Support for the usefulness of passive postdischarge surveillance in surgical site infection.

The recently published article, “Measuring hand hygiene compliance at hospital entrances” by Vaidotas et al1 was very interesting. These authors evaluated the hand hygiene compliance of patients, visitors, and employees upon entry to a hospital and demonstrated abysmally low hand hygiene rates. Using direct observation of patients, visitors, and health care workers at 2 points of entry, they reported that compliance rates were 2.2% and 1.7% at each site. We applaud their work and agree with their suggestion that coordinated efforts are necessary to improve hand hygiene compliance among hospital visitors as well as patients and care providers. That said, we were quite surprised by the first line of the abstract, which states: “There are no studies evaluating hand hygiene at hospital entrances.” This sentence is somewhat troubling because we published similar findings in this journal in 2012: “Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby.”2 Our findings are consistent with those of Vaidotas et al.1 We found that hand hygiene rates among hospital visitors are alarmingly lowand that the use of visual cues increased compliance only slightly. Our baseline rates were even more worrisome than those of Vaidotas et al1 at 0.52%, perhaps because our study focused exclusively on visitors. In our study,2 even when a brightly colored sign and free-standing dispenser were placed directly in front of the registration area, hand hygiene compliance rates only improved to a maximum of 11.7%. We congratulate Vaidotas et al1 for once again evaluating the influence of hand hygiene in hospital lobbies and believe that this is an important step toward the goal of reduction of health care-associated infections, especially those that may be related to the contaminated hands of hospital visitors. We are aware that many factors can prevent good citation practices; however, studies that have explored similar topics should be cited whenever possible. Not only is it important to researchers in both professional and personal ways, it is also crucial as a means to “link together the concepts, technologies, and advances that define scientific disciplines.”3