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Abstract Background Hand hygiene (HH) is one of the simplest and most effective methods to decrease healthcare-associated infections (HAIs). However, in outpatient settings, it is difficult to audit HH practices as patient-healthcare provider (HCP) interactions take place behind closed doors. Within our system, secret observers (SO) monitor HCPs HH, which is routinely reported at near 100%. We wished to determine patient’s perception of their HCP’s HH and see how well it matched SO HH observations. Methods We developed an anonymous two-question survey which queried patients if their HCP performed HH upon entering and exiting the room. Both questions had a three choice/one answer categorical responses choices: (yes) (no) (I didn’t notice/I do not remember). The survey took place at two large outpatient facilities with multiple medical subspecialties, primary care groups, and surgical specialties. The facilities were surveyed in October 2017 and March 2018, respectively. No patient or HCP-specific identifiers were obtained through the surveys. Results A total of 1,268 surveys were collected over two separate time periods. Overall, HCP HH compliance was high both upon room entry and exit (90.4% and 87.4% “yes” responses, respectfully). Our SO HH observation compliance was 96% during these periods. Orthopedics was the top preforming subgroup (289/301, 96.0% and 285/301, 94.7% HH on room entry and exit). The immediate care center was the lowest preforming subgroup (135/171, 79.0% and 132/171, 77.2% HH on room entry and exit), with other groups’ (primary care medicine, subspecialty medicine, women’s health, Ears-Nose-Throat, ophthalmology, rehabilitation, psychology, and pain clinic) HH practices falling somewhere in between. Conclusion HH is a cornerstone for preventing HAIs. Our survey revealed that ambulatory care HCP HH practices are perceived by patients to be quite high, and to a large extent supports reported HH observations by SO. Service-based variability in HH practices can be used as for positive reinforcement for the highest achieving practices, and to challenge poorer performing groups to improve their HH practices. Using patient-based audits of HCPs HH practice is a viable alternative method of HH compliance data collection/monitoing. Disclosures J. P. Parada, Merck: Speaker’s Bureau, Speaker honorarium.

open forum infectious diseases

459. Patient-Based Surveys to Better Understand Patients’ Perceptions of Healthcare Providers’ Hand Hygiene Practices and if Patient Responses Validate Secret Observers’ Hand Hygiene Compliance Reporting