Background. It is a fact that hand hygiene prevents nosocomial infection, but compliance with recommended instructions is commonly poor. The purpose of this study was to implement a hand hygiene program for increase compliance with hand hygiene and its relationship with nosocomial infection (NI) and MRSA infection/colonization rates. Methods. Compliance to hand hygiene was evaluated in a hospital by direct observation and measured of health care-associated infections, including methicillin resistant Staphylococcus aureus, before and after an educational intervention, using visual poster, colorful stamps, and feedback of the results. Results. Overall compliance did not increase during intervention, only handwashing before and after patient contact has improved from 40% to 76% ( ) for HCWs, but NI and MRSA rates remained high and stable. Conclusion. In a combination of high prevalence of NI and low compliance to hand hygiene, the programme of measure does not motivate the HCW hand hygiene. Future interventions should employ incremental evaluation to develop effective hand hygiene initiatives. 1. Introduction Hand hygiene is the single most important measure of prevention and control of nosocomial infection and can significantly reduce the burden of disease, in particular in developing countries [1, 2]. Unfortunately, compliance with recommended hand hygiene procedures has been unacceptably poor, with mean baseline rates of 5% to 81% [3–7]. The identification of several risk factors associated with poor hand hygiene compliance is of extreme importance in the design of an education programme [4]. On the other hand, both nosocomial infection and colonization by methicillin resistant Staphylococcus aureus (MRSA) have become increasingly common during the past two decades [8], especially in countries with limited resources [9]. The hand hygiene campaign at the University of Geneva Hospital was the first which reported experience of improvement hand hygiene compliance and reduction nosocomial infection and MRSA transmission [4]. The purpose of the present study was implementation of the program for increase hand hygiene compliance and its association with nosocomial infection (NI), MRSA infection, and colonization rates. 2. Methods 2.1. Study Design This study was developed in four different wards clinical, surgical, pediatric, and adult medical-surgical intensive care unit (ICU) in a teaching hospital in Brazil, under 12 months, after approval by the ethics committee of the institution. 2.2. Data Collection Two observers were trained to conduct the prevalence
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