More Doctor–Patient Contact Is Not the Only Explanation For Lower Hand-Hygiene Compliance in Australian Emergency Departments

To the Editor—Previous reports have demonstrated low hand-hygiene (HH) compliance in emergency departments (EDs).1,2 Barriers to compliance in this setting include crowding, higher patient acuity, nonstandardized workflow, higher staff turnover, lower penetration of HH promotion activities, and high representation of doctors in ED audits, a group with known suboptimal HH compliance.1,3,4 We sought to use a nationwide dataset to describe HH performance in Australian EDs and to test the hypothesis that lower HH compliance in EDs is explained by a higher proportion of observed HH activity by doctors in this setting.