Effective hand hygiene prevents healthcare-associated infections. This systematic review evaluates the evidence for the World Health Organization\'s (WHO) technique in reducing the microbial load on the hands of healthcare workers (HCWs).
This study was conducted in accordance with Joanna Briggs Protocol 531. Index and free-text terms for technique, HCW, and microbial load were searched in CINAHL, Medline, Web of Science, Mednar, Proquest, and Google Scholar. Inclusion criteria were articles in English that evaluated the WHO 6-step hand hygiene technique for healthcare staff. Two reviewers independently performed quality assessment and data extraction.
All 7 studies found that the WHO technique reduced bacterial load on HCW hands, but the strongest evidence came from 3 randomized controlled trials, which reported conflicting evidence. One study found no difference in the effectiveness of the WHO 6-step technique compared to the Centers for Disease Control and Prevention\'s 3-step technique (P = .08); another study found the WHO 6-step technique to be more effective (P = .02); and the third study found that a modified 3-step technique was more effective than the 6-step technique (P = .021).
This review provides evidence of the effectiveness of the WHO technique but does not identify the most effective hand hygiene technique. Questions to be addressed by further research are identified. Meanwhile, current practices should continue.

Microbial load on fresh fruit and vegetables causes decay and losses after harvest and may lead to foodborne illness in case of contamination with human pathogens on raw consumed produces. Washing with tap water only marginally reduces microorganisms attached to produce surfaces. Chlorine is widely used for decontamination on fresh horticultural produces. However, due to harmful by-products and the questionable efficacy it has become increasingly challenged. During the last 20 years, the interest to study ClO2 treatments as an alternative sanitation agent for industrially prepared fresh produce has largely increased. For a wide range of commodities, the application of gaseous ClO2 has meanwhile been investigated. In addition, since several years, the interest in aqueous ClO2 treatments has further risen because of the better manageability in postharvest processing lines compared to gaseous application. This article critically evaluated the effects of postharvest application of aqueous ClO2, either alone or in combination with other treatments, on microbial loads for various horticultural produces. In laboratory investigations, application of aqueous ClO2 at concentrations between 3 and 100 ppm effectively reduced counts of natural or inoculated microorganisms (bacteria, yeasts, and mold) in the range of 1 and 5 log. However, various effects of ClO2 treatments on produce quality have been described. These mainly comprise implication on sensory and visual attributes. In this context, there is increasing focus on the potential impacts of aqueous ClO2 on relevant nutritional components of produces such as organic acids or phenolic substances.