Measurement and interpretation of hand hygiene compliance rates: importance of monitoring entire care episodes M. Eveillard a,b,c, *, H. Hitoto a,b , F. Raymond b , A. Kouatchet d ,L.Dube´ e , V. Guilloteau f , M-T. Pradelle f , P. Brunel f , A. Mercat d , M-L. Joly-Guillou a,c a Laboratoire de bacte´riologie-hygie`ne, Centre hospitalier universitaire, Angers, France b Unite´de pre´vention et de lutte contre les infections nosocomiales, Centre hospitalier universitaire, Angers, France c Groupe d’e´tude des interactionshoˆtes-pathoge`nes (GEIHP, UPRESEA 3142), Universite´d’Angers, France d Service de re´animation me´dicale, Centre hospitalier universitaire, Angers, France e Service de re´animation chirurgicale, Centre hospitalier universitaire, Angers, France f Re´seau ANJELIN, Centre re´gional de re´e´ducation et de re´adaptation fonctionnelle, Angers, France Received 4 February 2009; accepted 27 March 2009 Available online 29 May 2009 KEYWORDS Hand hygiene; Nosocomial infection; Observational study Summary Our objective was to assess the importance of monitoring hand hygiene compliance (HHC) during series of successive contacts with pa- tients or surroundings for measurement and interpretation of the compli- ance rates. A direct observational study of HHC was performed in four intensive care units (ICUs) and four healthcare settings with non-intensive care wards (NICWs). Hand hygiene (HH) opportunities were differentiated into two categories: extra-series opportunities (ESOs) (before or after a single contact, and before the first contact or after the last contact of a series of successive contacts) or as intra-series opportunities (ISOs) (from the opportunity following the first contact to the opportunity preceding the last in the same series). In all, 903 opportunities of HH were performed in ICUs and 760 in NICWs. The proportion of ISOs was 46.0% in ICUs and 22.9% in NICWs. The overall HHC was significantly higher in NICWs than in ICUs (61.2% vs 47.5%, P < 0.00001). The HHC was significantly higher for ESOs than for ISOs (67.7% vs 28.5%, P < 0.00001). The HHC for ISOs was signifi- cantly higher in ICUs (32.2% vs 19.0%, P < 0.005). If the distribution of * Corresponding author. Address: Laboratoire de bacte ´riologie-hygie `ne, Centre hospitalier universitaire d’Angers, 4 rue Larrey, F-49000 Angers, France. Tel.: þ33 2 41 35 33 15; fax: þ33 2 41 35 41 64. E-mail address: MaEveillard@chu-angers.fr 0195-6701/$ - see front matter ª 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2009.03.025 Journal of Hospital Infection (2009) 72, 211e217 Available online at www.sciencedirect.com www.elsevierhealth.com/journals/jhin