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Implentation of a multiomodal approach to improve hand hygiene in a teaching hospital: change of paradigm

Introduction / objectives

Many factors have been involved with low compliance of hand hygiene strategy such as the lack of resources and cultural barriers. In order to improve the level of adherence, a comprehensive program was implemented since Oct 09.

The aim of this study was to evaluate the impact of a multimodal approach to increase the compliance to hand hygiene among health personnel of our institution.


The program was based on the concept that “hand hygiene is everyone's commitment” (paradigm change). A multimodal strategy was implemented using WHO recommendations. Alcohol-gel was used as universal method for hand hygiene.Measurements of adherence were carried out identifying the 5 WHO’s opportunities through five cross-sectional studies. The results of each study were shown through a graphic chart to each hospital area in comparison with the rest of institution. Data from Oct 09 were compared with those of Oct’10.


A total of 4618 observations were performed. The overall adherence to hand hygiene increased from 46.3% to 59.9% (diff: 13.6%, 95% CI 7.7% to 19.5 %, p <0.001). Stratified by type of professional, both nurses and doctors increased their level of adherence (52.1 vs 68.7% [diff: 16.6%, 95% CI 8.3% to 24.9%, p <0.001], 41.6% vs 57.9% [diff: 16.3%, 95% CI 6.6% to 26.0%, p <0.01], respectively). Higher levels of adherence were observed in intensive care units (77%) in comparison with general wards (38%). The consumption of alcohol-gel increased from 49.9 liters per ‰pt-days to 76.5 liters per ‰pt-days (diff: 26.6 ‰, 95% CI 18.4 ‰ to 34.7 ‰, p <0.01).


The implementation of a multimodal approach in our institution increased the adherence to hand hygiene among health personnel. The feed-back to each hospital area may have helped to raise the level of compliance.

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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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Quirós, R., Novau, A., Fabbro, L. et al. Implentation of a multiomodal approach to improve hand hygiene in a teaching hospital: change of paradigm. BMC Proc 5 (Suppl 6), P254 (2011).

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  • Public Health
  • Intensive Care Unit
  • Teaching Hospital
  • Hand Hygiene
  • Health Personnel