Skip to main content
  • Poster presentation
  • Open access
  • Published:

Comparison of hand hygiene opportunities (HHOS) between a us study and in acute care facilities in three other countries


There is a lack of published data on HHOs/patient/day across countries. While HH compliance rates are often published based on observations by auditors, some recognised disadvantages are training required, valuable hours taken to collect representative samples and the Hawthorne effect. Emerging technologies have potential to improve data reliability, timeliness and density. A key challenge is to establish an accepted “denominator” (HHOs) in the compliance equation.


Our aim was to establish the average HHOs/patient/day in a variety of acute care facilities in Australia, Netherlands and United Kingdom based on the WHO 5 Moments for HH recommendations.


Australia: 24-hr expert observations of HHOs were made in 2 wards for 7 days. HHOs/patient/day were averaged for both wards, tested for difference and aggregated. Aggregated average HHOs/patient/day were adjusted for care level using patient:nurse ratio and weighted for auditor bias.

Netherlands: Case patients were followed for 7 days to directly observe HHOs/patient/day. Data were tested for difference and averaged.

UK: Commonly performed care scenarios, “virtual patient/HCW observations”, were gathered from a range of wards in 3 hospitals and aggregated into typical care-days representative of patient type by care level to generate HHOs/patient/day. Selected expert observations were completed to validate results.

Average HHOs established from a USA study were then compared against the results from the 3 countries.


In all 3 countries average HHOs/patient/day were in the range 50-85. Patient:nurse ratios in all 3 countries fell in the range 3-5. All results compared closely with the USA study findings.


Our work indicates that in acute care facilities in the 3 countries studied and USA, HHOs/patient/day is similar and driven by the prevailing similar patient:nurse ratio as a universal indicator of patient care level. This novel information provides valuable insight and allows emerging technologies that use HHOs as a denominator in a compliance equation to be considered for use in different developed countries where facilities and practices are similar.

Disclosure of interest

None declared.

Author information

Authors and Affiliations


Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McLaws, ML., Hines, J., Kilpatrick, C. et al. Comparison of hand hygiene opportunities (HHOS) between a us study and in acute care facilities in three other countries. Antimicrob Resist Infect Control 4 (Suppl 1), P299 (2015).

Download citation

  • Published:

  • DOI: