Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.
BACKGROUND
Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan.


OBJECTIVE
The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan.


METHODS
An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer.


RESULTS
In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%).


CONCLUSIONS
The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.
From the *Kurume University Graduate school of Medicine, Kurume City Fukuoka, Japan; †Division of Infectious Diseases, Department of General Internal Medicine, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan; ‡VA Ann Arbor Healthcare System, Ann Arbor, Michigan; §University of Michigan Medical School, Ann Arbor, Michigan; ∥Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan; ¶Division of General Internal Medicine & Infection Diseases, Rakuwakai Otowa Hospital, Kyoto, Japan; #Division of Infection Control, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan; **Department of Infection Control and Prevention, Kobe University Hospital, Kobe City, Hyogo, Japan; ††Division of Infectious Diseases Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe City, Hyogo, Japan; and ‡‡Department of Nursing, Kurume University School of Nursing, Kurume City Fukuoka, Japan.
Tomoko
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Sakihama
Hitoshi
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Honda
Sanjay
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Saint
Karen E
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Fowler
Taro
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Shimizu
Toru
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Kamiya
Yumiko
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Sato
Soichi
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Arakawa
Jong Ja
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Lee
Kentaro
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Iwata
Mutsuko
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Mihashi
Yasuharu
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Tokuda
D003428:Cross Infection / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D019983:Guideline Adherence; D063373:Hand Hygiene; D006748:Hospital Departments; D006761:Hospitals; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D006920:Hygiene; D007564:Japan; D009726:Nurses; D010564:Personnel, Hospital; D010820:Physicians