Intended for healthcare professionals

Feature Christmas 2019: Let it Be

Wash your hands, Brother John!

BMJ 2019; 367 doi: (Published 16 December 2019) Cite this as: BMJ 2019;367:l6050
  1. Nisha Thampi, assistant professor1,
  2. Lekha N Villeneuve, student2,
  3. Yves Longtin, associate professor3
  1. 1Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Canada
  2. 2OMS Montessori School, Ottawa, Canada
  3. 3Department of Medicine, Jewish General Hospital, Montreal, Canada
  1. Corresponding author: N Thampi nthampi{at}

Use of a six step hand hygiene technique as recommended by the World Health Organization is important to ensure thorough cleansing of hands, but learning and memorising the steps is a major barrier to its adoption. We hereby describe a musical mnemonic based on the popular nursery rhyme “Brother John” (also known as “Frère Jacques”) that can help learning and remembering of the proper technique.

Regular hand hygiene education at day care and school is recommended as an effective method to prevent gastrointestinal and respiratory infections, which are common in children.1 Hand cleansing may seem a relatively simple task, and the correct technique can improve the effectiveness of hand hygiene at eliminating microorganisms.2 Numerous studies have investigated the specific effect of school based hand hygiene interventions on infections and school absenteeism; however, few interventions have focused on how hand hygiene technique is taught to children.3

Using songs, in particular musical mnemonics based on popular nursery rhymes, may help children learn the process of hand hygiene techniques by making it more fun, thereby increasing attention and the development of memory and motor coordination.45 Learning through song lyrics, where the instructions are stated before completion of each step, has been shown to produce quicker …

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