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The challenges of hand hygiene improvement: a comparison between inpatient and outpatient units

Introduction / objectives

WHO Hand Hygiene (HH) Improvement Strategy Program has been implemented mostly in inpatient units. We implemented this strategy in inpatient and outpatient units.


Compare the results of HH adherence in inpatient and outpatient units.


This program was conducted in a 500-bed private hospital in São Paulo, Brazil. WHO tool was used to assess HH adherence before (Jun-Aug2008) and after the intervention (Jul-Sept2009). The inpatient units were: Medical Surgical Ward, Oncology, Neonatal and Pediatrics and outpatient were: Surgical Ambulatory, Obstetric Center, Emergency, Post Anesthesia, Diagnostic Medicine Department and Dialysis Center. Several strategies were applied – campaigns, behavioral methods, and educational programs. More dispensers of alcohol-based product were made available in areas of the hospital such as restaurants, cafeterias, waiting rooms, lounges, receptions and next to elevators.


In inpatient units the overall HH adherence improved 30.8%, from 63.8% (1433/2248 opportunities) to 83.5% (2144/2567 opportunities). In outpatient units it improved 53.2%, from 39.5 % (679/1721 opportunities) to 60.4% (1044/1728 opportunities). The only exception in HH improvement was physician (no increase in inpatient unit) and Obstetric Center (5% decrease).


The higher compliance was in inpatient units, although there was a significant improvement in outpatient units. We must develop and apply different strategies according to the needs of inpatient and outpatient units.

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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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Kawagoe, J., Silva, C., Cardoso, M. et al. The challenges of hand hygiene improvement: a comparison between inpatient and outpatient units. BMC Proc 5 (Suppl 6), P110 (2011).

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