Medical Students Should Receive Hand Hygiene Training, Researchers Say

Researchers from the University Hospital Basel in Basel, Switzerland, writing in the November issue of Infection Control and Hospital Epidemiology say that hand hygiene training programs based on the guidelines issued by the World Health Organization (WHO) as well as on the proper technique for use of an alcohol-based handrub should be included in the curriculum of medical students as well as offered to physicians throughout their career.

Sutter, et al. (2010) acknowledge that physicians have some of the lowest rates of hand hygiene compared to other healthcare professionals and sought to evaluate the level of bacterial killing on hands of medical students using the WHO technique (including the six steps of proper hand hygiene technique), as well as hypothesized that advanced medical students improve in hygiene performance because they receive multiple training sessions while on clinical duty.

Medical students at the University of Basel, Switzerland attended a training lecture on the scientific background on hand hygiene that included a hand hygiene demonstration based on WHO recommendations and techniques. An infection control professional made recommendations for improvement after the students passed visual evaluation. This visual evaluation consisted of testing the technique by the addition of a fluorescent dye to the alcohol-based handrub. Following the hand hygiene procedure, students placed their hands in a standardized box under UV light; the areas of the hand that had been missed by the handrub did not fluoresce. Compliance with recommended WHO technique was continuously monitored by at least two infection control professionals.

The number of colony-forming units (CFUs) of bacteria on the fingertips was determined before and after use of alcohol-based handrub by the finger imprint technique (obtaining an imprint of the five fingertips of the dominant hand on a culture plate and subsequently quantifying bacterial growth as CFUs per plate).

The researchers report that before the use of alcohol-based handrub, the bacterial density on the hands of students was 26 to 100 CFUs per plate for 259 students and was more than 100 CFUs per plate for 207 students. Fewer than 26 CFUs per plate were found for the remaining 97 students. Staphylococcus aureus was recovered from the hands of 68 students before use of alcohol-based handrub, and Klebsiella pneumoniae were recovered from the hand of one student. The skin flora found on the hands of the medical students before use of alcohol-based handrub were Propionibacterium species, Corynebacterium species, coagulase-negative staphylococci and Bacillus species.

After the use of alcohol-based handrub, 244 medical students had no detectable bacteria on their hands, 262 had very low bacterial density, 45 had 25 to 100 CFUs per plate, and 12 had fewer than 100 CFUs per plate. S. aureus was eliminated from the hands of 98.9 percent of students after applying the alcohol-based hand sanitizer according to the WHO technique.

The researchers emphasize that medical students in academic years three and four achieved a significantly greater reduction in bacterial density on their hands than did students in the first two years of training; they say that this difference in performance most likely relates to their participation in repeated training sessions promoting the WHO hand hygiene technique, which is part of their routine training at the University Medical School of Basel. They add that this observation underlines the need for repeated training programs throughout medical school and later during professional life.

Reference: Sutter ST, Frei R, Dangel M and Widmer AF. Effect of Teaching Recommended World Health Organization Technique on the Use of AlcoholBased Hand Rub by Medical Students. Infect Control Hosp Epidemiol. 2010;31:1194-1195.