Journal of Hospital Infection (2002) 50: 276±280 doi:10.1053/jhin.2002.1202, available online at http://www.idealibrary.com on Hand contamination before and after different hand hygiene techniques: a randomized clinical trial J.-C. Lucet*, M.-P. Rigaud*, F. Mentrey, N. Kassisz, C. Deblangy* A. Andremontzx and E. Bouvetx *Infection Control Unit, yDepartment of Biostatistics and Epidemiology, zBacteriology Laboratory and x Infection Control Committee, Bichat-Claude Bernard Hospital, Paris, France Summary: The efficacy of alcohol-based handrubs (ABH) for hand hygiene (HH) compared with hand- washing (HW) remains to be established in the clinical setting. Factors associated with severe hand con- tamination before HH techniques were medical ward, physician and not wearing gloves. Forty-three healthcare workers [HCW, 26 nurses (N), nine nurse assistants (NA) and eight physicians (P)] each performed six HH techniques in random order, immediately after a patient care activity: HW with non-antiseptic soap for 10 (US10) and 30 (US30) s; HW with antiseptic (polyvidone iodine- or chlorhexidine-based) soap for 10 (AS10), 30 (AS30) or 60 (AS60) s; and ABH (Sterillium, Bode Chemie, Germany). The fingertips of the dominant hand were pressed on to agar for culture before and after each HH technique. Five hundred and sixteen specimens were obtained. Log 10 -transformed bacterial count reductions after HH were 0.74, 0.51, 1.13, 1.14, 1.21 and 1.40 for US10, US30, AS10, AS30, AS60 and ABH, respectively; both AS and ABH were significantly better than US. Qualitative assessment showed that 11 of the 256 pre-HH specimens (4.3%) had pathogenic bacteria, and that two of these 11 remained positive after HH (US in both instances). & 2002 The Hospital Infection Society Introduction Handwashing is recognized as a basic measure for preventing nosocomial infections. 1 However, compliance with handwashing in hospital environ- ments is generally less than 50%. 2 Furthermore, correct handwashing technique, particularly in respect of duration, is often not practiced. Reasons for insufficient compliance have recently been studied. 3 Problems include insufficient facilities, lack of training and information, a lack of time and a high patient care load, as well as cutaneous intol- erance of soaps. Alcohol-based hand disinfectant solutions are used increasingly as an alternative to handwashing 4,5 and may enable many obstacles in the way of handwashing to be overcome. The microbiological efficiency of alcohol-based hand disinfectants has been demonstrated in vitro 5 in reducing the bacterial count on artificially con- taminated hands. In a clinical situation, several studies have shown that handrubbing with alcohol- based hand disinfectants is more efficient than with unmedicated soap. 6±8 Experimental conditions, however, especially the duration of handwashing, have not always been described in these studies. Furthermore, there are no Received 17 August 2001; revised manuscript accepted 5 February 2002; published online 18 March 2002. Author for correspondence: Dr J. C. Lucet, Unite d'HygieÁne et de Lutte contre l'Infection Nosocomiale, GH Bichat-Claude Bernard, F-75877 Paris Cedex 18, France. Fax: 33 (0)1 40 25 88 11; E-mail: jean-christophe.lucet@bch.ap-hop-paris.fr 0195±6701/02/040276 1 05 $35.00/0 & 2002 The Hospital Infection Society