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Original Research |

Compliance with Handwashing in a Teaching Hospital

Didier Pittet, MD, MS; Philippe Mourouga, MD, MSc; Thomas V. Perneger, MD, PhD, and the Members of the Infection Control Program
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From University of Geneva Medical School and University of Geneva Hospitals, Geneva, Switzerland.

Ann Intern Med. 1999;130(2):126-130. doi:10.7326/0003-4819-130-2-199901190-00006
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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 ≤ 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]).

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.


Grahic Jump Location
Opportunities to wash hands and compliance with handwashing.

Compliance with handwashing is plotted against the number of opportunities per hour of care for 293 20-minute observation periods of routine hospital work at the University of Geneva Hospital in 1994. The line represents the nonparametric regression function.

Grahic Jump Location




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