Hidden Germs, Bigger Risks: How Each Missed Step in Hand Hygiene Alters Microbial Load and Healthcare-associated Infections

Saravana Priya J K; Karthika Venugopal; Veena Kumari H B

doi:10.11910/j.issn.2791-2043.2025.2.03

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Hidden Germs, Bigger Risks: How Each Missed Step in Hand Hygiene Alters Microbial Load and Healthcare-associated Infections

REVIEW ARTICLES | Updated：2026-02-06

- Hidden Germs, Bigger Risks: How Each Missed Step in Hand Hygiene Alters Microbial Load and Healthcare-associated Infections
- Sterile Supply Vol. 4, Issue 2, (2025)
- Affiliations：
  
  Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru, Karnataka, India
- Author bio：
  
  Veena Kumari H B at stayunique.micro@gmail.com
- Funds：
- DOI：10.11910/j.issn.2791-2043.2025.2.03
  CLC：
- Published：15 August 2025
- Accepted：
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J K Saravana Priya,Venugopal Karthika,H B Veena Kumari.Hidden Germs, Bigger Risks: How Each Missed Step in Hand Hygiene Alters Microbial Load and Healthcare-associated Infections[J].Sterile Supply,2025,04(02):78-83.
DOI：

J K Saravana Priya,Venugopal Karthika,H B Veena Kumari.Hidden Germs, Bigger Risks: How Each Missed Step in Hand Hygiene Alters Microbial Load and Healthcare-associated Infections[J].Sterile Supply,2025,04(02):78-83. DOI： 10.11910/j.issn.2791-2043.2025.2.03.

摘要

Abstract

Background

Healthcare-associated infections (HAIs) primarily originate from environmental pathogens or patients’ endogenous flora

with the hands of healthcare workers (HCWs) serving as a major transmission vector. Therefore

improving hand hygiene is cr

ucial to controlling HAIs

and how to improve hand hygiene is a topic worthy of study.

Aims and

Objectives

This study aims to evaluate the effectiveness of hand hygiene practices in reducing microbial load and their role in mitigating HAIs. It also analyzes the microbial profiles on HCWs’ hands

identifies species and resistance patterns

and assesses the impact of omitting specific hand hygiene steps. The goal is to formulate evidence-based recommendations to improve compliance and enhance infection control.

Methods

A cross-sectional study was conducted involving HCWs from the intensive care unit (ICU) and high-dependency unit (HDU) at the National Institute of Mental Health and Neurosciences (NIMHANS). Based on the WHO 6-step hand hygiene protocol

hand impressions were collected before and after hand hygiene using 5% sheep blood agar plates. Microbial identification was performed using the matrix-assisted laser desorption ionization-time of flight (MALDI-TOF)

and susceptibility testing was conducted with VITEK. The impact of omitting each step of the hand hygiene protocol was evaluated.

Results

Omitting Step 4 resulted in the highest reduction (96.82% without gloves; 98.03% with gloves)

while omitting Step 6 revealed the lowest reduction (71.23% without gloves; 66.18% with gloves). Handwashing was more effective (90.84%) than hand rubbing (87.72%).

Discussion

　The findings emphasize the importance of meticulous hand hygiene in reducing microbial contamination and HAIs. Education and reinforcement of protocol are crucial for effective infection control.

Conclusion

Rigorous hand hygiene

supported by environmental cleaning

education

monitoring

and leadership

is essential for reducing multidrug-resistant organisms and improving patient outcomes. This study highlights the need to account for baseline microbial levels

identifies Steps 6 and 5 as most critical

and confirms the superior efficacy of handwashing over hand rubbing — key insights for refining hygiene protocols and compliance strategies.

关键词

Keywords

references

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