Compliance to a novel hand hygiene protocol tailored to non-sterile healthcare workers in the operating theatre.

<bold>Background: </bold>Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCW) in the operating theatre (OT) is challenging, since there are no tailored protocols or observation tools.<bold>Aim: </bold>To develop and test a hand hygiene protocol tailored to non-sterile HCW in the OT.<bold>Methods: </bold>In this prospective observational study, nine hospitals in the Rotterdam-Rijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95%-confidence intervals (CI) were calculated by type of hospital and type of HCW.<bold>Findings: </bold>The protocol contains three sections: 1. written general hand hygiene rules, 2. written hand hygiene rules specific for anaesthesia and surgery, and 3. visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing from area. An average HHC of 48.0% (95%-CI:45.2%-61.2%) was observed in OTs across all hospitals. The two specialized hospitals (64.0%, 95%-CI: 30.6%-89.8% and 76.7%, 95%-CI:62.8%-84.5%) scored the highest HHC, while the academic teaching hospital scored the lowest (23.1%, 95%-CI: 0.0%-45.8%). The average HHC of anaesthesiologists was the lowest (31.6%, 95%-CI: 19.2%-62.4%), the OT-assistants scored the highest (57.4%, 95%-CI: 50.1%-78.2%).<bold>Conclusion: </bold>This uniform way of observing HHC in the OT, enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50% and needs to be addressed in teaching hospitals and among physicians. [ABSTRACT FROM AUTHOR]