a total of 60,027 HH opportunities were observed, 34,648 (57.7%) in KVGH and 25,379 (42.3%) in other hospitals all over Taiwan. The overall HH compliance was 46.12%, 56.5% in KVGH and 32.0% in other hospitals. Health care workers performed HH action most frequently in indication 4 (55.4%), followed by indication 3 (54.7%), indication 2 (51.8%), indication 1 (46.0%) and indication 5 (33.5%). The doctors (46.2%) and nurses (46.4%) had very similar HH compliance. In hospitals other than KVGH,

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... tals located in Northern Taiwan (37.8%) had better HH compliance than those in other area. Conclusions: The overall HH compliance was low, and the observation bias was profound. We suggested that HH compliance should be observed both overtly and covertly to decrease the bias. HH compliance observed overtly is not a suitable performance indicator due to its potential bias.