Comparison of four methods of hand washing in situations of inadequate water supply.

BACKGROUND

Hand washing is the single most important means of preventing hospital acquired infections, but requires for effectiveness, a constant supply of running water and proper facilities. Most developing countries do not have constant running water facilities, so alternate methods have been developed and used in clinics and hospitals.

OBJECTIVE

To compare and validate alternate methods of hand washing developed for use in Nigeria.

METHODS

The hands of 12 volunteers were pre-contaminated with known isolates of Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. The volunteers washed their hands as described by Ayliffe. The hands and equipment were cultured pre- and post-contamination and post-hand washing. The water used for the hand wash was also cultured pre-hand washing to control for water-based contamination. Each method was evaluated three times and various parts of the equipment were cultured to determine the areas contaminated by the hands during the hand wash.

RESULTS

"Elbow-way" was shown to be the best and the gold standard Sink and Tap for promoting an effective hand washing, as there was no evidence of post-contamination. The worst was the single-bowl method in which the hands of all the 12 (100%) volunteers were contaminated from the bowl, followed by the two-bowl initiative 10 (83%) and the bucket and bowl 9 (75%).

CONCLUSION

The bucket and bowl as well as the single-bowl methods most commonly used in hospitals result in gross contamination of the bowls and bucket and are therefore unsafe and should be discouraged. The elbow way on the other hand appears to be an easy and safe alternative in situations where there is no running water.