Is something better than nothing? How many ways can we modify hand hygiene practices to boost compliance without sacrificing safety?

Reviewed by Jen Cihlar, DO, Vanderbilt University Medical Center

Thom and colleagues are at it again investigating alternative hand hygiene (HH) practice efficacy.

Different from their prior study conducted between 2016-2017 looking at HH prior to gloving vs gloving without HH at room entry and exit, this study was a randomized 3 arm trial between 2017-2018 looking at the efficacy of applying alcohol-based hand rub (ABHR) directly to gloved hands vs gold standard of glove removal, HH and donning new gloves vs usual care (unprompted HH practices with notable low compliance). Rather than just on entry and exit, this study looked practice between multiple HH moments during a single patient care encounter, and compared bacterial colony counts and pathogenic bacteria rates.  The intervention group of ABHR directly to gloves did not perform as well as the gold standard arm (4 vs 2 CFU; 7.3% vs 3.9% pathogenic bacteria) but was found to half as time consuming (14 vs 28.7 sec) and still performed better than the usual care by a significant amount (2 vs 29 CFU; 7.1% vs 28.1%). However, they did not look at adherence to the intervention arm when unprompted to represent a more real-world clinical scenario. 

Overall this alternative HH practice might be an acceptable and feasible compromise to boost compliance compared to the current lack of adherence to HH gold standards without a substantial increase in patient harm. The study questions whether HH practice recommendations could benefit from an update to accommodate for more real-world application.


Thom KA, Rock C, Robinson GL, et al. Alcohol-based decontamination of gloved hands: A randomized controlled trial. Infection Control & Hospital Epidemiology. 2023:1-7. doi:10.1017/ice.2023.243

Thom KA, et al.  Direct gloving vs hand hygiene before donning gloves in adherence to hospital infection control practices.  JAMA Network Open. 2023; 6(10):e2336758.

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