title: Rates of hand disinfection associated with glove use, patient isolation, and changes between exposure to various body sites.
abstract: BACKGROUND
  Handwashing is the most effective and economic intervention shown to reduce nosocomial infection rates. However, studies have consistently documented low hand disinfection compliance. Literature regarding the roles that concomitant glove use and isolation precautions play in health care worker compliance with hand disinfection is limited. It is unclear whether workers change gloves and disinfect hands adequately between exposures to different body sites/secretions while caring for a patient.
  
  
  METHODS
  This was an observational study in which hand disinfection compliance and glove use among workers was evaluated in 2 intensive care units at a tertiary care hospital.
  
  
  RESULTS
  Five hundred eighty-nine opportunities for hand disinfection were recorded in 40 hours of observation. Overall compliance was 22.1%. We found a statistically significant, positive association between glove use and subsequent hand disinfection (relative risk [RR], 3.9 [95% CI, 2.5-6.0]; P <.0001). Isolation precautions did not significantly increase disinfection compliance. Only 4.8% (3/63) of workers appropriately complied with disinfection when hands were exposed to multiple body sites/secretions while caring for a patient.
  
  
  CONCLUSIONS
  Glove use increases compliance with hand disinfection. Isolation precautions do not increase compliance. Workers do not appropriately comply with disinfection guidelines when attending to multiple body sites/secretions on the same patient. Compliance with hand disinfection remains low.
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, USA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Kim
authors.forename: Mary-Claire
authors.initials: MC
authors.lastname: Roghmann
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
mesh_terms: D001291:Attitude of Health Personnel; D016001:Confidence Intervals; D003428:Cross Infection / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D017575:Gloves, Protective / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006235:Hand Disinfection / Q000592:standards*; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000592:standards*; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008396:Maryland; D008505:Medical Staff, Hospital; D010349:Patient Compliance; D010356:Patient Isolation / Q000706:statistics & numerical data*; D011336:Probability