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Improvement in hand hygiene compliance. The impact of a regional strategy

Introduction / objectives

Health-care workers (HCWs) adherence to hand hygiene (HH) guidelines is usually low. According to WHO recommendations, the key strategy components to improve the compliance is evaluation and feed-back.In this study we monitored HH compliance of HCWs by direct observation in Madrid and to asses the impact of an interventional strategy.


We observed 33 Madrid’s Public Hospitals (more than 40.000 Health care workers) before and after the implementation of a regional intervention following WHO multimodal HH improvement strategy. It included different interventions but was specially focused in an online education tool with a play learning methodology. Our study involved a wide range of HWCs: dentists, physiotherapist, nurses, physicians and students. We performed a 6-week observation period, March-April 2010 and the same period in 2011.


Around 10.000 opportunities for HH were observed in each period. Compliance in the first period was 30.9% (95% C.I.:30-31.7). The second period is currently taking place, but an interim analysis reveals a HH compliance of a 47%(95% C.I.:44,92-49,38).

In the 1st period the lowest compliance is achieved at the 2nd moment (14.6%; before an aseptic task), followed by the 1st moment (25.1%; before patient contact). In the second period the use of alcohol based solutions have increased reaching a 77% of all HH performed. The technique has also improved.


The result of the regional strategy shows an important improvement in HH compliance.

We believe this improvement is having a impact in reducing health care associated infections. Further studies are needed to assure sustainability in time and impact in infection rates.

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None declared.

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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.

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Rodriguez-Perez, P., Mireia, C., Cristina, R. et al. Improvement in hand hygiene compliance. The impact of a regional strategy. BMC Proc 5 (Suppl 6), O67 (2011).

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