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Cluster Randomized Trial to Evaluate the Effect of a Multimodal Hand Hygiene Improvement Strategy in Primary Care

  • Carmen Martín-Madrazo (a1), Sonia Soto-Díaz (a2), Asuncion Cañada-Dorado (a3), Miguel Angel Salinero-Fort (a4), Manuela Medina-Fernández (a5), Enrique Carrillo de Santa Pau (a6), Paloma Gómez-Campelo (a7) and Juan Carlos Abánades-Herranz (a8)...



To evaluate the effectiveness of a multimodal intervention in primary care health professionals for improved compliance with hand hygiene practice, based on the World Health Organization's 5 Moments for Health Hygiene.


Cluster randomized trial, parallel 2-group study (intervention and control).


Primary healthcare centers in Madrid, Spain.


Eleven healthcare centers with 198 healthcare workers (general practitioners, nurses, pediatricians, auxiliary nurses, midwives, odontostomatologists, and dental hygienists).


The multimodal hand hygiene improvement strategy consisted of training of healthcare workers by teaching sessions, implementation of hydroalcoholic solutions, and installation of reminder posters. The hand hygiene compliance level was evaluated by observation during regular care activities in the office visit setting, at the baseline moment, and 6 months after the intervention, all by a single external observer.


The overall baseline compliance level was 8.1% (95% confidence interval [CI], 6.2-10.1), and the healthcare workers of the intervention group increased their hand hygiene compliance level by 21.6% (95% CI, 13.83-28.48) compared with the control group.


This study has demonstrated that hand hygiene compliance in primary healthcare workers can be improved with a multimodal hand hygiene improvement strategy.


Corresponding author

Centra de Salud Monóvar, Gerencia de Atencion Primaria de Madrid, Spain (


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