Study objectives: Nosocomial infections affect nearly 10% of hospitalized patients and represent a major problem in health care facilities, resulting in prolonged hospital stays, substantial morbidity and mortality, and excessive costs. The hands of health care workers are the primary mode of transmission of drug-resistant pathogens to patients, and proper hand hygiene is the single most important means of preventing health care–associated infections. Even the routine use of gloves does not provide complete protection. Microorganisms from patients have been recovered on the hands of up to 30% of health care workers who wore gloves, so handwashing remains an important part of preventing nosocomial infections. We examine the patterns of handwashing among a group of emergency physicians and nurses in a busy urban emergency department (ED). Methods: Practitioners (physicians and nurses) were observed for 2-hour blocks of time in an ED setting. These caregivers were told they were being observed to collect data on another ED study. Each patient contact and handwashing event was noted. The use of gloves during the patient contact and the use of antimicrobial gel were also noted. Results: There were 250 patient contacts noted (123 by 16 physicians and 127 by 14 nurses) during a total of 30 hours. Overall, there were 22 handwashing events that accompanied these visits (8.8%), 3 uses of gel sanitizer, and 111 glove uses (44%). The physicians averaged 7.7 contacts per 2-hour block and 0.73 handwashing events (10.3%; 95% confidence interval [CI] 4.2% to 16.4%). Nurses averaged 8.9 patient contacts per 2-hour block, with 0.76 handwashing events (7.6%; 95% CI 1.7% to 13.5%). Physicians and nurses used gloves 44% of the time. Conclusion: In this busy ED, health care providers washed their hands 8% to 10% of the time after a patient visit and used gloves less than 50% of the time. There exists, at least in this population, a significant deficit in compliance with what should be standard operating procedure in the care of patients. Study objectives: Nosocomial infections affect nearly 10% of hospitalized patients and represent a major problem in health care facilities, resulting in prolonged hospital stays, substantial morbidity and mortality, and excessive costs. The hands of health care workers are the primary mode of transmission of drug-resistant pathogens to patients, and proper hand hygiene is the single most important means of preventing health care–associated infections. Even the routine use of gloves does not provide complete protection. Microorganisms from patients have been recovered on the hands of up to 30% of health care workers who wore gloves, so handwashing remains an important part of preventing nosocomial infections. We examine the patterns of handwashing among a group of emergency physicians and nurses in a busy urban emergency department (ED). Methods: Practitioners (physicians and nurses) were observed for 2-hour blocks of time in an ED setting. These caregivers were told they were being observed to collect data on another ED study. Each patient contact and handwashing event was noted. The use of gloves during the patient contact and the use of antimicrobial gel were also noted. Results: There were 250 patient contacts noted (123 by 16 physicians and 127 by 14 nurses) during a total of 30 hours. Overall, there were 22 handwashing events that accompanied these visits (8.8%), 3 uses of gel sanitizer, and 111 glove uses (44%). The physicians averaged 7.7 contacts per 2-hour block and 0.73 handwashing events (10.3%; 95% confidence interval [CI] 4.2% to 16.4%). Nurses averaged 8.9 patient contacts per 2-hour block, with 0.76 handwashing events (7.6%; 95% CI 1.7% to 13.5%). Physicians and nurses used gloves 44% of the time. Conclusion: In this busy ED, health care providers washed their hands 8% to 10% of the time after a patient visit and used gloves less than 50% of the time. There exists, at least in this population, a significant deficit in compliance with what should be standard operating procedure in the care of patients.