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19 January 1999 | Volume 130 Issue 2 | Pages 126-130
Background: Transmission of microorganisms from the hands of health care workers is the main source of cross-infection in hospitals and can be prevented 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 physicians (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 contamination (OR, 1.8 [CI, 1.4 to 2.4]), and when intensity of patient care was high (compared with
Conclusions: Compliance with handwashing was moderate. Variation across hospital ward and type of health care worker suggests that targeted educational programs may be useful. Even though observational data cannot prove causality, the association between noncompliance and intensity of care suggests that understaffing may decrease quality of patient care.
Author and Article Information
From University of Geneva Medical School and University of Geneva Hospitals, Geneva, Switzerland.
Acknowledgments: The authors thank the health care workers at the University of Geneva Hospitals and the members of the Infection Control Program, in particular V. Sauvan, RN, S. Touveneau, RN, and N. Colaizzi (for data entry). Members of the Infection Control Program (Unité de Prévention et Contrôle de l'Infection, UPCI) at the University of Geneva Hospitals participated in the design of the study and conducted field observations (A. Alexiou, P. Copin, N. Henry, V. Sauvan, and S. Touveneau).
Requests for Reprints: Didier Pittet, MD, MS, Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, 1211 Geneva 14, Switzerland; e-mail, didier.pittet{at}hcuge.ch.
Current Author Addresses: Dr. Pittet: Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, 1211 Geneva 14, Switzerland.
Dr. Mourouga: Service de Réanimation Médicale, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75011 Paris, France.
Dr. Pernerger: Institute of Social and Preventive Medicine and Medical Director's Office, University of Geneva Hospitals, 1211 Geneva 14, Switzerland. BRIEF COMMUNICATION
Compliance with Handwashing in a Teaching Hospital
20 opportunities for handwashing per hour of care, 21 to 40 opportunities: OR, 1.3 [CI,1.0 to 1.7]; 41 to 60 opportunities: OR, 2.1 [CI,1.5 to 2.9]; and >60 opportunities: OR, 2.1 [CI,1.3 to 3.5]).
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|
|
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|
|
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