We conducted a 3-month observational study in 2008 to assess hand hygiene adherence of doctors and nurses. Four of the units (ophthalmology, cardiology, geriatrics, and infectious diseases) were within one hospital, and the fifth unit (an emergency department) was in another hospital located less than 1 km away. External observers were used to assess the hand hygiene adherence of doctors and nurses before patient contact.
A total of 665 doctor–patient observations and 1147 nurse–patient observations were made. Doctors used some type of hand hygiene before touching the patient in 28 % of their patient interactions (soap and water in 16 % and alcohol-based handrub in 12 % ). Nurses used some type of hand hygiene in 34 % of their interactions (soap and water in 27 % and alcohol-based handrub in 7 % ). Hand hygiene adherence varied substantially across the units, from a low of 6 % to a high of 66 % for doctors and from 19 % to 56 % for nurses. The correlation between nurse adherence and doctor adherence was 0.90.
The overall rates of hand hygiene adherence observed were similar to those found when Tuscany initiated a hand hygiene campaign 3 years earlier. Focusing on overall rates may be misleading, however, because substantial variability existed between units. Furthermore, these rates come only from the “first moment” (before touching the patient) and can only be compared with rates from studies using the same approach.