Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador M.A. Caniza a, *, G. Maron b , E.J. Moore c , Y. Quintana d , T. Liu e a Department of Infectious Diseases and International Outreach Program, St Jude Children’s Research Hospital, Memphis, TN, US b Department of Infectious Diseases, Hospital Nacional de Nin˜os Benjamin Bloom, San Salvador, El Salvador c Office of Educational Assessment, University of Washington, Seattle, WA, USA d International Outreach Program, St Jude Children’s Research Hospital, Memphis, TN, USA e Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, TN, USA Received 23 June 2006; accepted 29 August 2006 Available online 4 December 2006 KEYWORDS Hand hygiene; Infection control; Education; Developing countries; El Salvador; Flipcharts Summary In developing countries, continuing education for healthcare staff may be limited by staff shortages and lack of sophisticated means of delivery. These limitations have implications for compliance with an im- portant infection control practice, namely good hand hygiene. A compari- son was made between the efficacy of two educational tools commonly used in healthcare and practical sanitation settings in developing coun- tries, i.e. videotapes and flipcharts, in delivering hand hygiene education to 67 nurses in a paediatric hospital in El Salvador. Efficacy was measured on the basis of scores obtained in pre- and post-training tests consisting of 10 multiple-choice questions. Half of the nurses received video-based instruction and half received instruction via flipcharts. Both methods of instruction increased participants’ knowledge of good hand hygiene, and the extent of knowledge acquisition by the two methods was similar. Feed- back obtained from flipchart users six months after training indicated that most of the respondents used the flipchart to teach hand hygiene to pa- tients’ families (62.5%), patients (50%) and healthcare workers (43.8%). Flipchart users ranked flipcharts as their favourite educational tool. Flip- charts offer an economical, easy-to-use, non-technological yet effective alternative to videotapes for delivering education in developing countries. * Corresponding author. Address: St Jude Children’s Research Hospital, 332 North Lauderdale St, MS 721, Memphis, TN 38105-2794, USA. Tel.: þ1 901 495 4194; fax: þ1 901 495 2099. E-mail address: miguela.caniza@stjude.org 0195-6701/$ - see front matter ª 2006 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2006.08.011 Journal of Hospital Infection (2007) 65, 58e64 www.elsevierhealth.com/journals/jhin