What are the three by three rules?

Beyond Hand Sanitizer: Demystifying the Three by Three Infection Control Guidelines

In healthcare settings, preventing the spread of infection is paramount. While complex protocols and advanced sterilization techniques exist, sometimes the most effective strategies are simple, easily remembered rules of thumb. One such method, often referred to informally as the Three by Three rules, offers a foundational approach to minimizing the risk of germ transmission. While the specific interpretation can vary slightly, the core concept revolves around three actions, each emphasizing a three-fold application to ensure thoroughness.

Understanding the Core Principles:

The Three by Three rules are designed to be easily remembered and implemented, fostering a culture of vigilance. The primary goal is to break the chain of infection transmission, focusing on key points of potential vulnerability. While the specific actions might be adapted to the context, the underlying principle of repetition and thoroughness remains constant.

Common Interpretations and Applications:

Heres a breakdown of a common, though possibly not universally accepted or evidence-based, interpretation of these guidelines, followed by a discussion on more evidence-backed principles:

• Hand Hygiene (with a twist): The typical Three by Three rule might suggest washing hands for three minutes. However, current best practices strongly advocate for at least 20 seconds of thorough handwashing with soap and water, or using an alcohol-based hand sanitizer containing at least 60% alcohol, applied for a similar duration to cover all surfaces of the hands. The emphasis is on proper technique and adequate time to eliminate microorganisms, not just the absolute duration. Repeating hand hygiene procedures throughout patient care is critical. Three separate hand hygiene procedures between each task within patient care, for example.

• Injection Site Preparation: This rule often dictates cleaning the injection site with three alcohol swabs. While using multiple swabs provides more thorough disinfection, the most important factor is the technique. Using one swab and rubbing the site using circular motions for 30 seconds, allowing the site to air dry for another 30 seconds, before an injection is the recommendation. This allows the alcohol to effectively kill the bacteria.

• Needle Insertion Angle (Caveat): The final Three by Three often mentions inserting a needle at a 30-degree angle. This is highly context-dependent and incorrect in many situations. The correct angle of insertion depends on the type of injection (intramuscular, subcutaneous, intradermal) and the patients anatomy. For instance, intramuscular injections typically require a 90-degree angle to reach the muscle tissue effectively, while subcutaneous injections use a 45-degree angle. The recommendation is to follow proper needle angle depending on injection type and anatomical location. Three steps in setting up for needle insertion may be more appropriate: confirming the correct medication, confirming the correct dosage, and reviewing patient information for allergies.

Beyond the Specifics: Focusing on Evidence-Based Practices:

While the Three by Three rules offer a simplistic framework, its crucial to emphasize that they shouldnt replace evidence-based infection control practices. These broader strategies include:

• Following Standard Precautions: Treat all patients as potentially infectious and adhere to universal precautions, including wearing gloves, masks, and eye protection when appropriate.
• Proper Waste Disposal: Safely dispose of sharps and contaminated materials to prevent accidental exposures.
• Environmental Cleaning: Regularly clean and disinfect surfaces and equipment in patient care areas.
• Respiratory Hygiene: Encourage patients and staff to practice cough etiquette (covering coughs and sneezes) and use tissues.
• Aseptic Technique: Employ sterile techniques when performing invasive procedures to minimize the risk of introducing pathogens.

Conclusion:

The Three by Three rules can serve as a basic reminder of the importance of infection control. However, healthcare professionals must prioritize adhering to current, evidence-based guidelines and adapting their practices based on the specific clinical context. While the simplicity of these rules might be appealing, a comprehensive understanding of infection control principles is essential for protecting both patients and healthcare workers.