1441. Hand hygiene compliance in Brazil: from rich hospitals in the southwest to jungle hospitals - the big challenge
Authors: Couto Braulio , Silva Estevão Urbano , Souza Guenael Freire , Ferreira Shirley , Vrandecic Erika , Góis Louranny , Peixoto Maria Luiza , Santos Thais , Andrade Virginia , Vieira Carolina , Romaniello Jeruza , Covello Luciana , Couto Thaís , Vieira Angela , Fonseca Anna Elisa , Novato Thiago , Silva Vanessa , Maia Amanda , Macêdo Jéssica , Pereira Matheus , Lima Thalita , Zampa Camila , de Paula Fabrizia , Soares Jacqueline , Ferreira Janete , Carmos Sara , Fernandes Rafael , Pereira Hoberdan , Munefiça Eder Hideki , Mantovanelli Lorraine , Mota Gabrielle , Miranda Kehone M , Starling Carlos E 
Published: November 2023

Abstract

Background
Our study seeks to address three important questions: (a) What is the current rate of HH adherence in Brazilian hospitals? (b) Which of the five moments of HH has the lowest adherence rate in Brazilian hospitals? (c) What is the HH compliance rate, as measured by direct observation, among physicians, nurses, nursing technicians, and other healthcare professionals? And (d) is there a difference in HH adherence rates when comparing private hospitals to public/philanthropic hospitals?

Methods
We conducted covert, random daily observations to assess hand hygiene compliance in 8 Brazilian hospitals over three months (Jan-Mar/2023). Observations were conducted in both critical and non-critical care units, and data on compliance rates were collected in the SACIH 3i system (https://nsp.sacihweb.com). To calculate the compliance rate, we divided the number of observations in which hand hygiene was performed correctly when necessary by the total number of observed instances where hand hygiene was required.

Results
We conducted observations on 4,662 hand hygiene opportunities across 8 hospitals in three months. The global hand hygiene adherence rate varied between hospitals, ranging from 14% to 74% (Fig. 1), with a median adherence rate of 57% for Brazilian hospitals. The first moment, before touching a patient, had the lowest adherence rate of 47% (Fig. 2). Nursing technicians were the most frequently observed professional group (69%), with compliance rates of physicians = 51%, nurses = 65%, nursing technicians = 62%, and other healthcare professionals = 54% (p-value &lt; 0.001). There was no difference in the overall hand hygiene rate between private and public/philanthropic hospitals, both with a compliance rate of 60%. However, significant differences were found between hospital types in Moment 1, Moment 2, and Moment 5 (Tab.1 ).Figure 1Hand hygiene adherence in Brazilian hospitals (2023): comparing global rates and adherence across the five moments.Figure 2Hand hygiene adherence rates in Brazilian hospitals (2023): private vs. public/philanthropic hospitals by the five moments.Table 1Hand hygiene adherence rates in Brazilian hospitals (2023): private vs. public/philanthropic hospitals compared across five moments.

Conclusion
Hand hygiene adherence in Brazilian hospitals remains low at 47%. The first moment, before touching the patient, has the lowest adherence rate, indicating that professionals prioritize their own safety over patients. Physicians have the lowest adherence rate, and private hospitals have better adherence than public/philanthropic hospitals.

Disclosures
All Authors: No reported disclosures