Compliance with handwashing in a teaching hospital

Background: Transmission of microorganisms from the hands of health care wo rkers is the main source of cross-infection in hospitals and can be prevent ed by handwashing. Objective: To identify predictors of noncompliance with handwashing during routine patient care. Design: Observational study. Setting: Teaching hospital in Geneva, Switzerland. Participants: Nurses (66%), physicians (10%), nursing assistants (13%), and other health care workers (11%). Measurements: Compliance with handwashing. Results: In 2834 observed opportunities for handwashing, average compliance was 48%. In multivariate analysis, noncompliance was higher among physicia ns (odds ratio [OR], 2.8 [95% CI, 1.9 to 4.1]), nursing assistants (OR, 1.3 [CI, 1.0 to 1.6]), and other health care workers (OR, 2.1 [CI, 1.4 to 3.2] ) than among nurses and was lowest on weekends (OR, 0.6 [CI, 0.4 to 0.8]). Noncompliance was higher in intensive care than in internal medicine units (OR, 2.0 [CI, 1.3 to 3.1]), during procedures that carry a high risk for co ntamination (OR, 1.8 [CI, 1.4 to 2.4]), and when intensity of patient care was high (compared with less than or equal to 20 opportunities for handwash ing per hour of care, 21 to 40 opportunities: OR, 1.3 [CI, 1.0 to 1.7]; 41 to 60 opportunities: OR, 2.7 [CI, 1.5 to 2.9]; and >60 opportunities: OR, 2 .1 [CI, 1.3 to 3.5]). Conclusions: Compliance with handwashing was moderate. Variation across hos pital ward and type of health care worker suggests that targeted educationa l programs may be useful. Even though observational data cannot prove causa lity, the association between noncompliance and intensity of care suggests that understaffing may decrease quality of patient ca re.