title: Patterns of handwashing behavior and visits to patients on a general medical ward of healthcare workers.
abstract: OBJECTIVE
  To obtain accurate data regarding the handwashing behavior and patterns of visits to patients by healthcare workers (HCWs).
  
  
  METHODS
  All visits by HCWs to selected patient rooms were recorded for 3 days and 2 nights. Additionally, 5 nurses were observed for 1 day each and 2 nurses were observed for 1 night each. Nurses were observed for their entire shifts and all of their activities were recorded.
  
  
  METHODS
  A general medical ward in a tertiary-care hospital.
  
  
  METHODS
  Convenience samples of HCWs and patients.
  
  
  RESULTS
  Patients were visited every 25 minutes on average. Monitoring rooms and observing nurses resulted in similar rates of patient visits. The highest level of risk was contact with body fluids in 11% of visits and skin in 40% of visits. The overall rate of handwashing was 46%; however, the rate was higher for visits involving contact with body fluids (81%) and skin (61%). Nurses returned immediately to the same patient 45% of the time. The rate of handwashing was higher for the last of a series of visits to a patient's room (53% vs 30%, P < .0001).
  
  
  CONCLUSIONS
  Nurses adjusted their handwashing rates in accordance with the risk level of each visit. Monitoring patient rooms and observing nurses yielded similar estimates of patient visits and proportions of visits involving contact with skin or body fluids. Education programs about hand hygiene may be more effective if patterns of care and levels of risk are incorporated into recommendations.
authors.affiliation: Department of Public Health Sciences, University of Toronto and the University Health Network, Toronto, Ontario, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.forename: Refik
authors.initials: R
authors.lastname: Saskin
authors.forename: Kurt
authors.initials: K
authors.lastname: Wong
authors.forename: Christine
authors.initials: C
authors.lastname: Moore
authors.forename: Grace
authors.initials: G
authors.lastname: Parucha
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Bennett
authors.forename: Karen
authors.initials: K
authors.lastname: Green
authors.forename: Don
authors.initials: D
authors.lastname: Low
authors.forename: Mark
authors.initials: M
authors.lastname: Loeb
authors.forename: Andy
authors.initials: A
authors.lastname: Simor
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
mesh_terms: D001826:Body Fluids / Q000382:microbiology; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D004866:Equipment Contamination; D017575:Gloves, Protective / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006225:Hand / Q000382:microbiology; D006235:Hand Disinfection / Q000592:standards*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000592:standards*; D017757:Infectious Disease Transmission, Professional-to-Patient; D016015:Logistic Models; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data; D009864:Ontario; D010362:Patients' Rooms; D010564:Personnel, Hospital / Q000523:psychology / Q000592:standards*; D018570:Risk Assessment; D012867:Skin / Q000382:microbiology