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To describe nurse hand hygiene practices in the home health care (HHC) setting, nurse adherence to hand hygiene guidelines, and factors associated with hand hygiene opportunities during home care visits. Observational study of nurse hand hygiene practices. and Participants Licensed practical/vocational and registered nurses were observed in the homes of patients being served by a large nonprofit HHC agency. Two researchers observed 400 home care visits conducted by 50 nurses. The World Health Organization's "5 Moments for Hand Hygiene"