title: An average hand hygiene day for nurses and physicians: The burden is not equal.
abstract: To understand whether the burden of hand hygiene contributes to poor compliance we measured the daily number of hand hygiene opportunities (HHOs) by shift for nurses and physicians in 2 wards in a 850-bed university teaching hospital.
  
  
  
  On each ward 4 trained auditors collected the number of HHOs and compliance events for 24 hours over 7 days. Twenty-one thousand four hundred fifty HHOs were collected from a medical and a surgical ward. The proportion of alcohol-based handrub used daily, the burden of hand hygiene, and compliance rates were calculated separately for nurses and physicians.
  
  
  
  The average indication for alcohol-based handrub cleansing represented 68% of all HHOs. Nurses had an average burden of 55 HHOs per 24 hours or 27 HHOs per shift, 3 times higher than the burden for physicians, who had 16 HHOs per 24 hours or 8 HHOs per shift. Overt observations of the weekly compliance identified nurses had 1.5 times higher compliance than physicians: 76% and 52% (P < .01), respectively.
  
  
  
  Nurses have 3 times more HHOs than physicians, yet nurses have 1.5 times higher compliance than physicians. Hand hygiene compliance in physicians cannot be explained by burden of HHOs.
authors.affiliation: School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Syed
authors.initials: S
authors.lastname: Azim
authors.affiliation: Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Juergens
authors.affiliation: School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: m.mclaws@unsw.edu.au.
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: McLaws
mesh_terms: D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D009726:Nurses; D010820:Physicians
keywords: 24/7; Hand hygiene burden opportunities; Overt observation audit