An average hand hygiene day for nurses and physicians: The burden is not equal

Background: To understand whether the burden of hand hygiene contributes to poor compliance we measured the daily number of hand hygiene opportunities (HHOs) by shift for nurses and physicians in 2 wards in a 850-bed university teaching hospital. Methods: On each ward 4 trained auditors collected the number of HHOs and compliance events for 24 hours over 7 days. Twenty-one thousand four hundred fifty HHOs were collected from a medical and a surgical ward. The proportion of alcohol-based handrub used daily, the burden of hand hygiene, and compliance rates were calculated separately for nurses and physicians. Results: The average indication for alcohol-based handrub cleansing represented 68% of all HHOs. Nurses had an average burden of 55 HHOs per 24 hours or 27 HHOs per shift, 3 times higher than the burden for physicians, who had 16 HHOs per 24 hours or 8 HHOs per shift. Overt observations of the weekly compliance identified nurses had 1.5 times higher compliance than physicians: 76% and 52% (P < .01), respectively. Conclusions: Nurses have 3 times more HHOs than physicians, yet nurses have 1.5 times higher compliance than physicians. Hand hygiene compliance in physicians cannot be explained by burden of HHOs. Crown Copyright (C) 2016 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.