Differences in Hand Hygiene Behavior Related to the Contamination Risk of Healthcare Activities in Different Groups of Healthcare Workers

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Abstract
Background:The Fulkerson scale lists 15 typical clinical activities ranked according to their risk of hand contamination.Objective:To investigate how often healthcare workers (HCWs) apply antiseptic handrubs after each of the specified activities ranked in the Fulkerson scale.Design:Observational study.Setting:University Hospital of Heidelberg, a 1,600-bed teaching hospital.Methods:Using a structured protocol, 41 observers recorded whether HCWs rubbed their hands in 1 of 15 given situations.Results:Handrubs were used in 1,115 (52.2%) of 2,138 observations. Comparatively high rates of handrub use were observed after contact with sterile materials (39.6%) and after contact with excretions (90% to 97%). Nurses used handrubs significantly more frequently than did physicians after contact with the inanimate environment, but physicians applied handrubs significantly more frequently after contact with body secretions.Conclusions:This study showed better compliance with hand hygiene than that reported by many previous studies, but compliance was still inadequate and varied significantly by type of HCW, type of activity, and location in the hospital.