More on bare below the elbows and hand hygiene

I am always on the lookout for studies that evaluate bare below the elbows, but they remain few and far between. I previously blogged about a paper that showed that wrist hygiene was better when bare below the elbows was observed. No cultures were performed in that study, which used a fluorescent marker to determine the surface area of decontamination. A new study in the Journal of Hospital Infection looked at fingertip cultures in 92 doctors (49 were bare below the elbows and 43 were not). No MRSA or VRE was found in any of the cultures and there was no difference in colony counts between the two groups. However, I think the underlying premise of the study is wrong. There is a good argument to be made, in my opinion, that bare below the elbows can improve hand hygiene. But the fingertips would seem to be the least likely place for this to be true. A much stronger study would have involved culturing the wrists, which are hard to wash without getting sleeves wet. I suspect the investigators got the results they wanted given that the tone of the paper is one of anti-bare below the elbow. Now they can claim that bare below the elbow has no effect on hand hygiene. Even if that were true, we would still have the problem of pathogens on the coat potentially being transmitted to patients.