International
Glossary

Rub-in method for hand disinfection

To ensure the required success of hygienic hand disinfection, all hand areas need to be completely covered with the preparation during rubbing. Since the 1970s, a sequence of six steps has beenconsidered the best rub-in technique to prevent gaps in coverage. It represents the standard rub-in method of EN 1500 for the efficacy testing of disinfectants for hygienic hand disinfection [1].The so-called 6-step method of the World Health Organization (WHO) also goes back to this [2].

Self-responsible rubbing method covers the hands best

In 2008, a comprehensive study [3] scientifically proved that a ‘responsible application’ yields the best results. In this study, the test persons rubbed the preparation in using their individual technique while paying attention to complete coverage. Yielding the largest gaps in coverage, the known six steps performed worst among all methods tested. Furthermore, the study showed that safe hand disinfection requires 25 to 30 seconds – shorter exposure times led to poor coverage results. In addition to sufficient exposure time, thorough coverage of fingertips and thumbs is of major importance as they have particular clinical relevance. However, also the responsible application and complete coverage should be trained regularly.
Rub-in method for hand disinfection

Simplified method could also improve hand hygiene compliance

Rub-in method for hand disinfection
In hand disinfection, particular attention has to be paid to fingertips and thumbs.
Another study from 2017 [4] tested a simplified 3-step method as an adaptation of the 6-step method with medical students in a randomized crossover laboratory study. The 3-step method consisted of covering the entire skin surface of the hands, then rubbing the fingertips in a circular motion in the palm of the other hand, and finally rubbing both thumbs in a circular motion. The simplified method reduced the bacterial count on the hands more effectively than the 6-step method and may also improve hand hygiene compliance due to the simplicity of the technique.

German Clean Hands Campaign also relies on self-responsibility

Since 2011, the German Clean Hands Campaign (AktionSaubereHände, ASH) has recommended the self-responsible complete coverageof the hands with disinfectant without following any specific steps. According to ASH, this method is not inferior to the 6-step method in terms of coverage gaps [5].

Sources:

  1. DIN EN 1500-2013: Chemical disinfectants and antiseptics - Hygienic handrub - Test method and requirements (phase 2/step 2). 2013.
  2. World Health Organization (2009) WHO Guidelines on Hand Hygiene in Health Care. First Global Patient Safety Challenge – Clean Care is Safer Care (accessed onAugust1, 2025)
  3. Kampf Get al. (2008) Influence of rub-in technique on required application time and hand coverage in hygienic hand disinfection. BMC Infect Dis8:149.
  4. Tschudin-Sutter S et al. (2017) Simplifying the WHO ‘how to hand rub’ technique: three steps are as effective as six-results from an experimental randomized crossover trial. Clin Microbiol Infect23:409.e1-409.e4.
  5. AktionSaubereHände (2011). https://www.aktion-sauberehaende.de/files/public/fileadmin/ash/download-Material/Positionspapiere-Literatur/03-ASH_Positionspapier_Einreibemethode_30092011.pdf (accessed onAugust1, 2025)

This might also interest you