title: Multimodal strategy to improve the adherence to hand hygiene and self-assessment of the institution for the promotion and practice of hand hygiene.
abstract: Hand hygiene (HH) has a low rate of adherence worldwide. This study aimed to estimate the HH adherence rate before and after the implementation of the multimodal strategy and to perform a self-assessment of an institution for promotion and practice of HH.
  
  
  
  Before and after study, conducted in a university hospital. Professionals of the medical and nursing staff were included. Data collection was from October 2013 to July 2015, through observations of the HH opportunities and application of the HH self-assessment instrument for the institution. Descriptive and univariate analysis were performed.
  
  
  
  A total of 9500 HH opportunities were observed. The rate of adherence to HH in pre-intervention period was 20.8%, compared to 16.2% and 15.7% in post-intervention. Regarding the evaluation of the institution, it did not have an established ongoing program of training of professionals, no feedback of HH rates to professionals.
  
  
  
  The low rate of HH adherence reflected the evaluation of the institution in relation to its investment in the practice and promotion of HH, showing that the investment policy for HH adherence needs to be reviewed, considering that before the study the hospital has not been trained in the 'My Five Moments for HH'.
authors.affiliation: Post Doctorate from the University of New York. Associate Professor of the Federal University of Minas Gerais (UFMG) School of Nursing, Basic Nursing Department, 190 Av. Prof. Alfredo Balena - Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: A C
authors.initials: AC
authors.lastname: Oliveira
authors.affiliation: Doctoral student in Federal University of Minas Gerais (UFMG) School of Nursing, Belo Horizonte, Brazil.
authors.forename: C S
authors.initials: CS
authors.lastname: Gama
authors.affiliation: PhD in Nursing from the Federal University of Minas Gerais (UFMG) School of Nursing, Technical consultant of GJO, Belo Horizonte, Brazil.
authors.forename: A O
authors.initials: AO
authors.lastname: Paula
mesh_terms: D001938:Brazil; D054869:Clinical Audit; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010564:Personnel, Hospital