Objectives: To propose the improvements measures by analysing the influencing factors of hand hygiene (HH) compliance by observing the behaviour of health care workers (HCWs). Method: The observational study was conducted at a public tertiary hospital in Zhejiang, China, from September 2018 to March 2021. A total of 58 HH observers were trained to conduct a direct observation on the HH behaviors of personnel in the hospital amongst the health care workers. We have observed over 9000 hand hygiene opportunities. The collected data were classified according to time factors, department parameters, and profession conduct of the observed. Hand hygiene (HH) compliance rates were calculated for each category, and a chi-square test was used to analyze differences of the HH compliance rates. Furthermore, binary logistic regression was used for multivariate analysis in each of the hand hygiene moments. Results: The HH compliance rates of HCWs were statistically different before and after the Corona Virus Disease 2019 (COVID-19) pandemic, in the morning and the afternoon, this was observed per parameters stated into objectives on weekdays vs non weekdays. And we found that HH compliance rates drop off a cliff from weekdays to non-weekdays. Conclusions: COVID-19, departments, professions, and weekdays were all factors that influence HH compliance amongst HCWs. However, the influencing factors were not all present in every HH behavior, and had different intensities of influence on HH compliance amongst the HCWs. These findings provide some reference for us to propose improvement measures.
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