Predictors of hand hygiene compliance in the era of alcohol-based hand rinse

Background: Predictors of hand-hygiene compliance have not been re-evaluated in the alcohol-based hand rinse (ABHR) era. Aim: To re-evaluate predictors of hand-hygiene compliance in the era of ABHR. Methods: Hand-hygiene compliance was monitored at a Canadian teaching hospital for a period of two years using direct observation. Standardized definitions of compliance were used and potential predictors of compliance were recorded. A generalized linear mixed model was developed to evaluate the impact of predictors of hand-hygiene compliance while correcting for clustering. Findings: We observed 7364 opportunities for hand hygiene among 3487 healthcare workers. Hand-hygiene compliance was 45% and did not vary over time. Predictors of improved compliance on multivariate analysis included the indication for hand hygiene with higher compliance seen after body fluid exposure (odds ratio: 4.7; 95% confidence interval: 3.7-6.1) and after patient contact (3.9; 3.5-4.4) compared with hand hygiene prior to patient contact. Glove use was associated with higher compliance (1.3; 1.1-1.4). A professional designation other than nurse or physician was associated with lower compliance (0.72; 0.61-0.86). The number of hand hygiene opportunities per hour was not associated with lower compliance. Higher ward level use of ABHR (vs use of soap/water) was associated with better compliance (P = 0.035). Conclusions: In the ABHR era a higher frequency of hand-hygiene opportunities is no longer the primary barrier to achieving optimal hand-hygiene compliance. However, heterogeneous use of ABHR by ward may still provide a target for improvement. (C) 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.