Proper hand hygiene is one of the simplest interventions to reduce spread of infectious diseases in the hospital setting. CDC currently recommends hand washing with soap and water or alcohol‐based gel before and after each patient encounter. Hidden observers and total product utilization are the current standards for measuring compliance with these recommendations, but these methods allow for very limited analysis of details of hand hygiene practices.


Data were collected as part of a time‐motion study of hospitalists at 3 facilities. Two were academic medical centers, and the third was a community hospital. Twenty‐four hospitalists were observed for a full day, 8 at each institution. Observation by a single observer focused on all aspects of practice, including time spent in direct and indirect patient care. Hand hygiene was specifically singled out as an end point of interest a priori. Observations of hand washing before and after each patient encounter were recorded. Patient and physician demographics, as well as diagnoses, were recorded. Chi‐square analysis and linear regression analysis were used to evaluate the resulting data.


In following 24 physicians for a total of 43 hours, 389 patient encounters were observed. Across the institutions, providers washed their hands 30% of the time before patient encounters, 42% after, and 17% both before and after the same patient encounter. Statistically significant differences in hand hygiene frequency among providers were seen across the 3 hospitals in terms of the frequency of hand washing before patient interactions (range across sites 56%‐5.0%; P < 0.05), and both before and after a single patient encounter (range across sites 30%‐0.6%; P < 0.05). Neither physician age nor sex influenced hand‐washing practices. Among the patient factors explored, the presence of an infectious disease diagnosis did not significantly affect frequency of appropriate hand hygiene practices. Physical examination during the patient encounter, significantly increased frequency of appropriate hand hygiene before (32% versus 21%), after (57% versus 17%), and before and after (19% versus 9%), all P < 0.05.


Compliance with CDC recommendations related to hand hygiene practices among hospitalist physicians during the course of a day of observation was poor. Intensity of infection control interventions aiming to improve compliance with current recommendations at the different institutions may explain the variation across sites. Specific training and teaching to reinforce the importance of proper hand hygiene to hospitalists may be beneficial for the well‐being of both patients and providers.

Author Disclosure:

D. Tad‐y, none; D. Kyatkin, none; F. Kisuule, rone; S. Wright, none.