Are hospitals too clean to trigger good hand hygiene?

Compliance with hand hygiene in the healthcare setting is generally low. The aim of the present study was to investigate the degree of compliance with hand hygiene after toilet visits inside and outside the hospital. We observed hospital/laboratory staff, participants of the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2007, and users of public lavatories. Compliance with hand hygiene after toilet visits was 46% for hospital staff, 84% for conference participants and 75% for members of the public. Healthcare workers show different behaviour regarding hand hygiene inside and outside the healthcare setting. Perhaps the feeling of a 'miasmic' environment such as public toilets triggers better hand hygiene, whereas the relatively clean hospital environment may block the trigger for hand disinfection.