskforce acknowledges , “ Assessing the quality of direct observation is crucial given the effort , time , and personnel involved . The Hawthorne effect , which occurs when individuals modify their behavior because of their awareness of being observed , is considered a significant bias . Hence , standardized methodologies are crucial for measuring its extent in diverse care and clinical settings and for identifying effective interventions that can minimize it .”

The important gaps in monitoring as identified by the ICPIC taskforce include establishing methods to improve the accuracy of direct observations ; establishing methods that assess and allow for the Hawthorne effect to be quantified ; and evaluating differences in Hawthorne effect between clinical specialties .

The ICPIC taskforce also scrutinized alcohol-based handrub ( ABHR ), which we know kills the entire spectrum of vegetative bacteria , yeasts , and molds ( but not bacterial spores or parasites ), and therefore is a useful antimicrobial agent . However , a

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