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


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.


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

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Kawagoe, J., Toniolo, A., Santos, C. et al. Multimodal hand hygiene program: twelve years of continuous improvement in the hospital. Antimicrob Resist Infect Control 4 (Suppl 1), O21 (2015).

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