Scientific article
Open access

Factors associated with hand washing effectiveness : an institution-based observational study

Published inAntimicrobial resistance and infection control, vol. 12, no. 1, 85
  • The original article contains a typo in a sentence in the Methods section (correct sentence should be as follows: “[…] hands using the hand scanner (Semmelweis Scanner ™, HandInScan Zrt., Debrecen, Hungary)” )
  • DOI : 10.1186/s13756-023-01313-0
  • PMID : 37775834
Publication date2023-08-30
First online date2023-08-30


Few studies have investigated how the effectiveness of hand washing in removing hand contaminants is influenced by the performance and duration of each step involved. We conducted an observational study by recruiting participants from a university campus, with the aim to comprehensively evaluate how performance, duration and demographic factors influence hand washing effectiveness.


A total of 744 videos were collected from 664 participants in July-October 2022 and independently evaluated by two infection control experts through labelling videos for correct and incorrect performance of each step. The individual hand washing effectiveness was determined by quantifying the percentage of residual fluorescent gel on the dorsum and palm areas of each participant’s hands. A logistic regression analysis was conducted to identify factors that were significantly associated with better hand washing effectiveness. An exposure-response relationship was constructed to identify optimal durations for each step. Approximately 2300 hand images were processed using advanced normalization algorithms and overlaid to visualize the areas with more fluorescence residuals after hand washing.


Step 3 (rub between fingers) was the most frequently omitted step and step 4 (rub the dorsum of fingers) was the most frequently incorrectly performed step. After adjustment for covariates, sex, performance of step 4 and step 7 (rub wrists), rubbing hands during rinsing, and rinsing time were significantly associated with hand washing effectiveness. The optimal overall hand washing time was 31 s from step 1 to step 7, and 28 s from step 1 to step 6, with each step ideally lasting 4–5 s, except step 3. The palms of both hands had less fluorescence residuals than the dorsums. The areas where residuals most likely appeared were wrists, followed by finger tips, finger webs and thumbs.


Performance and duration of some hand washing steps, sex and rinsing time were associated with hand washing effectiveness. The optimal duration might be applied to all seven steps to achieve the best decontamination results. Further studies are needed to refine hand hygiene standards and enhance compliance.

  • Hand hygiene
  • Hand washing
  • Infection prevention and control
  • Standards
Citation (ISO format)
SHI, Chen et al. Factors associated with hand washing effectiveness : an institution-based observational study. In: Antimicrobial resistance and infection control, 2023, vol. 12, n° 1, p. 85. doi: 10.1186/s13756-023-01293-1
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ISSN of the journal2047-2994

Technical informations

Creation09/20/2023 7:56:55 AM
First validation01/10/2024 9:32:18 AM
Update time01/10/2024 9:32:18 AM
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