Background. Haemodialysis patients are at high risk for developing healthcare-associated infections as well as acquiring multidrug-resistant microorganisms. Hand hygiene is considered to be the single most effective tool to prevent healthcare-associated infections. The number of indications and the extent of indication-specific compliance with hand rubs in the haemodialysis setting are currently unknown. Methods. We conducted a prospective, three-phase, observational intervention study on hand

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... ygiene during haemodialysis treatments. Optimized hand hygiene standard operating procedures (SOPs) for dialysis connections (Intervention I) and disconnections (Intervention II) were compiled and implemented during two predefined intervention periods. Results. A total of 8897 indications for hand rubs were observed throughout this study. In the course of the study, we identified an increase in the number of hand rubs performed (6-9, mean number per dialysis procedure), parallelled by a decrease in the indications for hand rubs (21-15), resulting in a significant increase of overall hand rub compliance (30-62%). The greatest improvement was seen before aseptic tasks (21-52%), the indication with the greatest impact on preventing healthcare-associated infections. There was no difference between haemodialysis via central venous catheter access or arterio-venous (AV) fistulas. Conclusions. This study provides the first detailed data on the number of and indications for hand rubs during dialysis. An >100% increase in overall hand hygiene compliance could be achieved by a comparably moderate increase in hand rubs performed in combination with optimized hand hygiene SOPs.