Background: The hands of health care workers are a major source of nosocomial infection. Studies conducted mainly in intensive-care units and emergency departments have shown low compliance with hand hygiene recommendation. Objective: To study hand hygiene practices in outpatient dermatology clinics in Israel. Methods: The fingers of 13 dermatologist physicians were sampled for bacterial cultures and their hand hygiene practices were monitored by two observers. In addition, 51 dermatologists attending a professional conference completed a questionnaire on hand hygiene practice. Results: All the physicians’ hands were found to be contaminated. Staphylococcus aureus was isolated in 9 cases (69.2%), a methicillin-resistant S. aureus in 1 (7.7%). Monitoring revealed 555 opportunities for handwashing; the average compliance was 31.4%. In the questionnaire, the main reasons given for poor hand hygiene were excessive work schedule (58%), lack of awareness (35.3%), reaction to disinfectants (17.7%) and lack of readily available facilities (15.7%). Conclusion: The hands of dermatologists are frequently colonized with microbial pathogens, but compliance with hand hygiene practice recommendations is low, despite a fairly high awareness of the importance. An active educational infection control program should be introduced in dermatology clinics.

1.
Albert RK, Condie F: Handwashing patterns in medical-intensive care untis. N Engl J Med 1981;304:1465–1466.
2.
Doebbeling BN, Stanley GL, Sheetz CT, Pfaller MA, Houston AK, Annis L, Li N, Wenzel RP: Comparative efficacy of alternative handwashing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:88–93.
3.
Donowitz LG: Handwashing technique in a pediatric intensive care unit. Am J Dis Child 1987;141:683–685.
4.
Larson E: Compliance with isolation techniques. Am J Infect Control 1981;11:221–225.
5.
Larson E, Leyden JJ, McGinley KJ, Grove GL, Talbot GH: Physiologic and microbiologic changes in skin related to frequent handwashing. Am J Infect Control 1986;7:59–63.
6.
Lohr JA, Ingram DL, Dudley SM, Lawton EL, Donowitz LG: Handwashing in pediatric ambulatory settings: An inconsistent practice. Am J Dis Child 1991;145:1198–1199.
7.
Meengs MR, Giles BK, Chisholm CD, Cordell WH, Nelson DR: Handwashing frequency in an emergency department. Ann Emerg Med 1994;23:1307–1312.
8.
Preston GA, Larson EL, Stamm WE: The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641–645.
9.
Garner JS, Favero MS: Guidelines for the prevention and control of nosocomial infections: Guideline for handwashing and hospital environmental control. Am J Infect Control 1985;14:110–129.
10.
Checko PJ, Soule BM: Survey of purchasers of the APIC Curriculum for Infection Control Practice: Findings and recommendations. Am J Infect Control 1985;13:250–258.
11.
Larson EL, and the Association for Professionals in Infection Control and Epidemiology, 1992–1993 and 1994 APIC Guidelines Committee: APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.
12.
Larson E, Killien M: Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:93–99.
13.
Mortimer EA, Lipsitz PJ, Wollinsky E: Transmission of staphylococci between newborns: Importance of the hand of personnel. Am J Dis Child 1962;104:289–295.
14.
Taylor LJ: An evaluation of handwashing techniques. Nurs Times 1978;74:54–55.
15.
Pittet D; Mourouga P, Perneger TV, and the members of the Infection Control Program: Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.
16.
Pittet D, Boyce JM: Hand hygiene and patient care: Pursuing the Semmelweis legacy? Lancet Infect Dis 2001;1:9–20.
17.
Dubbert PM, Dolce J, Richter W, Miller M, Chapman SW: Increasing ICU staff handwashing: Effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191–193.
18.
Bauer AW, Kirby WM, Sheris JC, Turch M: Antibiotic susceptibility using a standardized single disk method. Am J Clin Pathol 1966;45:493–496.
19.
Garner JS, Favero MS: CDC guideline for handwashing and hospital environmental control. Infect Control 1986;7:231–243.
20.
Herwaldt LA: Control of methicillin-resistant Staphylococcus aureus in the hospital setting. Am J Med 1999;106:11S–18S, Discussion 48S–52S.
21.
Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RP: Handwashing compliance by health care workers: The impact of introducing accessible, alcohol-based hand antiseptics. Arch Intern Med 2000;160:1017–1021.
22.
Larson EL, Bryan JL, Adler LM, Blane C: A multifaceted approach to changing handwashing behavior. Am J Infect Control 1997;25:3–10.
23.
Maury E, Elzieu M, Baudel JL, Haram N, Barbut F, Guided B, Offenstadt G: Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am J Respir Crit Care Med 2000;162:324–327.
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