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  • Oral presentation
  • Open Access

Multimodal hand hygiene program: twelve years of continuous improvement in the hospital

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Antimicrobial Resistance and Infection Control20154 (Suppl 1) :O21

  • Published:


  • Hand Hygiene
  • Hand Hygiene Compliance
  • Positive Deviance
  • Hand Hygiene Improvement
  • Incidence Density Rate


Many organizations and infection prevention experts agree that effective hand hygiene (HH) reduces the incidence of healthcare-associated infections (HAI). Multimodal strategies have been recommended to achieve successful and sustained HH improvement.[1]


Present a twelve-year HH Multimodal Improvement Program at a private and large hospital.


Descriptive study about HH compliance improvement and HAI reduction at 650-bed hospital, in São Paulo, Brazil, by implementing multiple actions:

selecting and installing a good alcohol-based hand rub (ABHR) at point of care with a training program called “Reminder project” (2003-2005);

providing ongoing training and education and annual campaigns aiming at behavioral change focusing on ABHR as primary product and sustained compliance for HH, using different strategies (formal and web-based training; campaigns with varied themes as “Hospital Safe Attitude”, “Make a Commitment”);

evaluating and providing feedback on infrastructure and HH compliance, knowledge and perception;

participating in National and State HH programs (2008 and 2011);

applying Positive Deviance strategy as a motivational tool for HH promotion;

achieving leadership and front-line staff commitment and patient and physician engagement.


ABHR consumption (L/1000 patient-days) increased from 19.0 (2005) to 82.7 (2014) and HH compliance increased from 53.2 % (2008) to 72.6% (2014). HAI incidence density rates per 1000 patient-days decreased from 16.2 (2003) to 4.2 (2014) and central line-associated bloodstream infections density rates reduction from 5.7 (2003) to 1.0 (2014).


Multimodal HH strategies and leadership engagement were essential to achieve these results. Sustain and improve HH compliance is a continuous challenge.

Disclosure of interest

None declared.

Authors’ Affiliations

Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil
Nursing Post-graduation Course, Albert Einstein Nursing Faculty, São Paulo, Brazil


  1. World Health Organization: WHO Guidelines on Hand Hygiene in Health Care: a Summary. 2009, Geneva: WHOGoogle Scholar