Hand hygiene compliance: universally better post-contact than pre-contact in healthcare workers in the UK and Australia

Objective: To establish whether post-patient contact hand hygiene practice is universally higher than pre-patient contact in two highly resourced countries. Methods: Observations of medical and nursing staffs' hand hygiene compliance were made by the same observers in two different hospitals in Sydney and Birmingham, in both intensive care units (ICU) and surgical wards, using a standardised data collection tool. Results: Hand hygiene rates pre- and post-patient contact were low for both nurses and doctors in Sydney and Birmingham, with the exception of Sydney ICU doctors (pre-contact 74.8% and post-contact 75.7%, p=0.868). Post-contact compliance was low but significantly better than pre-contact in Sydney ICU nurses (41.3% versus 59.6% p<0.0001), surgical ward nurses (14.9% versus 29.6%, p=0.0019) and Sydney surgeons (10.2% versus 30.2%, p<0.0001). Post-contact compliance rates were low but higher than pre-contact in Birmingham ICU nurses (33.1% versus 52.2%, p=0.0011) and doctors (29.3% versus 70.1%, p<0.0001) but not in the Birmingham surgical ward (nurses: 42.6% versus 43.4%, p=0.89; surgeons: 39.6% versus 48.4%, p=0.187). Handwashing on removal of gloves was extremely low (1.7% to 16.6%), regardless of city, specialties or clinical staff. Conclusion: The pattern of post-contact compliance and non-compliance associated with glove use strongly suggests hand hygiene practice in both countries is primarily self-protective rather than a patient safety centred practice.