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Hand Hygiene Practices After Brief Encounters With Patients: An Important Opportunity for Prevention

  • Rebecca E. Dedrick (a1), Ronda L. Sinkowitz-Cochran (a1), Candace Cunningham (a2), Robert R. Muder (a2), Peter Perreiah (a2), Denise M. Cardo (a3) and John A. Jernigan (a1)...



To identify characteristics of encounters between healthcare workers (HCWs) and patients that correlated with hand hygiene adherence among HCWs.


Observational study.


Intensive care unit in a Veterans Affairs hospital.




There were 767 patient encounters observed (48.6% involved nurses, 20.6% involved physicians, and 30.8% involved other HCWs); 39.8% of encounters involved patients placed under contact precautions. HCW contact with either the patient or surfaces in the patient's environment occurred during all encounters; direct patient contact occurred during 439 encounters (57.4%), and contact with environmental surfaces occurred during 710 encounters (92.6%). The median duration of encounters was 2 minutes (range, <1 to 51 minutes); 33.6% of encounters lasted 1 minute or less, with no significant occupation-associated differences in the median duration of encounters. Adherence with hand hygiene practices was correlated with the duration of the encounter, with overall adherences of 30.0% after encounters of ≤1 minute, 43.4% after encounters of >1 to ≤2 minutes, 51.1% after encounters of >3 to ≤5 minutes, and 64.9% after encounters of >5 minutes (P < .001 by the x2 for trend). In multivariate analyses, longer encounter duration, contact precautions status, patient contact, and nursing occupation were independently associated with adherence to hand hygiene recommendations.


In this study, adherence to hand hygiene practices was lowest after brief patient encounters (ie, <2 minutes). Brief encounters accounted for a substantial proportion of all observed encounters, and opportunities for hand contamination occurred during all brief encounters. Therefore, improving adherence after brief encounters may have an important overall impact on the transmission of healthcare-associated pathogens and may deserve special emphasis in the design of programs to promote adherence to hand hygiene practices.


Corresponding author

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Mailstop A-31, 1600 Clifton Road, Atlanta, GA 30333 (


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1.Larson, E. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control 1988;9:2836.
2.Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:12871294.
3.Murthy, R. Implementation of strategies to control antimicrobial resistance. Chest 2001;119(2 Suppl):405S411S.
4.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Morb Mortal Wkly Rep 2002;51(RR-16):144.
5.Shlaes, DM, Gerding, DN, John, JF Jr, et al. Guidelines for the prevention of antimicrobial resistance in hospitals. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance. Clin Infect Dis 1997;25:584599.
6.Zimakoff, J, Kjelsberg, AB, Larsen, SO, Holstein, B. A multicenter questionnaire investigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway. Am J Infect Control 1992;20:5864.
7.Hugonnet, S, Perneger, TV, Pittet, D. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Intern Med 2002;162:10371043.
8.Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330339.
9.Courington, KR, Patterson, SL, Howard, RJ. Universal precautions are not universally followed. Arch Surg 1991;126:9396.
10.Kretzer, EK, Larson, EL. Behavioral interventions to improve infection control practices. Am J Infect Control 1998;26:245253.
11.Bischoff, WE, Reynolds, TM, Sessler, CN, Edmond, MB, Wenzel, RP. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160:10171021.
12.Newton, J, Knight, D, Woolhead, G. General practitioners and clinical guidelines: a survey of knowledge, use and beliefs. Br J Gen Pract 1996;46:513517.
13.Gross, PA, Pujat, D. Implementing practice guidelines for appropriate antimicrobial usage: a systematic review. Med Care 2001;39(8Suppl 2):1155-69.
14.Pittet, D. Improving adherence to hand hygiene practice: a multidisci-plinary approach. Emerg Infect Dis 2001;7:234240.
15.Garner, IS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:5380.
16.Kleinbaum, D. Logistic Regression. New York: Springer-Verlag; 1994.
17.Sanderson, PJ, Weissler, S. Recovery of coliforms from the hands of nurses and patients: activities leading to contamination. J Hosp Infect 1992;21:8593.
18.Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:3240.
19.McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204210.
20.Ojajarvi, J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. J Hyg (Lond) 1980;85:193203.
21.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622627.
22.Scott, E, Bloomfield, SF. The survival and transfer of microbial contamination via cloths, hands and utensils. J Appi Bacteriol 1990;68:271278.
23.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med 1999;130:126130.
24.O'Boyle, CA, Henly, SI, Larson, E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. Am J Infect Control 2001;29:352360.
25.Trampuz, A, Widmer, AF. Hand hygiene: a frequently missed lifesaving opportunity during patient care. Mayo Clin Proc 2004;79:109116.
26.Pittet, D. Hand hygiene: improved standards and practice for hospital care. Curr Opin Infect Dis 2003;16:327335.
27.Voss, A, Widmer, AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205208.
28.Giblin, TB, Sinkowitz-Cochran, RL, Harris, PL, et al. Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities. Arch Intern Med 2004;164:16621668.
29.Wester, CW, Durairaj, L, Evans, AT, Schwartz, DN, Husain, S, Martinez, E. Antibiotic resistance: a survey of physician perceptions. Arch Intern Med 2002;162:22102216.
30.Srinivasan, A, Song, X, Richards, A, Sinkowitz-Cochran, R, Cardo, D, Rand, C. A survey of knowledge, attitudes, and beliefs of house staff physicians from various specialties concerning antimicrobial use and resistance. Arch Intern Med 2004;164:14511456.
31.Sinkowitz-Cochran, RL, Dedrick, RE, Harrison, EI, Jernigan, JA, Cardo, DM, and the Pittsburgh Regional Healthcare Initiative. Healthcare personnel perceptions of hospital policy, practice, and prevention regarding methicillin-resistant Staphylococcus aureus. In: Program and abstracts of the International Conference on Emerging Infectious Diseases; February 29 to March 3, 2004; Atlanta, GA. Poster 40.
32.Vernon, MO, Peterson, BJ, Welbel, SF, Trick, WE, Weinstein, RA. Impact of an interactive educational intervention on hand hygiene adherence rates in a multi-center study. In: Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy; September 22-25, 2001; Chicago, IL. Abstract K-1331.

Hand Hygiene Practices After Brief Encounters With Patients: An Important Opportunity for Prevention

  • Rebecca E. Dedrick (a1), Ronda L. Sinkowitz-Cochran (a1), Candace Cunningham (a2), Robert R. Muder (a2), Peter Perreiah (a2), Denise M. Cardo (a3) and John A. Jernigan (a1)...


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