Low rate of compliance with hand hygiene before glove use.

To the Editor: The major cause of hospital-acquired infections is the transmission of microorganisms from the hands of health care workers (HCWs). Even though this has been known for many years, compliance with hand hygiene procedures remains unacceptably low. Compliance rates differ among institutions and are as low 20% in some. In 2009,we conducted anobservational study atAnadolu Medical Center in Kocaeli, Turkey, a not-for-profit, private 209-bed hospital with 870 staff members. Observations of hand hygiene opportunities were made over a 3-month period by 10 trained nurses working in clinicalwards, intensive careunits, and laboratorydepartments. The HCWs were not informed about the observation. In this study, hand hygiene opportunities weredefined as before and after invasive procedures, after contact with blood and body fluids, before and after glove use, before drug preparation, between two patients, after physical examination, and before and after wound care. Hand hygiene was required regardless of whether or not gloves were used or changed. A form was designed that included all of these situations. Compliance with the hand hygiene protocol was defined as either handwashing with water and soap or hand rubbing with alcohol-based antiseptic gel. Over 175 hours of observation, 826 opportunities for hand hygiene were documented. Among these observations, 245 involved physicians (29.6%), 407 involved nurses (49.2%), 81 involved technicians (9.8%), and 93 involved other HCWs (11.2%). In terms of an infection control method, 61.41% of the HCWs prefered handwashing with soap, 13.1% preferred hand rubbing with alcohol-based antiseptic gel, 21.2%preferredwearing gloves, and 4.3% used more than one method. The mean rate of compliance was 59.1% for all categories. Our snalysis demonstrated little variation among nurses, technicians, and other HCWs; thus, these groups were combined, and the analysis was done between physicians and nonphysicians. The compliance rate was 40.8% inphysicians and66.8% innonphysicians. Physicians had significantly lower compliance with the hand hygiene protocol (P < .0001). Compliance after patient