Proper hand hygiene, which prevents health care-associated infections, takes time, which is limited as workload increases. Studies showing that hand hygiene compliance falls as health care workload increases have raised questions about whether 100% compliance is achievable. Researchers conducted a retrospective analysis to examine hand hygiene compliance at different workload levels and determine whether there are limits to the level of compliance that can be achieved at higher workloads.

They identified 42,349 hand hygiene opportunities in an ICU data set. Hand hygiene compliance was at about 40% until the workload reached 30 hand hygiene opportunities per hour, at which point compliance decreased by about 1% per additional hand hygiene opportunity per hour.

As workload increased, the number of unique types of health care workers and the proportion of sterile and open wound-related tasks during an observation period increased. The proportion of hand hygiene opportunities for which physicians were responsible increased at higher workload levels, physicians' hand hygiene compliance was low in general, and compliance for opportunities associated with isolation precautions was very low.

The researchers note that complex patient care tasks may take more time than other tasks, thus reducing the time available for hand hygiene. The results of their analysis suggest health care workers may be unable to reach 100% hand hygiene compliance, especially during high-intensity patient care. Hand hygiene interventions designed to improve compliance before critical procedures, physician compliance, and compliance during care for patients in isolation may be more effective than interventions targeting all hand hygiene opportunities, the authors conclude.